Risk factors for the prognosis of patients with decompensated hepatitis B cirrhosis and their predictive values.

Factores de riesgo para el pronóstico de pacientes con cirrosis por hepatitis B descompensada y sus valores predictivos.

• Li Li The First People’s Hospital of Fuyang District, Hangzhou, Zhejiang Province, China. https://orcid.org/0000-0002-8278-638X
• Jihui Zhang Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China. https://orcid.org/0000-0001-9251-7047
• Peng Yuan General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China. https://orcid.org/0000-0002-4305-6499
• Jianjun Song General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China. https://orcid.org/0000-0003-0401-3936
• Zhenhui Lu General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China. https://orcid.org/0000-0002-8983-7901
• Guozhong Zhao General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China. https://orcid.org/0000-0001-6218-0973

DOI: https://doi.org/10.54817/IC.v64n2a06

Keywords: decompensated hepatitis b cirrhosis, prognosis, risk factor, predictive value

Abstract

We aimed to investigate the risk factors affecting the prognosis of patients with decompensated hepatitis B cirrhosis and their predictive values. The clinical data of 149 patients with decompensated hepatitis B cirrhosis, treated from August 2015 to June 2019, were analyzed retrospectively. They were divided into death and survival groups during a one-year follow-up. Their baseline data were compared, and the risk factors affecting death, correlations among risk factors, and predictive values of these factors for death were analyzed. Survival analysis was conducted. During a one-year follow-up, 103 patients survived, and 46 died. High neutrophil-lymphocyte ratio (NLR), red cell distribution width (RDW), the model for end-stage liver disease (MELD) score, the Child-Turcotte-Pugh (CTP) score, and low serum sodium were independent risk factors for death in patients with decompensated hepatitis B cirrhosis. NLR correlated positively with CTP and MELD scores (r=0.346, p=0.0001, r=0.243, p=0.0003, respectively). Likewise, the RDW had positive correlations with CTP and MELD scores (r=0.417, p=0.0001, r=0.413, p=0.0003, respectively). Serum sodium was negatively correlated with CTP and MELD scores (r=-0.484, p=0.0001, r=-0.476, p=0.0001, respectively). The survival rate was high in patients with NLR<7.38, RDW<16.15%, serum sodium>146.31 mmol/L, CTP score<10.26 points, and MELD score<11.31 points (p=0.0001). NLR, RDW, serum sodium, MELD, and CTP scores had high death predictive values. NLR, RDW, serum sodium, CTP score, and MELD score can be considered as critical indices for evaluating and predicting the prognosis of patients with decompensated hepatitis B cirrhosis.

References

Yoshiji H, Nagoshi S, Akahane T, Asaoka Y, Ueno Y, Ogawa K, Kawaguchi T, Kurosaki M, Sakaida I, Shimizu M, Taniai M. Evidence-based clinical practice guidelines for liver cirrhosis 2020. J Gastroenterol 2021;56(7): 593-619. https://doi.org/10.1007/ s00535-021-01788-x.

Surial B, Wyser D, Béguelin C, Ramírez-Mena A, Rauch A, Wandeler G. Prevalence of liver cirrhosis in individuals with hepatitis B virus infection in sub-Saharan Africa: Systematic review and meta-analysis. Liver Int 2021; 41(4): 710-719. https://doi. org/10.1111/liv.14744.

Lapointe-Shaw L, Georgie F, Carlone D, Cerocchi O, Chung H, Dewit Y, Feld JJ, Holder L, Kwong JC, Sander B, Flemming JA. Identifying cirrhosis, decompensated cirrhosis and hepatocellular carcinoma in health administrative data: a validation study. PLoS One 2018; 13(8): e0201120. https://doi.org/10.1371/journal.pone.0201120.

Xie Y, He C, Wang W. A potential novel inflammation biomarker for predicting the prognosis of decompensated liver cirrhosis. Ann Med 2022; 54(1): 3201-3210. https://doi.org/10.1080/07853890.2022. 2142277.

Higgins DC, Kuncio DE, Johnson CC, Viner KM. Influence of birth origin and risk factor profile on hepatitis B mortality: Philadelphia, PA 2003–2013. Ann Epidemiol 2018; 28: 169-174. https://doi. org/10.1016/j.annepidem.2017.12.006.

Chinese Society of Hepatology, Infectious Diseases Branch of Chinese Medical Association. [Diagnostic Criteria for Chronic Hepatitis B (2015)]. Chin J Integr Tradit Western Med Liver Dis 2015; 25: 384.

Akarapatima K, Chang A, Prateepchaiboon T, Pungpipattrakul N, Songjamrat A, Pakdeejit S, Rattanasupar A, Piratvisuth T. Predictive outcomes using child-turcotte-pugh and albumin-bilirubin scores in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. J Gastrointest Cancer 2022; 53(4): 1006-1013. https://doi.org/10.1007/s12029-021-00743-6.

Kim KM, Shim SG, Sinn DH, Song JE, Kim BS, Kim HG. Child-Pugh, MELD, MELD-Na, and ALBI scores: which liver function models best predicts prognosis for HCC patient with ascites? Scand J Gastroenterol 2020; 55(8): 951-957. https://doi.org/10.1080/00365521.2020.1788139.

