Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3678
Peer-review started: March 22, 2023
First decision: April 14, 2023
Revised: April 28, 2023
Accepted: May 22, 2023
Article in press: June 21, 2023
Published online: June 21, 2023
Processing time: 85 Days and 20.5 Hours
The lymphocyte-to-white blood cell ratio (LWR) is a blood marker of the systemic inflammatory response. The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) remains unclear.
To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.
This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital. Patients were divided into survivor and non-survivor groups according to their 28-d prognosis. The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses. Patients were divided into low- and high-LWR groups according to the cutoff values. Kaplan-Meier analysis was performed according to the level of LWR.
During the 28-d follow-up time, 135 patients died, and the mortality rate was 40.90%. The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients. A lower LWR level was an independent risk factor for poor 28-d outcomes (hazard ratio = 0.052, 95% confidence interval: 0.005-0.535). The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh, model for end-stage liver disease, and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores. In addition, the 28-d mortality was higher for patients with LWR < 0.11 than for those with LWR ≥ 0.11.
LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBV-ACLF patients.
Core Tip: This manuscript introduced a simple and effective inflammatory marker, the lymphocyte-to-white blood cell ratio (LWR). Our study found that a lower LWR level was associated with poor 28-d outcomes in hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients. It may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBV-ACLF patients, and it may be helpful in guiding a clinician to treatment allocation and assist in the prediction of prognosis.