Skip to main content
Top
Published in: Journal of Gastroenterology 11/2011

01-11-2011 | Original Article—Liver, Pancreas, and Biliary Tract

Platelet count for predicting fibrosis in nonalcoholic fatty liver disease

Authors: Masato Yoneda, Hideki Fujii, Yoshio Sumida, Hideyuki Hyogo, Yoshito Itoh, Masafumi Ono, Yuichiro Eguchi, Yasuaki Suzuki, Noriaki Aoki, Kazuyuki Kanemasa, Kento Imajo, Kazuaki Chayama, Toshiji Saibara, Norifumi Kawada, Kazuma Fujimoto, Yutaka Kohgo, Toshikazu Yoshikawa, Takeshi Okanoue, Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)

Published in: Journal of Gastroenterology | Issue 11/2011

Login to get access

Abstract

Background

The severity of liver fibrosis is known to be a good indicator for surveillance, and for determining the prognosis and optimal treatment of nonalcoholic fatty liver disease (NAFLD). However, it is virtually impossible to carry out liver biopsies in all NAFLD patients. The purpose of this study was to investigate the clinical usefulness of measuring the platelet count for predicting the severity of liver fibrosis in a large retrospective cohort of Japanese patients with NAFLD.

Methods

A total of 1,048 patients with liver-biopsy-confirmed NAFLD seen between 2002 and 2008 were enrolled from nine hepatology centers in Japan. Laboratory evaluations were performed for all patients.

Results

A linear decrease of the platelet count with increasing histological severity of hepatic fibrosis was revealed. The area under the receiver operating characteristic curve estimating the diagnostic performance of the platelet count for hepatic fibrosis Stage 3 was 0.774 (optimal cutoff value, 19.2 × 104/μl; sensitivity, 62.7%; specificity, 76.3%), and that for Stage 4 was 0.918 (optimal cutoff value, 15.3 × 104/μl; sensitivity, 80.5%; specificity, 88.8%).

