Role of Gamma Glutammyl Transpeptidase to Platelet Ratio (GPR) in Predicting Advanced Liver Fibrosis in Patients with Chronic Hepatitis C Infection
Raja Taha Yaseen Khan *
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Hina Ismail
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Muhammad Danish
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Muhammad Qaiser Panezai
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Abdullah Nasir
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Kiran Bajaj
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Ghulamullah Lail
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Rajesh Mandhwani
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Husnain Ali Metlo
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Danish Kumar
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Munir Tareen
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Abbas Ali Tasneem
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Farina M. Hanif
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Syed Mudassir Laeeq
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
Nasir Hasan Luck
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Pakistan.
*Author to whom correspondence should be addressed.
Abstract
The liver biopsy is the gold standard for the diagnosis of liver fibrosis, because of its invasiveness, high cost and lack of repeatability its use is limited. A new parameter widely used these days for evaluating the grade of hepatic fibrosis is the gamma-glutamyl transpeptidase (GGT)-to-Platelet ratio (GPR) and has shown great benefit in this regard. The aim of our study was to evaluate the role of GPR as a noninvasive predictor of liver fibrosis in patients with chronic hepatitis C in the study population.
Methods: All patients with chronic hepatitis C and compensated liver disease were included in the study after informed consent. Patient’s baseline characteristics were recorded. Patient’s baseline Complete blood count (CBC) and Liver function tests were also recorded. Patients then underwent shear wave elastography (SWE) to stratify the degree of fibrosis. These indices were used to calculate Gamma glutamyl transpeptidase (GGT) / platelet ratio. Results were presented as means ± SD for quantitative data or as numbers with percentages for qualitative data. Continuous variables were analyzed using the Student’s t-test; while categorical variables were analyzed using the Chi-square test. A p value of <0.05 was considered statistically significant.
Results: A total of 91 patients were included in the study. Out of 91 patients, 56(61.5%) were males. At baseline, 57(62.6%) patients had ≥F3 fibrosis (advanced fibrosis or cirrhosis). Mean GPR was 1.5±2.1. Area under ROC (Receiver Operating Curve) was obtained for GPR in predicting advanced liver fibrosis (≥F3) was 0.8 (p-≤0.001). Higher GPR values were significantly associated with prediction of advanced liver fibrosis (≥F3) in patients with chronic hepatitis C with a sensitivity was of 94.74%, specificity of 62%, positive predictive value of 80.69%, negative predictive value was of 87.50% and diagnostic accuracy of 82.42%.
Conclusion: The GPR found to be significantly associated with liver fibrosis in HCV patients presented in our clinic. However, further studies are needed to validate the role of GPR in predicting liver fibrosis.
Keywords: HCV, shear wave elastography, liver fibrosis, platelets, gamma glutamyl transpeptidase, GPR