Although the platelet count may provide clues regarding the severity of
liver disease, there are currently no available data supporting the utility of the platelet count to evaluate the degree of liver injury in patients with
chronic hepatitis B virus (HBV)
infection. The present study aimed to determine the association between the platelet count and the severity of liver injury in patients with chronic HBV
infection. A total of 941 patients were included and were stratified into a Child-Turcotte-Pugh (
CTP) class A group and a
CTP class B/C group using the
CTP scoring system. A total of 53 patients underwent liver biopsy. The pathological stage F4 was defined as
cirrhosis based on the METAVIR scoring system. Compared with that in patients with
CTP class A, the platelet count in patients with
CTP class B/C was lower (P<0.001). Similarly, for patients with normal
alanine aminotransferase (ALT) levels, the platelet count was significantly different between the
CTP class B/C and A groups (P<0.001). The platelet count was inversely correlated with the
CTP score (r=-0.420, P<0.001) and independently associated with
CTP grade B/C [odds ratio (OR), 0.994; 95% CI, 0.990-0.999; P=0.009]. The area under the receiver operating characteristic curve (AUC) of the platelet count to distinguish
CTP grade B/C from A was 0.712 and 0.791, respectively, in all patients with HBV
infection and the subset with normal ALT levels. In addition, compared to patients with
chronic hepatitis B, patients with
cirrhosis had a lower platelet count and higher
aspartate transaminase-to-platelet ratio index (APRI) and
fibrosis index based on four factors (FIB-4) (P<0.001). The platelet count was inversely correlated with FIB-4 (r=-0.855, P<0.001) and APRI (r=-0.741, P<0.001). The AUC for the platelet count to distinguish
cirrhosis from
chronic hepatitis B was 0.927 (sensitivity, 78.76%; specificity, 92.22%). Among patients who underwent liver biopsy, the platelet count in those with F4 was lower compared with that in patients with ≤F3 (P=0.013). The platelet count was inversely correlated with the pathological stage (r=-0.295, P=0.032) and was independently associated with F4 (OR, 0.978; 95% CI, 0.960-0.997; P=0.026). The AUC of the platelet count to distinguish F4 from patients with ≤F3 was 0.761. In conclusion, the platelet count may be used as a non-invasive marker to assess the severity of liver injury and of
liver fibrosis in patients with chronic HBV
infection.