Prognostic value of inflammatory markers including neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume, platelet distribution width, and red blood cell distribution width in viral hepatitis: A systematic review and meta

Hematological markers offer valuable and cost-effective tools for hepatitis prognosis and treatment customization due to their role in inflammatory responses. Hence, this study seeks to explore the prognostic potential of inflammatory markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red blood cell distribution width (RDW) in viral hepatitis patients. We conducted a systematic search in online databases of PubMed, Web of Science, Scopus, and Cochrane for related articles following PRISMA guidelines. Our endpoint was to evaluate the association between NLR, PLR, MPV, PDW, and RDW with fibrosis and cirrhosis outcomes in patients with hepatitis B and C. The analysis used the "meta" package in R, employing Hedges' g to calculate the standardized mean difference (SMD) and 95 % confidence intervals (CI). A P value less than 0.05 was considered statistically significant for all data analyses Thirty-seven studies were ultimately included in the analysis. PLR was higher in mild fibrosis (SMD = -0.48, 95 % CI: -0.90; -0.06), with no significant differences observed by hepatitis type. Both MPV and RDW were higher in advanced fibrosis (MPV: SMD = 0.36, 95 % CI: 0.19; 0.53, RDW: SMD = 0.32, 95 % CI: 0.14; 0.50), and they were significantly increased in advanced hepatitis C fibrosis. PDW was higher in advanced fibrosis (SMD = 0.32, 95 % CI: 0.02; 0.61), significantly in hepatitis B. In cirrhotic versus non-cirrhotic patients, MPV (SMD = 0.22, 95 % CI: 0.07; 0.38) and RDW (SMD = 1.35, 95 % CI: 0.62; 2.08) were higher in the cirrhotic group, while PLR (SMD = -1.15, 95 % CI: -2.16; -0.15) was higher in the non-cirrhotic group. NLR showed no significant difference between mild and advanced fibrosis or between cirrhotic and non-cirrhotic groups. This meta-analysis reveals the importance of hematological parameters of MPV, PDW, RDW, and PLR as predictors of viral hepatitis progression. MPV, PDW, and RDW are elevated in advanced fibrosis, while PLR is notably higher in mild fibrosis.