Predictive effects of platelet count and red blood cell distribution width on the prognosis of patients with acute hepatitis E-induced liver failure

doi:10.3877/cma.j.issn.1674-1358.2023.05.004

Abstract

Abstract:

Objective

To investigate the value of platelet count (PLT) and red blood cell distribution width (RDW) in predicting the prognosis of acute hepatitis E-induced liver failure.

Methods

Total of 128 patients with acute hepatitis E-induced liver failure who were hospitalized in Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University from January 2018 to December 2022 were selected. General data such as gender and age, liver and kidney function, blood routine, coagulation index, inflammation index and alpha-fetoprotein (AFP) of patients within one week after admission were collected, and the model of end-stage liver disease (MELD) score and model of end-stage liver disease combined serum sodium (MELD-Na) score were calculated. According to the survival status at 12 weeks after treatment, the enrolled patients were divided into survival group (104 cases) and death group (24 cases). The levels of total bilirubin (TBil), peripheral white blood cell count (WBC), red blood cell distribution width (RDW), MELD-Na score, serum glutamyltransferase (GGT), total cholesterol (TC), apolipoprotein A (ApoA), fibrinogen (FIB) and antithrombin-Ⅲ (AT-Ⅲ), platelet count (PLT), blood sodium (Na) and other indicators were compared between the two groups. Stata 14.0 software was used for statistical analysis. Logistic regression analysis was used to screen the risk factors affecting the prognosis of patients. The prognostic efficacy of these risk factors in hepatitis E-induced liver failure were evaluated by receiver operating characteristic curve (ROC).

Results

Among the 128 patients with acute hepatitis E-induced liver failure, 116 cases were males (90.62%) and 12 cases were females (9.38%), with an average age of (60.25 ± 9.96) years old. Among the 128 patients, 52 cases were complicated with infection, 12 cases were complicated with hepatic encephalopathy, and 55 cases were treated with artificial liver. In the death group, age (t =-0.35, P = 0.36), sex (χ² = 0.04, P = 0.85), incidence of infection (χ² = 1.97, P = 0.16), incidence of hepatic encephalopathy (χ² = 1.85, P = 0.17) and treatment rate of artificial liver (χ² = 3.16, P = 0.08). The difference was statistically significant compared with survival group. Serum TBil (t =-3.18, P < 0.001), WBC (t =-2.41, P = 0.01), RDW (Z =-2.40, P = 0.02) and MELD-Na score (t =-2.18, P = 0.02) of patients in death group were significantly higher than those of survival group, with significant differences. GGT (Z = 2.40, P = 0.02), TC (t = 2.03, P = 0.02), ApoA (Z = 3.27, P < 0.001), FIB (Z = 2.30, P = 0.02), AT-Ⅲ (t = 3.25, P < 0.001), PLT (t = 3.42, P < 0.001), Na (Z = 2.58, P = 0.01) levels were significantly lower than those of survival group, the differences were statistically significant. Multiple Logistic regression analysis indicated RDW (OR = 1.45, 95%CI: 1.04-2.12, P = 0.03) and PLT count (OR = 0.97, 95%CI: 0.95-0.99, P = 0.04) were all independent prognostic factors of patients with acute hepatitis E-induced liver failure at 12 weeks. Logistic regression analysis results obtained regression equation LogitP = 26.01-0.03 × PLT + 0.37 × RDW, according to a model including PLT and RDW which can be obtained and named PRM. Receiver operating characteristic (ROC) curves of PLT, RDW and PRW were plotted respectively, and the area under the curve (AUC) were calculated. The optimal Cut-off value of PLT for predicting 12-week prognosis of patients with acute hepatitis E-induced liver failure was 157.5, the sensitivity and specificity were 49% and 93%, respectively, and the AUC was 0.7303. The optimal Cut-off value of RDW for predicting prognosis was 16.75, the sensitivity and specificity were 53% and 92%, respectively, and the AUC was 0.6990. The optimal Cut-off value of PRM was 28.33, the sensitivity and specificity were 67% and 92%, respectively, and the AUC was 0.8369. The predictive value of PRM was significantly better than that of PLT (Z = 2.29, P = 0.02).

