An evaluation on low hemoglobin/red blood cell distribution width ratio for the prognosis of HBV-related decompensate cirrhosis

Abstract

Abstract: Objective To determine the value of hemoglobin/red blood cell distribution (Hb/ RDW) ratio in evaluating the prognosis of patients with hepatitis B virus (HBV)-related decompensate cirrhosis (HBV-DC). Methods 141 patients with HBV-DC admitted from January 2015 to February 2022 were selected, including 116 males and 25 females, with an average age of 52 (46, 64) years. HBV-DC was diagnosed according to the previous standard. One hundred and forty-one cases of HBV-DC were divided into a survival group and a death group according to their survival and death status. Results Of the 41 patients with HBV-DC, 120 survived and 21 died. In the survival group, the scores of TBil, Scr, RDW, INR and MELD were 36.3 (18.0, 99.6) μmol/L, 71.0 (58.7, 83.2) μmol/L, 15.8 (14.8, 17.8)%, 1.3 (1.2, 1.6) and 11.4(6.5, 15.7) points, which were significantly decreased when compared with those of 78.2 (51.0, 239.6) μmol/L, 92.3 (66.6, 125.1) μmol/L, 20.1 (17.3, 21.7)%, 1.6 (1.3, 1.9) and 20.2 (13.1, 22.5) points in the death group, respectively (P<0.05). Hb and Hb/RDW in the survival group were 108 (90, 122) g/L and 6.6 (5.2, 7.8), which were significantly higher than those of 95 (71, 110) g/L and 4.9 (3.9, 5.8) in the death group, respectively (P<0.05). Multivariate logistic regression analysis showed that Hb/RDW and MELD scores were independent risk factors for the deaths of HBV-DC patients (P<0.05). ROC curve analysis for the independent risk factors such as Hb/RDW and MELD score showed that the cutoff point of Hb/RDW in diagnosing the death of HBV-DC patients was 6.0%, with a sensitivity of 85.0% (102/120), a specificity of 66.7% (14/21) and the AUC value of 0.78; The cutoff point of MELD score was 17.4, with a sensitivity of 66.7% (80/120), a specificity of 85.7% (18/21), and the AUC value of 0.80. The AUC value of Hb/RDW combined with MELD score was 0.86. When setting Hb/RDW=6.0% as the cutoff point, the HBV-DC patients were divided into a low Hb/RDW group (n=62) and a high Hb/RDW group (n=79). In the low Hb/RDW group, the scores of Hb, RDW, INR, MELD and the 30-day mortality were 85 (72, 96) g/L, 18.4 (17.0, 20.8)%, 1.5 (1.3, 1.7), 14.2 (9.2, 18.7) and 17 cases (17 cases), which were significantly different than those of 110 (108, 130) g/L, 15.1 (17.3, 21.7)%, 1.3 (1.2,1.5), 11.2 (6.6, 14.9) and 4 cases (5.1%) in the high Hb/RDW group, respectively (P<0.05). Conclusion Hb/RDW and MELD scores are independent risk factors for the death of HBV-DC patients. The combined application of Hb/RDW and MELD scores can effectively predict the prognosis of HBV-DC patients.

Key words: Hepatitis B virus, Decompensated cirrhosis, Hemoglobin, Red blood cell distribution width, Receiver operating characteristic curve

GAO Zheng-cong, LEI Zuo-han, GUO Shun-qin. An evaluation on low hemoglobin/red blood cell distribution width ratio for the prognosis of HBV-related decompensate cirrhosis[J]. Chinese Hepatolgy, 2022, 27(9): 1004-1007.

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