Evaluation of five lymphocyte-based scores for prediction of mortality in hepatitis B virus-associated decompensated cirrhosis

Neutrophil-derived ratios as predictors of short-term mortality in HBV-associated decompensated cirrhosis

BACKGROUND

Hepatitis B virus-associated decompensated cirrhosis (HBV-DC) is recognized as a critical illness with an increased risk of short-term mortality. Neutrophil-derived ratios, including neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-albumin ratio, neutrophil-to-high-density lipoprotein-cholesterol ratio, neutrophil-to-hemoglobin ratio, and neutrophil-to-platelet ratio, have emerged as potential prognostic markers in various liver diseases. The present study aimed to determine the effectiveness of these neutrophil-derived ratios for prediction of mortality in patients with HBV-DC.

METHODS

We conducted a retrospective analysis of HBV-DC patients at our hospital between April 2022 and April 2024. The study endpoint was the 30-day mortality rate. These neutrophil-derived ratios were calculated from data obtained during routine laboratory tests on admission. Disease severity was assessed using the Model for End-Stage Liver Disease (MELD) score. Multivariate regression analyses and receiver operating characteristic (ROC) curve analyses were conducted.

RESULTS

The study investigated 160 HBV-DC patients, of whom 23 (14.4%) experienced mortality within 30 days. Non-survivors exhibited markedly higher values for neutrophil-derived ratios than survivors. All neutrophil-derived ratios were associated with mortality in univariate analyses, but only NLR and MELD score remained as independent predictors of mortality in multivariate analyses. In the ROC analyses, NLR showed a similar prognostic value to MELD score. Moreover, both NLR and MELD score had high specificity for prediction of mortality in HBV-DC patients.

CONCLUSIONS

Among neutrophil-derived ratios, NLR stands out as a simple and reliable predictor of mortality in HBV-DC patients.

Prognostic Value of Platelet-to-Monocyte Ratio for Mortality in HBV-Related Acute-on-Chronic Liver Failure

Purpose

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a critical condition associated with unfavorable survival rates. Recent studies have indicated that the platelet-to-monocyte ratio (PMR) is considered an effective prognostic marker in several diseases. However, there has been no study to evaluate the prognostic value of PMR in HBV-ACLF patients. Therefore, this study aimed to investigate the association between PMR and 28-day survival in these patients.

Methods

In this retrospective study, data, including clinical and laboratory parameters, were collected for 184 HBV-ACLF patients. Disease severity was assessed using the Model for End-Stage Liver Disease (MELD) score. Logistic regression analyses were conducted to identify predictors influencing 28-day survival. Receiver-operating characteristic curve (ROC) analyses were performed to assess the predictive abilities of the identified predictors.

Results

During the 28-day follow-up period, 56 (30.4%) HBV-ACLF patients died. PMR was significantly lower in non-survivors than in survivors (P <0.001). Logistic regression demonstrated that PMR (Odds ratio, 0.983; 95% Confidence interval, 0.976-0.990; P=0.001) and MELD score (Odds ratio, 1.317; 95% Confidence interval, 1.200-1.446; P <0.001) were independent risk factors for mortality in HBV-ACLF patients. The area under ROC curve for PMR was 0.760 (sensitivity=0.840, specificity=0.620, P=0.001) at a cut-off value of 140.6, and the area under ROC curve for MELD score was 0.819 (sensitivity=0.700, specificity=0.860, P=0.001) at a cut-off value of 23.1. PMR and MELD score exhibited similar predictive performances (Z=1.229; P=0.219). Furthermore, the combined use of PMR and MELD score further increased the area under the ROC curve to 0.858, which more accurate prognosis prediction than use of either factor alone (both P< 0.05).

Conclusion

The PMR could serve as a reliable tool for predicting mortality in HBV-ACLF patients. Additionally, combining the PMR with the MELD score could improve prognostic accuracy for predicting 28-day mortality in these patients. However, further and larger studies are needed to confirm our findings.