Platelet and Doppler ultrasound signatures of histological fibrosis in chronic liver disease: a correlation study based on Ishak staging.

BACKGROUND AND AIMS: Non-invasive assessment of hepatic fibrosis remains a major challenge in clinical hepatology. Platelet count and Doppler ultrasound parameters have been proposed as indirect markers of portal hypertension and fibrotic remodeling, yet their relationship with histological fibrosis severity across the full disease spectrum is not fully defined. This study aimed to evaluate the associations between platelet count (PLT) and Doppler ultrasound parameters along the histological continuum of hepatic fibrosis assessed by the Ishak staging system.

METHODS

In this retrospective study, 120 patients with biopsy-proven hepatic fibrosis were analyzed. Doppler ultrasound examinations were performed just before the liver biopsy. Assessed parameters included portal vein caliber, mean portal vein velocity, hepatic arterial resistive and pulsatility indices, splenic arterial indices, and splenic area. PLT was obtained from routine blood tests. Associations between PLT, Doppler parameters, and Ishak fibrosis stage were evaluated using Spearman's rank correlation. Subgroup analyses were conducted across Ishak stages 0-2 (mild fibrosis), 3-4 (moderate fibrosis), and 5-6 (advanced fibrosis/cirrhosis).

RESULTS

Platelet count showed a strong inverse correlation with Ishak fibrosis stage (ρ = - 0.55, q < 0.01). Significant inverse associations were also observed between platelet count and key Doppler markers of portal hypertension, including portal vein caliber (ρ = - 0.46, q < 0.05) and splenic area (ρ = - 0.51, q < 0.05). Hepatic and splenic arterial resistive and pulsatility indices demonstrated weaker positive correlations with fibrosis severity (ρ ≈ + 0.30 to 0.40), which did not consistently reach statistical significance after correction for multiple testing. Correlations between platelet count and portal vein caliber as well as splenic area were significantly stronger in patients with advanced fibrosis compared with those with mild fibrosis (p_diff < 0.05).

CONCLUSIONS

PLT and selected Doppler ultrasound parameters change in parallel with histological fibrosis severity, reflecting the progressive development of portal hypertension and vascular remodeling. These findings support a combined, trend-based interpretation of PLT and Doppler ultrasound markers as accessible, non-invasive indicators of advanced liver disease, rather than as stand-alone diagnostic tools.