Brief Article
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World J Gastroenterol. Nov 14, 2013; 19(42): 7412-7418
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7412
Is increased red cell distribution width an indicating marker of nonalcoholic steatohepatitis and fibrotic stage?
Mustafa Cengiz, Burcu Aslan Candır, Güldal Yılmaz, Gülen Akyol, Seren Ozenirler
Mustafa Cengiz, Seren Ozenirler, Department of Gastroenterology, Gazi University Faculty of Medicine, 06500 Ankara, Turkey
Burcu Aslan Candır, Department of Internal Medicine, Gazi University Faculty of Medicine, 06500 Ankara, Turkey
Güldal Yılmaz, Gülen Akyol, Department of Pathology, Gazi University Faculty of Medicine, 06500 Ankara, Turkey
Author contributions: Cengiz M and Ozenirler S designed the study, contributed to the acquisition of data, and analyzed and interpreted the data; Cengiz M performed the statistical analyses, drafted the article and revised it critically for important intellectual content; Candır BA recruited the patients and contributed to the interpretation of the data; Yılmaz G and Akyol G evaluated the liver histopathology, analyzed the data and contributed to the interpretation of the data.
Correspondence to: Mustafa Cengiz, MD, Department of Gastroenterology, Gazi University Faculty of Medicine, 06500 Ankara, Turkey. drmustafacen@gmail.com
Telephone: +90-312-20227586 Fax: +90-312-2213202
Received: June 9, 2013
Revised: August 19, 2013
Accepted: September 15, 2013
Published online: November 14, 2013
Abstract

AIM: To evaluate the red cell distribution width (RDW) as an indicator of the presence of non-alcoholic steatohepatitis (NASH) and its association with fibrotic scores.

METHODS: A retrospective study was carried out that included sixty-two biopsy proven NASH, 32 simple steatosis patients and 30 healthy controls. The correlation between the clinical and histopathological features of NASH patients and RDW values was evaluated. Liver fibrosis scores were measured using a 0 to 4 point scale and were divided in to two groups; fibrosis scores 0-1 were termed mild and fibrosis scores 2-4 were termed advanced fibrosis. RDW values were compared between NASH, simple steatosis and healthy controls. Univariate and multivariate analyses were performed to evaluate the independent predicting factors for the presence of liver fibrosis caused by NASH.

RESULTS: Patients with NASH had higher RDW values compared with simple steatosis and healthy control groups [14.28% ± 0.25% vs 13.37% ± 0.12%, 12.96% ± 0.14% (P < 0.01), respectively]. Patients with advanced fibrosis had higher RDW values than the mild fibrosis group (15.86% ± 0.4% vs 13.63% ± 0.67%, P < 0.01, respectively). RDW also correlated with fibrotic scores (r = 0.579 and P < 0.01). The variables that were significant in the univariate analysis were evaluated in multivariate logistic regression analysis, and RDW was an independent predicting factor of NASH (OR = 1.75, 95%CI: 1.129-2.711, P < 0.05).

CONCLUSION: RDW a new non-invasive marker that can be used to demonstrate the presence of NASH and indicate advanced fibrotic scores.

Keywords: Non-alcoholic steatohepatitis, Liver fibrosis, Red cell distribution width, Simple steatosis, Non-invasive marker, Liver biopsy

Core tip: We evaluated the role of red cell distribution width (RDW) as an indication of nonalcoholic steatohepatitis by comparing the values of biopsy proven non-alcoholic steatohepatitis (NASH) patients with simple steatosis and healthy controls. Independent predictors of the presence of NASH and advanced liver fibrosis were evaluated by using multivariate logistic regression analyses and RDW was a statistically significant independent predictor.