Prognostic Value of Complete Blood Cell Count-Derived Inflammatory Markers in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure.

BACKGROUND: Development and progression of HBV-related acute-on-chronic liver failure (HBV-ACLF) are associated with inflammatory responses. We aimed to explore the utility of blood cell count-derived inflammatory markers (white blood cell, neutrophil-to-lymphocyte ratio, red cell distribution width, and monocyte-to-lymphocyte ratio [MLR]) as prognostic index in HBV-ACLF patients. METHODS: A total of 160 HBV-ACLF patients were included in this retrospective study. Univariate and multivariate analyses were performed to identify predictors of poor outcomes, and the performance of these predictors was evaluated by receiver operating characteristic curve analysis. RESULTS: Fifty-six patients died within 28 days after admission. MLR was markedly higher in non-survivors than in survivors. Moreover, MLR was an independent predictor for 28-day mortality. CONCLUSIONS: This retrospective study found that MLR is a simple and accurate prognostic index for mortality in HBV-ACLF patients and can serve as a screening tool for prediction of poor outcomes in these patients.

Association of Low High-Density Lipoprotein Cholesterol Levels with Poor Outcomes in Hepatitis B-Associated Decompensated Cirrhosis Patients.

BACKGROUND: Lipid levels become decreased in cirrhotic patients and are correlated with disease severity. In the present study, we investigated the impact of serum high-density lipoprotein cholesterol (HDL-C) on prognosis in patients with HBV-associated decompensated cirrhosis (HBV-DeCi). METHODS: The medical records of 153 HBV-DeCi patients were analyzed. Patients were separated into survivors and nonsurvivors according to their 30-day survival. Univariate and multivariate analyses were performed to identify predictors of poor outcomes, and the performance of these predictors was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: The 30-day mortality in the cohort was 18.9%. HDL-C levels differed markedly between survivors and nonsurvivors. On multivariate analysis, Model for End-stage Liver Disease (MELD) score and HDL-C level were identified as independent risk factors for mortality in HBV-DeCi patients. In the ROC analyses, the prognostic accuracy for mortality was similar between HDL-C (area under ROC curve: 0.785) and MELD score (area under ROC curve: 0.853). CONCLUSIONS: Low HDL-C level had a significant correlation with mortality in HBV-DeCi patients and can be used as a simple marker for risk assessment and selection of therapeutic options.

Neutrophil count to albumin ratio as a prognostic indicator for HBV-associated decompensated cirrhosis.

BACKGROUND: To explore the value of neutrophil count to albumin ratio (NAR) in predicting the outcomes of patients with HBV-associated decompensated cirrhosis (HBV-DeCi). METHODS: One hundred and fifty-four HBV-DeCi patients were enrolled. The 30-day mortality was determined. Multivariate analysis was applied to identify risk factors for poor outcomes. Receiver operating characteristic curve analyses was performed to evaluate prognostic accuracy. RESULTS: The 30-day mortality was 10.4%. NAR was significantly higher in non-survivors than in survivors and was an independent predictor for unfavorable prognosis. CONCLUSIONS: The present results indicate that increased NAR is associated with poor survival in HBV-DeCi patients and has potential for clinical application.

Practical application of Westgard Sigma rules with run size in analytical biochemistry processes in clinical settings.

BACKGROUND: The performance of 18 routine chemical detection methods was evaluated by the sigma (σ) metric, and Westgard Sigma rules with run size were used to establish internal quality control (IQC) standards to reduce patient risks. MATERIALS AND METHODS: External quality assessment (EQA) and internal quality control data from 18 assays in a biochemical laboratory were collected from January to June 2020. The sigma values of each assay were calculated, based on the bias, total error allowable, and coefficient of variation, appropriate quality control rules were selected. According to the quality goal index, the main causes of poor performance were determined to guide quality improvement. RESULTS: At IQC material level 1, seven of the 18 assays achieved five sigma (excellent), and five assays (UA, Crea, AMY, TC and Na) showed world-class performance. At IQC material level 2, 14 of the 18 assays achieved 5 sigma (excellent), and thirteen assays (UA, ALT, CK, Crea, AMY, K, AST, ALP, Na, LDH, Mg, TC and GGT) showed world-class performance. The quality goal index (QGI) was calculated for items with analysis performance <5 sigma, and the main causes of poor performance were determined to guide quality improvement. CONCLUSIONS: Westgard sigma rules with run size are an effective tool for evaluating the performance of biochemical assays. These rules can be used to more simply and intuitively select the quality control strategy of related items and reduce the risk to patients.