RDW-SD is Superior to RDW-CV in Reflecting Liver Fibrosis Stage in Patients with Chronic Hepatitis B

Abstract

Purpose

The clinical significance of the red blood cell distribution width (RDW)-coefficient of variation (RDW-CV) has been recognized in numerous diseases, but few studies have investigated the usefulness of RDW-standard deviation (RDW-SD). This study aimed to compare the utility of RDW-SD and RDW-CV in evaluating liver fibrosis stage in patients with chronic hepatitis B (CHB).

Patients and Methods

In this retrospective study, we enrolled 720 treatment-naïve CHB patients and 578 healthy controls, and evaluated their clinical parameters. In CHB patients, the associations between RDW-CV and liver fibrosis stage were analyzed as compared to RDW-SD using one-way analysis of variance (ANOVA), Spearman’s rank correlation, student’s t-test, binary logistic regression, and receiver operating characteristic (ROC) curve.

Results

RDW-SD, rather than RDW-CV was significantly elevated in CHB patients compared with healthy controls. Correlation analysis showed a stronger association between RDW-SD and liver fibrosis stage than RDW-CV in CHB patients. RDW-CV and RDW-SD are both independent predictors of significant fibrosis. For the diagnosis of significant fibrosis, the area under the receiver operating characteristic curve (AUC) for RDW-CV was 0.599, while for RDW-SD, it was 0.706. RDW-to-platelet ratio (RPR), a novel index for liver fibrosis calculated as RDW-CV/platelet, exhibited an AUC of 0.730. This AUC increased to 0.752 when RDW-CV in the RPR formula was replaced with RDW-SD. Additionally, subgroup analyses based on age, gender, and HBeAg status showed that the AUC for RDW-SD in diagnosing significant fibrosis was significantly greater than that for RDW-CV, with statistically significant differences.

Conclusion

RDW-SD showed superiority in reflecting liver fibrosis stage and diagnosing liver significant fibrosis than RDW-CV in treatment-naïve CHB patients.

Keywords:

• red blood cell distribution width
• liver fibrosis
• chronic hepatitis B

Abbreviations

RDW-CV, Red blood cell distribution width-coefficient of variation; RDW-SD, Red blood cell distribution width-standard deviation; CHB, Chronic hepatitis B; RBCs, Red blood cells; MCV, Mean corpuscular volume; MCH, Mean corpuscular hemoglobin; MCHC, mean cell hemoglobin concentration; CBC, Complete blood count; RPR, Red blood cell distribution width-to-platelet ratio; HBV, Hepatitis B virus; HSCs, Hepatic stellate cells; ESLD, End-stage liver disease; HIV, Human immuno-deficiency virus; DLC, Decompensated liver cirrhosis; LF, liver failure; HCC, Hepatocellular carcinoma; TP, Total protein; ALT, Alanine aminotransferase; AST, Aspartate aminotransferase; TBIL, Total bilirubin; ALP, Alkaline phosphatase; γ-GGT, gamma-glutamyl transpeptidase; BUN, Blood urea nitrogen; Hb, hemoglobin; PDW, Platelet distribution width; MPV, Mean platelet volume; ACLF, Acute on chronic liver failure.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are not publicly available due to privacy restrictions but are available from the corresponding author on reasonable request.

Ethical Statement

This study was approved by the Institutional Review Board of Anhui Medical College and the Second Hospital of Anhui Medical University (2023-LLBG-014). All participants provided written informed consent so that their clinical data could be used in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflict of interest.

Additional information

Funding

This research was funded by the Project of Anhui Natural Science for Colleges and Universities (KJ2020ZD68).