Clinics and Research in Hepatology and Gastroenterology (2013) 37, e121—e123
Available online at www.sciencedirect.com
LETTER TO THE EDITOR
Mean platelet volume is not a predictive marker of histopathological changes of the liver in patients with chronic hepatitis B Dear Editor, We read the article conducted by Purnak et al. [1] in your journal with interest. They found that mean platelet volume (MPV) was increased in patients with hepatitis C. In addition, in the study performed by Ekiz et al. [2], it was claimed that MPV might be a marker in the determination of liver fibrosis score (LFS). In the present study, we investigated the relationship between MPV with LFS and the histological activity index (HAI) detected histopathologically in patients who underwent liver biopsy for chronic HBV infection. A total of 60 patients with chronic HBV infection with HBV DNA levels of more than 10,000 copy/mL and who had undergone a liver biopsy between January 2011 and December 2012 were included in the study. Age- and gendermatched fifty healthy outpatients were included in the control group. Levels of MPV, LFS and HAI were recorded for all participants. MPV was analyzed using the original reagents of a fully automatic blood analyzer (Beckman Coulter LH 780, Fullerton, CA, USA). Liver biopsy was performed for histopathological examination of the liver. Ishak scoring was used for the evaluation of liver fibrosis, and modified Knodell HAI was used for demonstration of necroinflammation. A scoring of 0 to 6 was used for fibrosis, and 0 to 18 for modified HAI. Subjects with any chronic diseases weren’t included. Statistical analysis was performed using SPSS 20.0 (SPSS Inc., Chicago, IL, USA). Chi-square test, independent sample T test or Mann-Whitney U test were used for comparisons between the groups. The capacity of serum MPV levels for predicting the presence of fibrosis was analyzed using receiver operating characteristic (ROC) curve analysis. A P value of 2 or 2. LFS was significantly higher in the group with a HAI of >4 than the one with HAI of ≤4 (P < 0.001) (Table 1). In the ROC curve analysis, the optimum cut-off value for an LFS of ≥2 was 7.75 (sensitivity 76.3%, specificity 35.3%, PPV 72.5%, NPV 40%, accuracy 63.6%, AUC 0.525, P = 0.771), and the optimum cut-off value for an LFS > 2 was 8.70 (sensitivity 60%, specificity 53.3%, PPV 51.7%, NPV 61.5%, accuracy 56.36%, AUC 0.487, P = 0.866). The MPV cut-off point for an HAI of >4 was 7.85 (sensitivity 78.1%, specificity 39.1%, PPV 64.1%, NPV 56.3%, accuracy 60.18%, AUC 0.481, P = 0.811). In a study [3], MPV levels were found to be significantly higher in patients with inactive HBV infection. In their study, the relationship between MPV and liver histopathology wasn’t investigated. Kurt et al. [4] found that MPV level was similar between patients with chronic HBV and their controls. In our study, MPV levels in the patient group were higher than the controls. No relationship was found between fibrosis scores and MPV. In another study [2], MPV level was found to be significantly higher in patients with chronic HBV. A significant relationship was found between fibrosis scores and MPV level, and it was claimed that MPV might be a marker in the determination of LFS. In a study conducted with patients with chronic HBV, MPV was claimed to be insignificant in the determination of advanced LFS (a fibrosis score between 4—6). In those two studies, MPV was demonstrated to be an independent risk factor for advanced HAI [5]. However, in another study conducted in patients with chronic HCV, MPV was found to be an independent risk factor in patients with advanced fibrosis [1]. In all those studies, the association of MPV and HAI wasn’t investigated. In our study, we investigated the association of MPV with either LFS or HAI, and we couldn’t determine any independent risk factors for HAI. In conclusion, MPV may increases in patients with chronic HBV as it does in other infectious diseases. However, this increase is not associated with either LFS or HAI.
2210-7401/$ – see front matter © 2013 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.clinre.2013.08.012
e122
Table 1
The values of study parameters according to either LFS or HAI in the patients with chronic HBV.
