Increased red cell width distribution to lymphocyte ratio is a predictor of histologic severity in primary biliary cholangitis

Primary biliary cholangitis (PBC) is a chronic disease that is increasingly being recognized in recent years. In this study, we sought to identify noninvasive markers of the severity of cirrhosis in patients with PBC based on routinely investigated laboratory parameters. Ninety-four patients with histologically-confirmed PBC based on liver biopsy performed between January 2013 and December 2017 at the First Hospital of Jilin University were divided into 2 groups: early-stage cirrhosis (fibrosis stage F1 and F2; n = 74) and advanced-stage cirrhosis (fibrosis stage F3 and F4; n = 20). Patients with advanced-stage had significantly higher red blood cell distribution width (RDW) (15.2 vs 13.7; P = .003) and significantly lower platelet (163.35 vs 202.73; P = .032) and lymphocyte counts (1.47 vs 1.79; P = .018) as compared with patients with early-stage cirrhosis. Advanced-stage cirrhosis was associated with significantly higher RDW to platelet ratio (RPR), RDW to lymphocyte ratio (RLR), aspartate aminotransferase to platelet ratio index (APRI), and fibrosis index based on the 4 factors (FIB-4) as compared with early-stage cirrhosis. RLR showed the highest area under receiver operating characteristic curve (AUROC) (0.744). The sensitivity and specificity of RLR were 65% and 78.3%, respectively. RLR had higher AUROC than the other 3 noninvasive markers. The noninvasive markers RPR, RLR, APRI, and FIB-4 showed good diagnostic accuracy for advanced-stage cirrhosis. These markers are easily acquired by routine laboratory tests and are reproducible predictors of the severity of PBC. RLR is a novel marker that may serve as a valuable supplement to APRI and FIB-4 for predicting the severity of cirrhosis.