| Objective: Previous studies have shown that lymphocyte to white blood cell ratio(LWR)as a marker of the inflammatory response can predict prognosis in a variety of diseases.However,the role of LWR in the prognosis of patients with decompensated liver cirrhosis(DLC)remains unclear.This study aimed to explore the prognostic value of the LWR in patients with DLC.Methods: This study retrospectively collected 214 patients with DLC admitted to the Department of Gastroenterology at our hospital from January 2018 to March 2021 as a developmental cohort and 139 patients with DLC admitted to our hospital from April2021 to February 2022 as a validation cohort.The clinical data of the patients were analyzed,including age,gender,etiology,complications,and the results of the first laboratory index test after admission.Patients were divided into survival and death groups according to the outcome of the disease at 1 month,3 months,and 6 months of follow-up.The patients were divided into high-LWR and low-LWR groups according to the Youden index in the receiver operating characteristic(ROC)curve of LWR in the development cohort,and the clinical-laboratory characteristics of patients in different groups were compared.Normally distributed continuous variables were compared using an independent sample t-test and non-normally distributed continuous variables were compared using the Mann-Whitney U test,whereas categorical variables were compared using the chi-square test.To evaluate the correlation between the LWR and Model for End-Stage Liver Disease(MELD)score,Spearman’s correlation test was used.Multivariate logistic analyses were performed to determine the effect of LWR on prognosis.Receiver operating characteristic(ROC)curve analyses were used to compare the values of the area under the ROC curve(AUC)of the LWR,MELD score,neutrophil to lymphocyte ratio(NLR),and Chronic Liver Failure consortium score for acute decompensated(CLIF-C ADs).In the development cohort,Restricted cubic spline(RCS)was used to determine whether the relationship between LWR and the risk of death was nonlinear.Results: 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.In the death group,LWR was significantly lower than that in the survival group,while NLR,MELD score,and CLIF-C ADs were significantly higher than those in the survival group(P < 0.05).LWR was significant negative correlated with the MELD score(r=-0.26,P < 0.001).ROC analysis showed that the optimal cut-off values of LWR for predicting death at 1 month,3 months,and 6 months were 0.163,0.163,and 0.264,respectively,with AUCs of 0.746,0.706,and 0.684,respectively.The Delong test showed that the LWR had comparable predictive power with the MELD score,NLR,and CLIF-C ADs(P > 0.05).Multivariate logistic regression analysis demonstrated that LWR was an independent predictor of1-month,3-month,and 6-month mortality in patients with DLC.RCS showed that the mortality risk gradually increased with the decrease of LWR;there was a non-linear relationship between the LWR and the risk of death at 1 and 3 months(P for non-linearity < 0.05),whereas a linear relationship was observed between the LWR and the risk of death at 6 months(P for non-linearity > 0.05).In the validation cohort,there were 11(7.9%),16(11.5%),and 24(17.3%)patients who died at 1,3,and 6 months,respectively.In the survival group,LWR was significantly higher than that in the death group,while NLR,MELD scores,and CLIF-C ADs were significantly lower than those in the death group(P < 0.05).ROC analysis demonstrated that the AUC value of LWR for predicted death at 1 month,3 months,and 6 months were 0.776,0.771,and 0.762,respectively.The Delong test showed there was no significant difference in the predictive ability of LWR and NLR,MELD score,and CLIF-C ADs for death in patients with DLC(P > 0.05).Multivariate logistic regression analysis showed that LWR was an independent predictor of death at 3 and 6 months in patients with DLC.Conclusions: Our findings indicate that a lower LWR is an independent factor for unfavorable outcomes and may serve as a potential novel prognostic predictor in patients with DLC. |
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