Red Blood Cell Distribution Width To Albumin Ratio As A Novel Prognostic Indicator In Chronic Hepatitis B-related Liver Cirrhosis

Objective Simple,reliably and accurately non-invasive indexes to predict severity and prognosis of chronic hepatitis B(CHB)-related liver cirrhosis(LC)are currently lacking.We developed and tested a novel index using routine laboratory results to predict the presence and severity of CHB-LC to include death.Methods Patients were enrolled from The Fifth People's Hospital of Suzhou and Nanjing Drum Tower Hospital(2011-2017).The derivation cohort contained 591 patients(n=230 CHB-LC,n=194 CHB without cirrhosis(CHB-NC),n=167 non-CHB healthy controls)from one center.A validation cohort(n=683,n=168 CHB-LC,n=318 CHB-NC,n=197 non-CHB)was independently enrolled from the other study center.The diagnostic value of predicting indexes was estimated by the area under receiver operating characteristic curve(AUROC).Survival estimates for different cohorts were generated using Kaplan–Meier methods.Multiple regression identified index predictors.Results By logistics regression analysis,red cell distribution width(RDW)and albumin(P<0.001)were independent predictors of CHB-related decompensated cirrhosis(CHB-DCC)in derivation and validation cohorts.Patients with more severity CHB-LC had significantly higher values of RAR.RAR values were positively correlated with Child-Turcotte-Pugh(CTP)score(r=0.492,P<0.001)and MELD score(r=0.803,P<0.001).The area under receiver operating characteristic curve(AUROC)of RDW to albumin ratio(RAR)in predicting CHB-LC was 0.819(95% confidence interval [CI] 0.779-0.858)and higher for CHB-DCC(0.874,95% CI 0.829-0.919),significantly higher than that of several known noninvasive scores.Validation cohort had similar results.Over a median follow-up of 33-34 months,CHB-LC patients with RAR?0.44 in both derivation cohort(24.5% vs.3.3%,P<0.001)and validation cohort(17.0% vs.3.6%,P=0.009)had significantly higher liver-related mortality.In addition,higher RAR levels independently predicted liver-related mortality(HR=16.65-43.15,P=0.018 to <0.001)in both derivation and validation cohorts.Conclusions: The RAR,a novel easy-to-use index,accurately diagnoses the presence of CHB-LC and predicts CHB-LC related morbidity and mortality in clinical practice.