Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2023; 29(23): 3678-3687
Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3678
Lymphocyte-to-white blood cell ratio is associated with outcome in patients with hepatitis B virus-related acute-on-chronic liver failure
Yue Zhang, Peng Chen, Xuan Zhu
Yue Zhang, Peng Chen, Xuan Zhu, Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Zhang Y and Chen P contributed equally to this study, and they wrote the original draft; Zhang Y designed this study; Chen P analyzed the data; Zhu X critically revised the manuscript; and all authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81960120 and 81660110; the Postgraduate Innovation Special Foundation of Jiangxi Province, No. YC2022-B052; and “Gan-Po Talent 555” Project of Jiangxi Province, No. GCZ (2012)-1.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Nanchang University Institutional Review Board (Approval No. IIT2021009).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data can be acquired from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xuan Zhu, PhD, Professor, Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Yongwaizhengjie Road, Donghu District, Nanchang 330006, Jiangxi Province, China. waiyongtg@163.com
Received: March 22, 2023
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
Abstract
BACKGROUND

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.

AIM

To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.

METHODS

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.

RESULTS

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.

CONCLUSION

LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBV-ACLF patients.

Keywords: Lymphocyte-to-white blood cell ratio; Hepatitis B virus; Acute-on-chronic liver failure; Child-Turcotte-Pugh score; Model for end-stage liver disease score; Chinese Group on the Study of Severe Hepatitis B-Acute-on-chronic liver failure II score

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.