Original article

Red cell distribution width-to-platelet ratio (RPR) as a simple non-invasive predictor of liver cirrhosis in patients with chronic hepatitis B: a cross-sectional study

Authors

• • Angelina Yuwono angel.yuwo@gmail.com Email Angelina Yuwono. (compose email, opens in email app.) Angelina Yuwono ORCID profile. (opens in new tab)
  • Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
• • Taufik Sungkar Taufik Sungkar ORCID profile. (opens in new tab)
  • Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
• • Ilhamd Ilhamd
  • Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Abstract

Aim: Chronic hepatitis B (CHB) is a major cause of liver cirrhosis worldwide. This study aimed to evaluate the red cell distribution width-to-platelet ratio (RPR) as a simple non-invasive predictor of cirrhosis in CHB patients.

Methods: A cross-sectional study was conducted in 221 CHB patients at H. Adam Malik General Hospital, Medan, Indonesia (May 2024–May 2025). Cirrhosis was diagnosed by FibroScan (≥ 14 kPa) or ultrasonography findings. RPR was calculated from routine haematology data. Bivariate analysis was used to compare the cirrhotic and non-cirrhotic groups. ROC curve analysis was used to evaluate the diagnostic accuracy of RPR and determine the optimal cut-off values in terms of sensitivity and specificity.

Results: Of 221 patients, 64 (29.0%) had cirrhosis. Cirrhotic patients were older (54.5 vs. 48 years; p = 0.001) and predominantly male (77.6% vs. 56.1%; p = 0.004). RPR was significantly higher in the cirrhotic group (0.16 vs. 0.05; p < 0.001). ROC analysis showed that RPR had an AUC of 0.938 (95% CI: 0.906–0.970; p < 0.001), with an optimal cut-off value of 0.085, yielding sensitivity of 87.5% and specificity of 87.3% for detecting cirrhosis.

Conclusion: RPR is a simple, inexpensive, and widely available haematological index with excellent diagnostic accuracy for predicting cirrhosis in CHB patients. It may serve as an effective screening tool in settings with limited access to advanced diagnostic modalities.

Keywords: erythrocyte indices, hepatitis B, chronic, liver cirrhosis, platelet count

How to Cite: Yuwono, A. , Sungkar, T. & Ilhamd, I. (2026) “Red cell distribution width-to-platelet ratio (RPR) as a simple non-invasive predictor of liver cirrhosis in patients with chronic hepatitis B: a cross-sectional study”, Medicinski glasnik. 23(2). doi: https://doi.org/10.17392/medglas-2196-23-2