PLATELETCRIT VERSUS TRANSIENT ELASTOGRAPHY (FIBROSCAN) FOR ASSESSING THE SEVERITY OF LIVER FIBROSIS IN CHRONIC HEPATITIS C: A CROSS-SECTIONAL STUDY FROM A RURAL TERTIARY CARE CENTRE IN NORTH INDIA
Main Article Content
Keywords
Hepatitis C, Plateletcrit, Platelet indices, Transient elastography, Liver fibrosis, Non-invasive markers, Rural India
Abstract
Background: Staging of liver fibrosis is central to the management of chronic hepatitis C virus (HCV) infection. Transient elastography (FibroScan) is the preferred non-invasive tool, but its cost and limited availability restrict its use in rural India. Plateletcrit (PCT), the percentage of blood volume occupied by platelets, is reported automatically in every complete blood count and may serve as a low-cost surrogate marker.
Objective: To assess the correlation of plateletcrit with FibroScan-defined fibrosis stage and its diagnostic accuracy for advanced fibrosis (F3–F4) in patients with chronic hepatitis C.
Methods: This retrospective cross-sectional analytical study included 180 anti-HCV-positive adults evaluated at the Department of Internal Medicine, UPUMS, Saifai, between January 2024 and December 2025. Plateletcrit was compared across FibroScan stages (F0–F1, F2, F3, F4) using one-way ANOVA, and its correlation with fibrosis stage was assessed using Pearson's correlation. Receiver operating characteristic (ROC) analysis was used to determine the optimal plateletcrit cut-off for advanced fibrosis.
Results: Fibrosis stages were distributed as F0–F1 in 28%, F2 in 24%, F3 in 26% and F4 in 22% of patients. Mean plateletcrit declined progressively from 0.26 ± 0.05% in F0–F1 to 0.14 ± 0.02% in F4 (p < 0.001). Plateletcrit showed a significant inverse correlation with fibrosis stage (r = −0.58, p < 0.001). For advanced fibrosis, plateletcrit had an area under the ROC curve of 0.81; at a cut-off of < 0.18%, sensitivity was 78% and specificity 74%.
Conclusion: Plateletcrit falls progressively with increasing fibrosis and identifies advanced fibrosis with good accuracy. As a zero-cost parameter of the routine blood count, it may help triage HCV patients for elastography or specialist referral in resource-limited settings, but it should complement rather than replace established tools until validated externally.
References
2.Polaris Observatory HCV Collaborators. Global change in hepatitis C virus prevalence and cascade of care since 2015: a modelling study. Lancet Gastroenterol Hepatol. 2022;7(5):396–415.
3.Ministry of Health and Family Welfare, Government of India. National Viral Hepatitis Control Program: operational guidelines. New Delhi: MoHFW; 2018.
4.Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996;24(2):289–93.
5.European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C: final update of the series. J Hepatol. 2020;73(5):1170–218.
6.European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol. 2021;75(3):659–89.
7.World Health Organization. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection. Geneva: WHO; 2018.
8.Castéra L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005;128(2):343–50.
9.Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41(1):48–54.
10.Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134(4):960–74.
11.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(2):518–26.
12.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(6):1317–25.
13.Lin ZH, Xin YN, Dong QJ, Wang Q, Jiang XJ, Zhan SH, et al. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology. 2011;53(3):726–36.
14.Pohl A, Behling C, Oliver D, Kilani M, Monson P, Hassanein T. Serum aminotransferase levels and platelet counts as predictors of degree of fibrosis in chronic hepatitis C virus infection. Am J Gastroenterol. 2001;96(11):3142–6.
15.Afdhal N, McHutchison J, Brown R, Jacobson I, Manns M, Poordad F, et al. Thrombocytopenia associated with chronic liver disease. J Hepatol. 2008;48(6):1000–7.
16.Peck-Radosavljevic M. Thrombocytopenia in chronic liver disease. Liver Int. 2017;37(6):778–93.
17.Aster RH. Pooling of platelets in the spleen: role in the pathogenesis of "hypersplenic" thrombocytopenia. J Clin Invest. 1966;45(5):645–57.
18.Kawasaki T, Takeshita A, Souda K, Kobayashi Y, Kikuyama M, Suzuki F, et al. Serum thrombopoietin levels in patients with chronic hepatitis and liver cirrhosis. Am J Gastroenterol. 1999;94(7):1918–22.
19.Nagamine T, Ohtuka T, Takehara K, Arai T, Takagi H, Mori M. Thrombocytopenia associated with hepatitis C viral infection. J Hepatol. 1996;24(2):135–40.
20.Shao LN, Zhang ST, Wang N, Yu WJ, Chen M, Xiao N, et al. Platelet indices significantly correlate with liver fibrosis in HCV-infected patients. PLoS One. 2020;15(1):e0227544.
21.Purnak T, Olmez S, Torun S, Efe C, Sayilir A, Ozaslan E, et al. Mean platelet volume is increased in chronic hepatitis C patients with advanced fibrosis. Clin Res Hepatol Gastroenterol. 2013;37(1):41–6.
22.Michalak A, Cichoż-Lach H, Guz M, Kozicka J, Cybulski M, Jeleniewicz W, et al. Plateletcrit and mean platelet volume in the evaluation of alcoholic liver cirrhosis and nonalcoholic fatty liver disease patients. Biomed Res Int. 2021;2021:8867985.
23.Gadallah AA, Elshayeb EI, Montaser BA, Shaheen GA, Mostafa AE. Plateletcrit and mean platelet volume in the evaluation of liver cirrhosis and nonalcoholic fatty liver disease in Egyptian patients. Surg Gastroenterol Oncol. 2024;29(2):105. doi:10.21614/sgo-643
24.Indian Council of Medical Research. National ethical guidelines for biomedical and health research involving human participants. New Delhi: ICMR; 2017.
25.Boursier J, Zarski JP, de Ledinghen V, Rousselet MC, Sturm N, Lebail B, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57(3):1182–91.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
