Lviv clinical bulletin 2020, 4(32): 22-34

Erythrogram Parameters and Their Constellations in Patients with Liver Cirrhosis of Various Etiologies with Osteopenia and Osteoporosis: Their Changes and Diagnostic Value

N. Drobinska1, O. Abrahamovych1, M. Abrahamovych1, O. Khodosevych2, R. Stakh2

1Danylo Halytsky Lviv National Medical University

2Municipal Regional Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital”

Introduction. There is a need to search for new publicly available methods for screening and diagnosing bone lesions in patients with liver cirrhosis (LC), one of which the detection of changes in individual parameters of the erythrogram and their combination in a routine general blood test could be.

The aim of the study. To characterize the parameters of erythrogram and their constellation in patients with liver cirrhosis of various etiologies with osteopenia and osteoporosis, to find out their diagnostic value.

Materials and methods. The study involved 79 patients with LC (women – 22; men – 57 aged 18 to 66 years) with bone mineral density (BMD) disorders (experimental group) (62 (78.48 %), which is divided into 2 subgroups: patients with LC with osteopenia (38 (48.10 %) and osteoporosis (24 (30.38%)) and without it (comparison group (17 (21.52 %)). The control group consisted of 25 healthy individuals of the same gender and age. We studied the characteristics of changes in individual erythrogram parameters and their constellations: sensitivity (Se), specificity (Sp), accuracy (Ac), positive and negative predicted values (PPV and NPV), the likelihood ratios of positive and negative result (LR + and LR-), post-test probability of bone damage, the difference between the frequency of cases. The relationship between individual erythrogram parameter or constellation and bone damage was considered statistically confirmed at the modulus of G. U. Yule’s coefficient of association (YCA) ≥ 0.5 or contingency coefficient (CC) ≥ 0.3.

Results. We found the confirmed inverse stochastic relationship between the constellation “normal hemoglobin (HGB) + normal mean cell hemoglobin (MCH) + increase in red cell distribution width in percent (RDWC)”, which may be combined with normal red blood cells (RBC) and/or normal mean corpuscular hemoglobin concentration (MCHC), and each of the bone lesions (with osteopenia: YCA = -0.69; CC = -0.33, with osteoporosis: YCA = -1.00, CC = -0.39), which most likely indicates BMD within normal limits. The individual erythrogram parameters and their constellations diagnostically valuable for osteopenia were not identified. We found such changes of the individual erythrogram parameters: revealed highly sensitive decrease in RBC, as the the most valuable (Se = 95.83 %; NPV = 83.33 %; LR- = 0.14; post-test probability of osteoporosis in its absence – 5.82%), decrease in HGB, decrease in hematocrit (HCT), moderately sensitive increase in red cell distribution width standard deviation in femtoliters (RDWS) (Se = 87.50–95.83%; NPV = 66.67–80.00 %; LR- = 0.17–0.35) and highly specific decrease in MCH (Sp = 94.12 %; PPV = 80.00 %; LR + = 2.83), between which and osteoporosis the direct stochastic relationship was confirmed (YCA = 0.52–0.81), being  characteristic for the diagnosis of osteoporosis. Among the constellations, “normal RBC + normal mean corpuscular volume (MCV) + normal MCHC” and “normal RBC + normal MCH + normal MCHC + normal RDWS” were found indicating the absence of osteoporosis, as evidenced by the presence of an inverse stochastic relationship between constellations and osteoporosis (YCA = -1.00; CC = -0.33). Also the moderately sensitive constellation “decrease in RBC + increase in RDWS” (Se = 83.33 %; LR- = 0.35) and constellations – highly specific “decrease in MCV + increase in RDWS” and the most specific (most valuable) “decrease in RBC + decrease in MCV + increase in RDWS” were found which can be combined with a decrease in HGB, and/or a decrease in HCT, and/or an increase in RDWC, and/or normal MCHC (Sp = 94.12-100.00 %; PPV = 88.89-100,00 %; LR + = 5.67 – tends to infinity), between which there and osteoporosis there is a confirmed direct stochastic relationship (YCA = 0.63–-1.00; SS = 0.33-0.38).

Conclusions. The presence of the constellation “normal HGB + normal MCH + increase in RDWC”, which may be combined with normal RBC and/or normal MCHC, indicates the absence of bone damage in a patient with liver cirrhosis.

The individual erythrogram parameters or their constellations diagnostically valuable for osteopenia were not identified. The absence of such highly sensitive changes of erythrogram parameters as decrease in RBC being of the greatest diagnostic value, or decrease in HGB content, HCT, or moderately sensitive increase in RDWS, or constellation “decrease in RBC + increase in RDWS”, or presence of constellations “normal RBC + normal MCV + normal MCHC” or “normal RBC + normal MCH + normal MCHC + normal RDWS” most likely indicates the absence of osteoporosis in patients with liver cirrhosis. The presence of highly specific decrease in MCH and/or constellations – highly specific “decrease in MCV + increase in RDWS”, or the most specific and most valuable “decrease in RBC + decrease in MCV + increase in RDWS” which can be combined with decrease in HGB and/or decrease in HCT, and/or increase in RDWC, and/or normal MCHC, indicates that patients with liver cirrhosis have osteoporosis.


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