Parameters
P1*
Fibrosis 1st classification
HAI MPV (fL) Fibrosis
P2**
2nd classification
≤2
>2
Available online at www.sciencedirect.com
LETTER TO THE EDITOR
Mean platelet volume is not a predictive marker of histopathological changes of the liver in patients with chronic hepatitis B Dear Editor, We read the article conducted by Purnak et al. [1] in your journal with interest. They found that mean platelet volume (MPV) was increased in patients with hepatitis C. In addition, in the study performed by Ekiz et al. [2], it was claimed that MPV might be a marker in the determination of liver fibrosis score (LFS). In the present study, we investigated the relationship between MPV with LFS and the histological activity index (HAI) detected histopathologically in patients who underwent liver biopsy for chronic HBV infection. A total of 60 patients with chronic HBV infection with HBV DNA levels of more than 10,000 copy/mL and who had undergone a liver biopsy between January 2011 and December 2012 were included in the study. Age- and gendermatched fifty healthy outpatients were included in the control group. Levels of MPV, LFS and HAI were recorded for all participants. MPV was analyzed using the original reagents of a fully automatic blood analyzer (Beckman Coulter LH 780, Fullerton, CA, USA). Liver biopsy was performed for histopathological examination of the liver. Ishak scoring was used for the evaluation of liver fibrosis, and modified Knodell HAI was used for demonstration of necroinflammation. A scoring of 0 to 6 was used for fibrosis, and 0 to 18 for modified HAI. Subjects with any chronic diseases weren’t included. Statistical analysis was performed using SPSS 20.0 (SPSS Inc., Chicago, IL, USA). Chi-square test, independent sample T test or Mann-Whitney U test were used for comparisons between the groups. The capacity of serum MPV levels for predicting the presence of fibrosis was analyzed using receiver operating characteristic (ROC) curve analysis. A P value of 2 or 2. LFS was significantly higher in the group with a HAI of >4 than the one with HAI of ≤4 (P < 0.001) (Table 1). In the ROC curve analysis, the optimum cut-off value for an LFS of ≥2 was 7.75 (sensitivity 76.3%, specificity 35.3%, PPV 72.5%, NPV 40%, accuracy 63.6%, AUC 0.525, P = 0.771), and the optimum cut-off value for an LFS > 2 was 8.70 (sensitivity 60%, specificity 53.3%, PPV 51.7%, NPV 61.5%, accuracy 56.36%, AUC 0.487, P = 0.866). The MPV cut-off point for an HAI of >4 was 7.85 (sensitivity 78.1%, specificity 39.1%, PPV 64.1%, NPV 56.3%, accuracy 60.18%, AUC 0.481, P = 0.811). In a study [3], MPV levels were found to be significantly higher in patients with inactive HBV infection. In their study, the relationship between MPV and liver histopathology wasn’t investigated. Kurt et al. [4] found that MPV level was similar between patients with chronic HBV and their controls. In our study, MPV levels in the patient group were higher than the controls. No relationship was found between fibrosis scores and MPV. In another study [2], MPV level was found to be significantly higher in patients with chronic HBV. A significant relationship was found between fibrosis scores and MPV level, and it was claimed that MPV might be a marker in the determination of LFS. In a study conducted with patients with chronic HBV, MPV was claimed to be insignificant in the determination of advanced LFS (a fibrosis score between 4—6). In those two studies, MPV was demonstrated to be an independent risk factor for advanced HAI [5]. However, in another study conducted in patients with chronic HCV, MPV was found to be an independent risk factor in patients with advanced fibrosis [1]. In all those studies, the association of MPV and HAI wasn’t investigated. In our study, we investigated the association of MPV with either LFS or HAI, and we couldn’t determine any independent risk factors for HAI. In conclusion, MPV may increases in patients with chronic HBV as it does in other infectious diseases. However, this increase is not associated with either LFS or HAI.
2210-7401/$ – see front matter © 2013 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.clinre.2013.08.012
e122
Table 1
The values of study parameters according to either LFS or HAI in the patients with chronic HBV.
Parameters
P1*
Fibrosis 1st classification
HAI MPV (fL) Fibrosis
P2**
2nd classification
≤2
>2
