Low Platelet to White Blood Cell Ratio Indicates Poor Prognosis for Acute-On-Chronic Liver Failure

Background. Platelet to white blood cell ratio (PWR) was an independent prognostic predictor for outcomes in some diseases. However, the prognostic role of PWR is still unclear in patients with hepatitis B related acute-on-chronic liver failure (ACLF). In this study, we evaluated the clinical performances of PWR in predicting prognosis in HBV-related ACLF. Methods. A total of 530 subjects were recruited, including 97 healthy controls and 433 with HBV-related ACLF. Liver function, prothrombin time activity (PTA), international normalized ratio (INR), HBV DNA measurement, and routine hematological testing were performed at admission. Results. At baseline, PWR in patients with HBV-related ACLF (14.03 ± 7.17) was significantly decreased compared to those in healthy controls (39.16 ± 9.80). Reduced PWR values were clinically associated with the severity of liver disease and the increased mortality rate. Furthermore, PWR may be an inexpensive, easily accessible, and significant independent prognostic index for mortality on multivariate analysis (HR = 0.660, 95% CI: 0.438–0.996, p=0.048) as well as model for end-stage liver disease (MELD) score. Conclusions. The PWR values were markedly decreased in ACLF patients compared with healthy controls and associated with severe liver disease. Moreover, PWR was an independent prognostic indicator for the mortality rate in patients with ACLF. This investigation highlights that PWR comprised a useful biomarker for prediction of liver severity.

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Relationship Between Platelet to White Blood Cell Ratio and 30-Day Prognosis of Patients with Acute-on-Chronic Liver Failure

Hepatitis Monthly ◽

10.5812/hepatmon.118640 ◽

2021 ◽

Vol 21 (9) ◽

Author(s):

Xiang Xu ◽

Chen Li ◽

Jing Chen ◽

Xiaoyan Liu ◽

Haibin Su ◽

...

Keyword(s):

Survival Rate ◽

Blood Cell ◽

Liver Failure ◽

White Blood Cell ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Cox Models ◽

Factors Affecting ◽

Cell Ratio ◽

The Relationship

Background: Acute-on-chronic liver failure (ACLF) is always associated with thrombocytopenia or leukocytosis. Therefor the platelet to white blood cell ratio (PWR) in ACLF patients is always reduced. Objectives: Here, we assessed the relationship between PWR and prognosis in ACLF patients. Methods: A retrospective cohort of 415 patients, including 100 patients that were diagnosed of chronic hepatitis B, 104 patients suffered of HBV-related liver cirrhosis and 211 patients suffered of HBV-related ACLF, was investigated. Univariate and multivariate COX models were used to investigate the relationship between PWR and 30-day survival in patients with ACLF. Factors affecting PWR in ACLF patients were also analysed using logistic regression analysis. Results: At baseline, the platelet count in patients with HBV-related ACLF was significantly lower than that in patients with CHB and patients suffered of HBV-related cirrhosis. The PWR value was much higher in the survivors of ACLF than in ACLF patients who died. PWR, age, total bilirubine, prothrombin activity, and aspartate transaminase were independent predictors of the 30-day survival rate of ACLF patients. We also found that ascites and infection were independent factors related to the decrease of PWR in ACLF patients. Conclusions: The PWR value was significant declined in ACLF patients. And it was independent risk factors for the survival rate of those patients.

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Bacteremia, Acute Physiology and Chronic Health Evaluation II and Modified End Stage Liver Disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure

Critical Care Medicine ◽

10.1097/ccm.0b013e3181b42a1c ◽

2010 ◽

Vol 38 (1) ◽

pp. 121-126 ◽

Cited By ~ 67

Author(s):

Constantine J. Karvellas ◽

Fred Pink ◽

Mark McPhail ◽

Mark Austin ◽

Georg Auzinger ◽

...

Keyword(s):

Liver Disease ◽

Liver Failure ◽

Critically Ill ◽

Chronic Liver ◽

Chronic Health Evaluation ◽

Health Evaluation ◽

Chronic Liver Failure ◽

Predictors Of Mortality ◽

End Stage Liver Disease ◽

End Stage

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Imaging Software-Based Sarcopenia Assessment in Gastroenterology: Evolution and Clinical Meaning

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/6669480 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Giovanni Marasco ◽

Sinan Sadalla ◽

Giulio Vara ◽

Rita Golfieri ◽

Davide Festi ◽

...

