Peran Indeks Platelet Dalam Prediksi Sirosis Pada Pasien Hepatitis B Di Rumah Sakit Adam Malik

Abstract

Chronic hepatitis B is a leading cause of liver cirrhosis and hepatocellular carcinoma in Indonesia. Accurate diagnosis of cirrhosis often relies on invasive procedures or costly noninvasive modalities such as FibroScan, which are not always available in primary care settings. Platelet indices, derived from routine hematological tests, have been proposed as simple markers for assessing the risk of cirrhosis. This study aimed to evaluate the role of platelet indices in predicting cirrhosis among patients with chronic hepatitis B at H. Adam Malik General Hospital, Medan. A cross-sectional analytic study was conducted on 221 patients, consisting of 64 with cirrhosis (29.0%) and 157 without cirrhosis (71.0%). The diagnosis of cirrhosis was established using FibroScan and abdominal ultrasonography. The assessed variables included platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet-to-lymphocyte ratio (PLR), platelet-to-monocyte ratio (PMR), red cell distribution width-to-platelet ratio (RPR), as well as APRI and FIB-4 scores. Results showed that cirrhotic patients were older (p=0.001) and predominantly male (p=0.004). Significant differences were observed in most hematological indices. Multivariate logistic regression identified PCT (B=-0.998; p<0.001), RPR (B=1.404; p=0.022), and FIB- 4 (B=0.046; p<0.001) as independent predictors of cirrhosis. Receiver operating characteristic (ROC) analysis demonstrated that FIB-4 had the highest diagnostic accuracy (AUC 0.956; cut-off 2.15; sensitivity 98.4%; specificity 82.8), while RPR also performed well (AUC 0.938; cut-off 0.085; sensitivity 87.5%; specificity 87.3%). In conclusion, FIB-4 and RPR are reliable, simple, and non-invasive hematological indices for detecting cirrhosis in chronic hepatitis B patients. They may serve as practical screening tools in resource-limited healthcare settings.