Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, PR China.
Ann Med. 2022 Dec;54(1):3201-3210. doi: 10.1080/07853890.2022.2142277.
This study aimed to explore the prognostic value of the lymphocyte (LYM)-to-white blood cell (WBC) ratio (LWR) in patients with decompensated liver cirrhosis (DLC).
This study was conducted by recruiting 214 patients with DLC with different aetiologies (development cohort). Receiver operating characteristic (ROC) curve analyses were used to assess the predictive accuracy of the LWR, and Youden's index was used to determine the optimal cut-off values of the LWR based on the ROC curve. Next, patients were divided into high- and low-LWR groups according to the cut-off values. Multivariate logistic analyses were performed to determine the independent predictors for the 1-, 3- and 6-month mortality. Restricted cubic spline (RCS) was used to determine and visualize the association between LWR and the risk of death. We verified the predictive ability of LWR in the validation cohort of 139 patients.
In the development cohort, there were 16 (7.5%), 22 (10.3%) and 30 patients (14.0%) who died at 1, 3 and 6 months, respectively. The LWR was significantly lower in non-survivors than in survivors and was an independent predictor of poor outcomes. The ROC analyses with the Delong test showed that the LWR had comparable predictive power with the Model for End-Stage Liver Disease (MELD) score, neutrophil-to-LYM ratio (NLR) and Chronic Liver Failure consortium score for acute decompensated (CLIF-C ADs). RCS showed a non-linear relationship between the LWR and the risk of death at 1 and 3 months, whereas a linear relationship was observed between the LWR and the risk of death at 6 months. We verified that the decreased LWR was an independent predictor of adverse outcomes at 3-, and 6-month follow-up endpoints in the validation cohort.
Our findings indicate that a lower LWR is an independent factor for unfavourable outcomes and may serve as a potential novel prognostic predictor in patients with DLC.KEY MESSAGESThis study is the first report on the prognostic value of the lymphocyte (LYM)-to-white blood cell (WBC) ratio (LWR) in patients with decompensated liver cirrhosis (DLC).Decreased LWR is an independent factor for adverse outcomes in patients with DLC.
本研究旨在探讨淋巴细胞（LYM）与白细胞（WBC）比值（LWR）对失代偿期肝硬化（DLC）患者预后的预测价值。
本研究纳入了 214 名不同病因的 DLC 患者（发展队列）。采用受试者工作特征（ROC）曲线分析评估 LWR 的预测准确性，根据 ROC 曲线采用 Youden 指数确定 LWR 的最佳截断值。接下来，根据截断值将患者分为高 LWR 组和低 LWR 组。采用多变量逻辑回归分析确定并评估 1、3 和 6 个月死亡率的独立预测因子。采用受限立方样条（RCS）确定和可视化 LWR 与死亡风险之间的关系。我们在 139 名患者的验证队列中验证了 LWR 的预测能力。
在发展队列中，分别有 16 例（7.5%）、22 例（10.3%）和 30 例（14.0%）患者在 1、3 和 6 个月时死亡。与幸存者相比，非幸存者的 LWR 显著降低，且是预后不良的独立预测因子。ROC 分析与 Delong 检验显示，LWR 与终末期肝病模型（MELD）评分、中性粒细胞与淋巴细胞比值（NLR）和急性失代偿性慢性肝衰竭联盟评分（CLIF-C ADs）具有相当的预测能力。RCS 显示 LWR 与 1 和 3 个月的死亡风险之间呈非线性关系，而与 6 个月的死亡风险之间呈线性关系。我们验证了在验证队列中，降低的 LWR 是 3 个月和 6 个月随访终点不良结局的独立预测因子。
我们的研究结果表明，较低的 LWR 是预后不良的独立因素，可能成为 DLC 患者潜在的新型预后预测指标。
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