Conclusions

Blood RDW and blood PLT count are independent factors of 12-week prognosis in patients with acute hepatitis E-induced liver failure. PRM model consisting of PLT and RDW could be used as a simple and accurate prognostic indicator to evaluate the prognosis of acute hepatitis E-induced liver failure.

Key words: Hepatitis E, Liver failure, Platelet, Red blood cell distribution width

Zhaoming Li, Ying Zhang, Xianjin Liu. Predictive effects of platelet count and red blood cell distribution width on the prognosis of patients with acute hepatitis E-induced liver failure[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(05): 307-314.

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References 30

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指标	生存组（104例）	死亡组（24例）	统计量	P值
年龄（ ± s，岁）	60.06 ± 0.92	61.07 ± 4.52	t =－0.35	0.36
性别[例（%）]			χ² = 0.04	1.00^a
男	94（90.38）	22（91.67）
女	10（9.62）	2（8.33）
并发感染[例（%）]			χ² = 1.97	0.16^b
是	36（34.62）	12（50.00）
否	68（65.38）	12（50.00）
并发肝性脑病[例（%）]			χ² = 1.85	0.24^a
是	8（7.69）	4（16.67）
否	96（92.31）	20（83.33）
人工肝治疗[例（%）]			χ² = 3.16	0.08^b
是	40（38.46）	14（58.33）
否	64（61.54）	10（41.67）

指标	生存组（104例）	死亡组（24例）	统计量	P值
年龄（ ± s，岁）	60.06 ± 0.92	61.07 ± 4.52	t =－0.35	0.36
性别[例（%）]			χ² = 0.04	1.00^a
男	94（90.38）	22（91.67）
女	10（9.62）	2（8.33）
并发感染[例（%）]			χ² = 1.97	0.16^b
是	36（34.62）	12（50.00）
否	68（65.38）	12（50.00）
并发肝性脑病[例（%）]			χ² = 1.85	0.24^a
是	8（7.69）	4（16.67）
否	96（92.31）	20（83.33）
人工肝治疗[例（%）]			χ² = 3.16	0.08^b
是	40（38.46）	14（58.33）
否	64（61.54）	10（41.67）

指标	生存组（104例）	死亡组（24例）	统计量	P值
ALT [M（P25，P75），U/L]	848.00（537.00，1 675.00）	180（69.50，1 604.00）	Z = 1.86	0.06
AST [M（P25，P75），U/L]	565.00（184.00，1 349.00）	250（63.50，1 087.50）	Z = 1.58	0.11
ALB [M（P25，P75），g/L]	32.60（30.20，34.60）	30.50（30.15，35.00）	Z = 0.38	0.71
TBil [ ± s，µmol/L]	246.68 ± 7.89	326.99 ± 10.60	t =－3.18	< 0.001
ALP [ ± s，U/L]	193.41 ± 7.69	163.93 ± 13.32	t = 1.71	0.05
GGT [M（P25，P75），U/L]	175.00（106.00，302.00）	90.00（75.00，165.00）	Z = 2.40	0.02
LDH [M（P25，P75），U/L]	220.00（180.00，329.00）	295.00（212.00，478.50）	Z =－1.81	0.07
PA（ ± s，mg/L）	98.94 ± 7.65	87.73 ± 7.69	t = 0.68	0.25
CHE（ ± s，U/L）	4 311.45 ± 173.79	3 665.13 ± 575.28	t = 1.43	0.08
C3（ ± s，g/L）	0.67 ± 0.09	0.42 ± 0.03	t = 1.31	0.10
AFP [M（P25，P75），ng/ml]	7.10（4.06，40.20）	7.20（3.06，16.80）	Z = 0.82	0.41
CA199 [M（P25，P75），U/ml]	56.62（24.18，145.00）	45.20（8.60，70.16）	Z = 1.09	0.28
TC（ ± s，mmol/L）	3.36 ± 0.12	2.77 ± 0.28	t = 2.03	0.02
ApoA [M（P25，P75），g/L]	0.52（0.42，0.72）	0.33（0.18，0.50）	Z = 3.27	< 0.001
PCT [M（P25，P75），ng/ml]	0.52（0.33，0.82）	0.68（0.43，0.81）	Z =－1.04	0.30
CRP [M（P25，P75），mg/L]	9.11（5.63，17.30）	12.90（4.25，41.50）	Z =－1.03	0.30
NK [M（P25，P75），个/μl]	130.00（70.00，176.00）	108.00（75.50，140.00）	Z = 1.21	0.22
INR（ ± s）	1.87 ± 0.08	2.06 ± 0.13	t =－1.10	0.14
FIB [M（P25，P75），g/L]	2.12（1.86，2.72）	1.71（1.58，2.26）	Z = 2.30	0.02
AT-Ⅲ（ ± s，%）	64.56 ± 2.19	49.17 ± 2.63	t = 3.25	< 0.001
WBC（ ± s，× 10⁹/L）	6.55 ± 0.26	8.23 ± 0.92	t =－2.41	0.01
RBC [M（P25，P75），× 10¹²/L]	4.53（4.24，4.89）	4.48（3.56，4.80）	Z = 1.12	0.26
PLT（ ± s，× 10⁹/L）	162.00 ± 6.19	112.93 ± 13.10	t = 3.42	< 0.001
RDW [M（P25，P75），%]	14.20（13.40，14.70）	16.80（14.00，19.45）	Z =－2.40	0.02
HB（ ± s，g/L）	140.91 ± 1.82	136.40 ± 6.06	t = 0.95	0.17
MPV（ ± s，fL）	11.53 ± 0.14	11.28 ± 0.23	t = 0.81	0.21
Na [M（P25，P75），mmol/L]	137.10（135.70，138.50）	135.6（132.8，136.7）	Z = 2.58	0.01
Cr [M（P25，P75），μmol/L]	67.50（57.00，80.60）	67.40（60.50，77.85）	Z = 0.06	0.95
MELD评分（ ± s）	20.66 ± 0.54	23.00 ± 1.89	t =－1.63	0.05
MELD-Na评分（ ± s）	21.42 ± 0.58	25.25 ± 2.70	t =－2.18	0.02

