Background and study aim: The gold standard investigation to stage hepatic cirrhosis is liver biopsy. Being invasive with several major and minor procedure-related complications, liver biopsy is not universally-applied in all the indicated population. In addition to observer-related variations and sampling errors, the need for alternatives to liver biopsy has emerged including several lab-based indices of those; red cell volume distribution width-to-platelet ratio (RPR) have been postulated in some studies. The aim of this article is to study the diagnostic performance of RPR in staging liver cirrhosis in HCV-infected patients.
Patients and Methods: 236 patients who had underwent liver biopsy for IFN-based therapy were included in the present study according to pre-defined inclusion and exclusion criteria. They were classified into 4 groups according to  the  stage     of
cirrhosis reported by the liver biopsy. Laboratory data, including CBC and biochemical studies, RPR, APRI score and FIB-4 were tabulated for statistical analysis.
Results: The AUROCs values for RPR were 0.795, 0.811 and 0.886 for F2, F3 and F4 stage of cirrhosis respectively which were consistently higher than those of APRI (0.680, 0.754 and 0.746 for F2, F3 and F4 stages respectively) and FIB-4 (0.653, 0.765 and 0.810 for F2, F3 and F4 stages respectively). RPR was significantly-correlated with APRI (P<0.002), and FIB-4 (P<0.001) for the prediction of F3 stage of cirrhosis, and F4 stage of cirrhosis (P Conclusion: RPR can be a promising, inexpensive non-invasive tool for the prediction of the stage of hepatic cirrhosis in patients with HCV.