Study of Platelet Count and Platelet Indices as Markers of Fibrosis in Nonalcoholic Fatty Liver Disease Patients

Abstract

Background: Platelet count and platelet indices are cheap, accurate and available methods to estimate fibrosis in Nonalcoholic fatty liver disease (NAFLD) patients.  Aim: This work aims to study platelet count and platelet indices as markers of fibrosis in NAFLD patients. Methods: This cross-sectional study was carried out on 150 patients with NAFLD. Patients were divided into three equal groups according to ultrasonographic findings: Group 1: healthy volunteers as the control group, Group 2: patients with mild (grade I) or moderate (grade II) steatosis and Group 3: patients with severe (grade III) steatosis and possible fibrosis. Results: Fibrosis-4 index (FIB-4) showed significant positive correlations with aspartate aminotransferase to platelet ratio index (APRI), platelet count, several metabolic and liver function parameters, and a negative correlation with white blood cell (WBCs) and high-density lipoprotein (HDL). APRI correlated similarly, with added significance for DBP. Platelet count correlated positively with FIB-4, APRI, and metabolic markers, and negatively with HDL. Mean platelet volume (MPV) showed positive correlations with aspartate aminotransferase (AST), alanine aminotransferase (ALT), Haemoglobin (Hb), FBG, 2HPPG, and negative correlations with WBCs and cholesterol. Platelet Distribution Width (PDW) correlated positively with platelet indices, SBP, metabolic markers, and negatively with AST, ALT, and Hb. PCT showed positive correlations with platelet indices and metabolic markers. All showed non-significant correlations with remaining parameters. Conclusions: The study found a significant association between insulin resistance and the severity of NAFLD. Furthermore, the homeostasis model assessment for insulin resistance (HOMA-IR) was shown to predict fibrosis in NAFLD patients. Notably, the APRI was found to be a reliable non-invasive blood test for diagnosing fibrosis, particularly for ruling out advanced fibrosis due to its high negative predictive value.