Clin Mol Hepatol.  2013 Sep;19(3):258-265. 10.3350/cmh.2013.19.3.258.

Elevated red cell distribution width is associated with advanced fibrosis in NAFLD

• Kim HM
• Kim BS
• Cho YK
• Kim BI
• Sohn CI
• Jeon WK
• Kim HJ
• Park DI
• Park JH
• Joo KJ
• Kim CJ
• Kim YS
• Heo WJ
• Choi WS

• KMID: 1705203
• DOI: http://doi.org/10.3350/cmh.2013.19.3.258

Abstract

BACKGROUND/AIMS
The red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores.
METHODS
This study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively.
RESULTS
After adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61+/-0.41% (mean+/-SD), 12.70+/-0.70%, 12.77+/-0.62%, 12.87+/-0.82%, and 13.25+/-0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71+/-0.72%, 12.79+/-0.66%, and 13.23+/-1.52% for those with FIB-4 scores of <1.30, 1.31-2.66, and > or =2.67, respectively (P<0.05). The prevalence of advanced fibrosis (BARD score of 24 and FIB-4 score of > or =1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score.
CONCLUSIONS
Elevated RDW is independently associated with advanced fibrosis in NAFLD.

Keyword

Red-blood-cell distribution width; Nonalcoholic fatty liver disease; BARD score; FIB-4 score

MeSH Terms

Adult
Alcohol Drinking
C-Reactive Protein/analysis
Diabetes Mellitus/pathology
Erythrocyte Indices
Fatty Liver/complications/*diagnosis/ultrasonography
Female
Humans
Hypertension/pathology
Liver Cirrhosis/*diagnosis/epidemiology/etiology
Male
Middle Aged
Odds Ratio
Prevalence
Questionnaires
Severity of Illness Index
C-Reactive Protein