Conclusions

The platelet count may be an ideal biomarker of the severity of fibrosis in NAFLD patients, because it is simple, easy to measure and handle, cost-effective, and accurate for predicting the severity of fibrosis. Furthermore, by using the platelet count cutoff value validated in our multiple large trials, efficient recruitment of NAFLD patients may be facilitated.
Literature
1.
go back to reference Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;18:1221–31.CrossRef Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;18:1221–31.CrossRef
2.
go back to reference Liou I, Kowdley KV. Natural history of nonalcoholic steatohepatitis. J Clin Gastroenterol. 2006;40(Suppl 1):S11–6.PubMed Liou I, Kowdley KV. Natural history of nonalcoholic steatohepatitis. J Clin Gastroenterol. 2006;40(Suppl 1):S11–6.PubMed
3.
go back to reference National Institutes of Health. National Institutes of Health Consensus Development Conference statement: management of hepatitis C 2002 (June 10–12, 2002). Hepatology. 2002;36(5 Suppl 1):S3–20. National Institutes of Health. National Institutes of Health Consensus Development Conference statement: management of hepatitis C 2002 (June 10–12, 2002). Hepatology. 2002;36(5 Suppl 1):S3–20.
4.
go back to reference Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30:1356–62.PubMedCrossRef Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30:1356–62.PubMedCrossRef
5.
go back to reference Cadranel JF. Good clinical practice guidelines for fine needle aspiration biopsy of the liver: past, present and future. Gastroenterol Clin Biol. 2002;26:823–4.PubMed Cadranel JF. Good clinical practice guidelines for fine needle aspiration biopsy of the liver: past, present and future. Gastroenterol Clin Biol. 2002;26:823–4.PubMed
6.
go back to reference Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology. 2001;33:196–200.PubMedCrossRef Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology. 2001;33:196–200.PubMedCrossRef
7.
go back to reference Poynard T, Ratziu V, Bedossa P. Appropriateness of liver biopsy. Can J Gastroenterol. 2003;14:543–8. Poynard T, Ratziu V, Bedossa P. Appropriateness of liver biopsy. Can J Gastroenterol. 2003;14:543–8.
10.
go back to reference Liaw YF, Tai DI, Chu CM, Chen TJ. The development of cirrhosis in patients with chronic type B hepatitis: a prospective study. Hepatology. 1988;8:493–6.PubMedCrossRef Liaw YF, Tai DI, Chu CM, Chen TJ. The development of cirrhosis in patients with chronic type B hepatitis: a prospective study. Hepatology. 1988;8:493–6.PubMedCrossRef
11.
go back to reference Poynard T, Bedossa P. Age and platelet count: a simple index for predicting the presence of histological lesions in patients with antibodies to hepatitis C virus. METAVIR and CLINIVIR Cooperative Study Groups. J Viral Hepat. 1997;4:199–208.PubMedCrossRef Poynard T, Bedossa P. Age and platelet count: a simple index for predicting the presence of histological lesions in patients with antibodies to hepatitis C virus. METAVIR and CLINIVIR Cooperative Study Groups. J Viral Hepat. 1997;4:199–208.PubMedCrossRef
12.
go back to reference Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.PubMedCrossRef Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.PubMedCrossRef
13.
go back to reference Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.PubMedCrossRef Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.PubMedCrossRef
14.
go back to reference Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–25.PubMedCrossRef Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–25.PubMedCrossRef
15.
go back to reference Sumida Y, Yoneda M, Hyogo H, Yamaguchi K, Ono M, Fujii H, et al. A simple clinical scoring system using ferritin, fasting insulin and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease. J Gastroenterol. 2011;46(2):257–68.PubMedCrossRef Sumida Y, Yoneda M, Hyogo H, Yamaguchi K, Ono M, Fujii H, et al. A simple clinical scoring system using ferritin, fasting insulin and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease. J Gastroenterol. 2011;46(2):257–68.PubMedCrossRef
16.
go back to reference Sanyal AJ. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002;123:1705–25.PubMedCrossRef Sanyal AJ. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002;123:1705–25.PubMedCrossRef
17.
go back to reference Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–9.PubMedCrossRef Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–9.PubMedCrossRef
18.
go back to reference Sanyal AJ, Brunt EM, Kleiner DE, Kowdley K, Chalasani N, Lavine J, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011;54(1):344–53.PubMedCrossRef Sanyal AJ, Brunt EM, Kleiner DE, Kowdley K, Chalasani N, Lavine J, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011;54(1):344–53.PubMedCrossRef
19.
go back to reference Brunt EM, Tiniakos DG. Histopathology of nonalcoholic fatty liver disease. World J Gastroenterol. 2010;16:5286–96.PubMedCrossRef Brunt EM, Tiniakos DG. Histopathology of nonalcoholic fatty liver disease. World J Gastroenterol. 2010;16:5286–96.PubMedCrossRef
20.
go back to reference Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.PubMedCrossRef Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.PubMedCrossRef
21.
go back to reference Charlton M. Nonalcoholic fatty liver disease: a review of current understanding and future impact. Clin Gastroenterol Hepatol. 2004;2:1048–58.PubMedCrossRef Charlton M. Nonalcoholic fatty liver disease: a review of current understanding and future impact. Clin Gastroenterol Hepatol. 2004;2:1048–58.PubMedCrossRef
