Predictive Value of the INR-to-Platelet Ratio (INPR) for Advanced Liver Fibrosis in Patients with Chronic Hepatitis C Infection

Abstract

Objective: To assess the suitability of the INR-to-platelet ratio (INPR) as a marker to help identify advanced stages of hepatic fibrosis in patients with chronic hepatitis C infection. Methodology: This cross-sectional study was conducted in the Department of  Hematology, Pathology, Bakhtawar Amin Medical and Dental College, Multan, during Sep 2025 and March 2026. 96 patients diagnosed with HCV infection. Participants underwent a series of diagnostic tests, including liver parenchymal biopsy, shear wave elastography (SWE), and blood tests to determine the INPR. The principal outcome was the assessment of advanced fibrosis (>F3), determined using the METAVIR scoring system. Endoscopic follow-up was also performed to document the presence or absence of esophageal varices. We analyzed the collected data using the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Participants had a mean age of 50 ± 15.6 years, with males accounting for 64.5% and females for 35.5% of the cohort. Advanced hepatic fibrosis was present in 56 patients (58.3%). INPR demonstrated good discriminatory ability, with sensitivity of 84%, specificity of 74%, PPV of 82.5%, and NPV of 76.9%. By comparison, GPR exhibited comparatively lower diagnostic accuracy. Conclusion: INPR is a potentially valuable non-invasive indicator for assessing advanced liver fibrosis in individuals with chronic HCV infection. Its practicality and simple application could facilitate bedside risk stratification and potentially reduce reliance on invasive liver biopsy.