Keyword(s):

Skeletal Muscle ◽

Liver Disease ◽

Liver Failure ◽

Chronic Liver Disease ◽

Liver Diseases ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

Sarcopenia is gaining attention as a negative prognostic factor in different fields of medicine, including chronic liver failure. However, the assessment of sarcopenia in patients with liver diseases is often neglected due to unawareness of reliable tools and methods and thus is limited to research studies. Cross-sectional imaging is a diffuse diagnostic tool and is commonly performed in patients with chronic liver failure. The last advancements in radiology image analysis using dedicated software allow an easy and standardized method to assess skeletal muscle volume. Several measures can be obtained from cross-sectional imaging analysis to evaluate sarcopenia in patients affected by chronic liver disease. We aimed to review the recent advances in imaging-based sarcopenia assessment, in particular in patients with chronic liver diseases. As a result, we found that the skeletal muscle index (SMI) seems to be a reliable method to assess sarcopenia in cirrhotic patients. Even if further studies are needed to validate proper cut-offs for each clinical endpoint, physicians are invited to consider the assessment of sarcopenia in the work-up of patients with chronic liver disease.

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Acute Liver Failure

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0041 ◽

2019 ◽

pp. 264-269

Author(s):

James Y. Findlay ◽

Eelco F. M. Wijdicks

Keyword(s):

Liver Disease ◽

Liver Function ◽

Liver Failure ◽

Acute Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Underlying Liver Disease ◽

Rapid Deterioration ◽

Uncommon Condition ◽

Acute Insult

Acute liver failure (ALF) is an uncommon condition in which an acute insult results in a rapid deterioration of liver function, encephalopathy, and coagulopathy in the absence of prior underlying liver disease. It is differentiated from rapid deterioration in the setting of underlying liver disease (acute on chronic liver failure) and from the gradual deterioration in liver function that can occur in chronic liver failure.

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Liver failure

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0321 ◽

2020 ◽

pp. 3089-3100

Author(s):

Jane Macnaughtan ◽

Rajiv Jalan

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Hepatic Encephalopathy ◽

Liver Injury ◽

Liver Failure ◽

Acute Liver Failure ◽

Organ Failure ◽

Clinical Manifestations ◽

Chronic Liver ◽

Chronic Liver Failure

Liver failure occurs when loss of hepatic parenchymal function exceeds the capacity of hepatocytes to regenerate or repair liver injury. Acute liver failure is characterized by jaundice and prolongation of the prothrombin time in the context of recent acute liver injury, with hepatic encephalopathy occurring within 8 weeks of the first onset of liver disease. Acute-on-chronic liver failure is characterized by hepatic and/or extrahepatic organ failure in patients with cirrhosis associated with an identified or unidentified precipitating event. The commonest causes of acute liver failure are acute viral hepatitis and drugs. Acute-on-chronic liver failure is most commonly precipitated by infection, alcohol abuse, and superimposed viral infection. The main clinical manifestations are hepatic encephalopathy, coagulopathy, jaundice, renal dysfunction, and haemodynamic instability. Infection and systemic inflammation contribute to pathogenesis and critically contribute to prognosis. Specific therapy for the underlying liver disease is administered when available, but this is not possible for most causes of liver failure. Treatment is predominantly supportive, with particular emphasis on (1) correction or removal of precipitating factors; (2) if encephalopathy is present, using phosphate enemata, nonhydrolysed disaccharide laxatives, and/or rifaximin; (3) early detection and prompt treatment of complications such as hypoglycaemia, hypokalaemia, cerebral oedema, infection, and bleeding. The onset of organ failure should prompt discussion with a liver transplantation centre. The mortality of acute liver failure (without liver transplantation) is about 40%. Patients with acute liver failure who do not develop encephalopathy can be expected to recover completely. Those who recover from an episode of acute-on-chronic liver failure should be considered for liver transplantation because otherwise their subsequent mortality remains high.

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