22.
go back to reference Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW, et al. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology. 1990;11:74–80.PubMedCrossRef Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW, et al. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology. 1990;11:74–80.PubMedCrossRef
23.
go back to reference Kajihara M, Okazaki Y, Kato S, Ishii H, Kawakami Y, Ikeda Y, et al. Evaluation of platelet kinetics in patients with liver cirrhosis: similarity to idiopathic thrombocytopenic purpura. J Gastroenterol Hepatol. 2007;22:112–8.PubMedCrossRef Kajihara M, Okazaki Y, Kato S, Ishii H, Kawakami Y, Ikeda Y, et al. Evaluation of platelet kinetics in patients with liver cirrhosis: similarity to idiopathic thrombocytopenic purpura. J Gastroenterol Hepatol. 2007;22:112–8.PubMedCrossRef
24.
go back to reference Park KS, Lee YS, Park HW, Seo SH, Jang BG, Hwang JY, et al. Factors associated or related to with pathological severity of nonalcoholic fatty liver disease. Korean J Intern Med. 2004;19:19–26.PubMed Park KS, Lee YS, Park HW, Seo SH, Jang BG, Hwang JY, et al. Factors associated or related to with pathological severity of nonalcoholic fatty liver disease. Korean J Intern Med. 2004;19:19–26.PubMed
25.
go back to reference Kaneda H, Hashimoto E, Yatsuji S, Tokushige K, Shiratori K. Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2006;21:1459–65.PubMed Kaneda H, Hashimoto E, Yatsuji S, Tokushige K, Shiratori K. Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2006;21:1459–65.PubMed
27.
go back to reference Schmidt KG, Rasmussen JW, Bekker C, Madsen PE. Kinetics and in vivo distribution of 111-In-labelled autologous platelets in chronic hepatic disease: mechanisms of thrombocytopenia. Scand J Haematol. 1985;34:39–46.PubMedCrossRef Schmidt KG, Rasmussen JW, Bekker C, Madsen PE. Kinetics and in vivo distribution of 111-In-labelled autologous platelets in chronic hepatic disease: mechanisms of thrombocytopenia. Scand J Haematol. 1985;34:39–46.PubMedCrossRef
28.
go back to reference Nakamura S, Konishi H, Kishino M, Yatsuji S, Tokushige K, Hashimoto E, et al. Prevalence of esophagogastric varices in patients with non-alcoholic steatohepatitis. Hepatol Res. 2008;38:572–9.PubMedCrossRef Nakamura S, Konishi H, Kishino M, Yatsuji S, Tokushige K, Hashimoto E, et al. Prevalence of esophagogastric varices in patients with non-alcoholic steatohepatitis. Hepatol Res. 2008;38:572–9.PubMedCrossRef
29.
go back to reference Reynolds TB, Hidemura R, Michel H, Peters R. Portal hypertension without cirrhosis in alcoholic liver disease. Ann Intern Med. 1969;70:497–506.PubMed Reynolds TB, Hidemura R, Michel H, Peters R. Portal hypertension without cirrhosis in alcoholic liver disease. Ann Intern Med. 1969;70:497–506.PubMed
30.
go back to reference Bolognesi M, Merkel C, Sacerdoti D. Role of spleen enlargement in cirrhosis with portal hypertension. Dig Liver Dis. 2002;34:144–50.PubMedCrossRef Bolognesi M, Merkel C, Sacerdoti D. Role of spleen enlargement in cirrhosis with portal hypertension. Dig Liver Dis. 2002;34:144–50.PubMedCrossRef
31.
go back to reference Suzuki K, Kirikoshi H, Yoneda M, Mawatari H, Fujita K, Nozaki Y, et al. Measurement of spleen volume is useful for distinguishing between simple steatosis and early-stage non-alcoholic steatohepatitis. Hepatology Res. 2010;40:693–700.CrossRef Suzuki K, Kirikoshi H, Yoneda M, Mawatari H, Fujita K, Nozaki Y, et al. Measurement of spleen volume is useful for distinguishing between simple steatosis and early-stage non-alcoholic steatohepatitis. Hepatology Res. 2010;40:693–700.CrossRef
32.
go back to reference Fujii H, Enomoto M, Fukushima W, Ohfuji S, Mori M, Kobayashi S, et al. Noninvasive laboratory tests proposed for predicting cirrhosis in patients with chronic hepatitis C are also useful in patients with non-alcoholic steatohepatitis. J Gastroenterol. 2009;44:608–814.PubMedCrossRef Fujii H, Enomoto M, Fukushima W, Ohfuji S, Mori M, Kobayashi S, et al. Noninvasive laboratory tests proposed for predicting cirrhosis in patients with chronic hepatitis C are also useful in patients with non-alcoholic steatohepatitis. J Gastroenterol. 2009;44:608–814.PubMedCrossRef
33.
go back to reference Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7:1104–12.PubMedCrossRef Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7:1104–12.PubMedCrossRef
Metadata
Title
Platelet count for predicting fibrosis in nonalcoholic fatty liver disease
Authors
Masato Yoneda
Hideki Fujii
Yoshio Sumida
Hideyuki Hyogo
Yoshito Itoh
Masafumi Ono
Yuichiro Eguchi
Yasuaki Suzuki
Noriaki Aoki
Kazuyuki Kanemasa
Kento Imajo
Kazuaki Chayama
Toshiji Saibara
Norifumi Kawada
Kazuma Fujimoto
Yutaka Kohgo
Toshikazu Yoshikawa
Takeshi Okanoue
Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)
Publication date
01-11-2011
Publisher
Springer Japan
Published in
Journal of Gastroenterology / Issue 11/2011
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-011-0436-4

Other articles of this Issue 11/2011

Journal of Gastroenterology 11/2011 Go to the issue

Original Article—Liver, Pancreas, and Biliary Tract

Reduction of liver stiffness by antiviral therapy in chronic hepatitis B

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.