Rachakonda V, Borhani AA, Dunn MA, Andrzejewski M, Martin K, Behari J. Serum leptin is a biomarker of malnutrition in decompensated cirrhosis. PloS One 2016; 11: e0159142. https://doi.org/10.1371/journal.pone.0159142.

Verma N, Kaur A, Sharma R, Bhalla A, Sharma N, De A, Singh V. Outcomes after multiple courses of granulocyte colony‐stimulating factor and growth hormone in decompensated cirrhosis: a randomized trial. Hepatology 2018; 68: 1559-1573. https:// doi.org/10.1002/hep.29763.

Privitera G, Spadaro L, Marchisello S, Fede G, Purrello F. Abnormalities of lipoprotein levels in liver cirrhosis: clinical relevance. Dig Dis Sci 2018; 63(1): 16-26. https://doi.org/10.1007/s10620-017-4862-x.

Zhang J, Qiu Y, He X, Mao W, Han Z. Platelet-to-white blood cell ratio: a novel and promising prognostic marker for HBV-associated decompensated cirrhosis. J Clin Lab Anal 2020; 34(12): e23556. https://doi.org/10.1002/jcla.23556.

Zhang Y, Zhao R, Shi D, Sun S, Ren H, Zhao H, Wu W, Jin L, Sheng J, Shi Y. Characterization of the circulating microbiome in acute-on-chronic liver failure associated with hepatitis B. Liver Int 2019; 39: 1207-1216. https://doi.org/10.1111/liv.14097.

Kalra A, Wedd JP, Bambha KM, Gralla J, Golden-Mason L, Collins C, Rosen HR, Biggins SW. Neutrophil-to-lymphocyte ratio correlates with proinflammatory neutrophils and predicts death in low model for end-stage liver disease patients with cirrhosis. Liver Transplant 2017; 23: 155-165. https://doi.org/10.1002/lt.24702.

Liu K, Wang FS, Xu R. Neutrophils in liver diseases: pathogenesis and therapeutic targets. Cell Mol Immunol 2021; 18(1): 38-44. https://doi.org/10.1038/s41423-020-00560-0.

Mustika S, Waafi AK. Platelet-lymphocyte ratio and neutrophil-lymphocyte ratio as early mortality predictors for patients with end-stage chronic liver disease. Indones J Gastroenterol Hepatol Dig Endosc 2022; 23(2): 123-132. https://doi. org/10.24871/2322022223-232.

Zhang M, Chen S, Zhu X, Huang A, Lan F, Chen H, Li S, Qin X. Value of red cell distribution width in assessing the severity of hepatitis B virus-related decom- pensated cirrhosis. Clin Lab 2017; 63:1467-1474. https://doi.org/10.7754/Clin. Lab.2017.170331.

Ferdous A, Ahmed AN, Rahman SA, Hasan T, Mahzabeen L. Role of red cell distribution width to platelet ratio in predicting hepatic fibrosis in chronic hepatitis B. Mymensingh Med J 2018; 27: 550-560.

Wang J, Huang R, Yan X, Li M, Chen Y, Xia J, Liu Y, Jia B, Zhu L, Zhang Z, Zhu C. Red blood cell distribution width: A promising index for evaluating the severity and long-term prognosis of hepatitis B virus–related diseases. Digest Liver Dis 2020; 52: 440-446. https://doi.org/10.1016/j. dld.2019.12.144.

Owoicho O, Tapela K, Olwal CO, Djomkam Zune AL, Nganyewo NN, Quaye O. Red blood cell distribution width as a prognostic biomarker for viral infections: prospects and challenges. Biomark Med 2022; 16(1): 41-50. https://doi.org/10.2217/bmm-2021-0364.

Patel R, Poddar P, Choksi D, Pandey V, Ingle M, Khairnar H, Sawant P. Predictors of 1-month and 3-months hospital readmissions in decompensated cirrhosis: a prospective study in a large Asian cohort. Ann Hepatol 2019; 18(1): 30-39. https://doi. org/10.5604/01.3001.0012.7859.

Barakat AA, Metwaly AA, Nasr FM, El- Ghannam M, El-Talkawy MD. Impact of hyponatremia on frequency of complications in patients with decompensated liver cirrhosis. Electron Physician 2015; 7: 1349-1358. https://doi.org/10.14661/1349.

Liamis G, Filippatos TD, Liontos A, Elisaf MS. Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemo-dynamic compromise. Hepatol Int 2016; 10: 762-772. https://doi.org/10.1007/s12072-016-9746-1.

Fernández Carrillo C, Lens S, Llop E, Pascasio JM, Crespo J, Arenas J, Fernández I, Baliellas C, Carrión JA, de la Mata M, Buti M. Treatment of hepatitis C virus infection in patients with cirrhosis and predictive value of MELD: Analysis of data from the He-pa-C registry. Hepatology 2017; 65: 1810-1822. https://doi.org/10.1002/hep.29097.

Qiang L, Qin J, Sun C, Sheng Y, Chen W, Qiu B, Chen X, Chen Y, Liu F, Wu G. A novel predictive model based on inflammatory markers to assess the prognosis of patients with HBV-related acute-on-chronic liver failure: a retrospective cohort study. BMC Gastroenterol 2020; 20(1): 301. https:// doi.org/10.1186/s12876-020-01437-2.