指标	生存组（104例）	死亡组（24例）	统计量	P值
ALT [M（P25，P75），U/L]	848.00（537.00，1 675.00）	180（69.50，1 604.00）	Z = 1.86	0.06
AST [M（P25，P75），U/L]	565.00（184.00，1 349.00）	250（63.50，1 087.50）	Z = 1.58	0.11
ALB [M（P25，P75），g/L]	32.60（30.20，34.60）	30.50（30.15，35.00）	Z = 0.38	0.71
TBil [ ± s，µmol/L]	246.68 ± 7.89	326.99 ± 10.60	t =－3.18	< 0.001
ALP [ ± s，U/L]	193.41 ± 7.69	163.93 ± 13.32	t = 1.71	0.05
GGT [M（P25，P75），U/L]	175.00（106.00，302.00）	90.00（75.00，165.00）	Z = 2.40	0.02
LDH [M（P25，P75），U/L]	220.00（180.00，329.00）	295.00（212.00，478.50）	Z =－1.81	0.07
PA（ ± s，mg/L）	98.94 ± 7.65	87.73 ± 7.69	t = 0.68	0.25
CHE（ ± s，U/L）	4 311.45 ± 173.79	3 665.13 ± 575.28	t = 1.43	0.08
C3（ ± s，g/L）	0.67 ± 0.09	0.42 ± 0.03	t = 1.31	0.10
AFP [M（P25，P75），ng/ml]	7.10（4.06，40.20）	7.20（3.06，16.80）	Z = 0.82	0.41
CA199 [M（P25，P75），U/ml]	56.62（24.18，145.00）	45.20（8.60，70.16）	Z = 1.09	0.28
TC（ ± s，mmol/L）	3.36 ± 0.12	2.77 ± 0.28	t = 2.03	0.02
ApoA [M（P25，P75），g/L]	0.52（0.42，0.72）	0.33（0.18，0.50）	Z = 3.27	< 0.001
PCT [M（P25，P75），ng/ml]	0.52（0.33，0.82）	0.68（0.43，0.81）	Z =－1.04	0.30
CRP [M（P25，P75），mg/L]	9.11（5.63，17.30）	12.90（4.25，41.50）	Z =－1.03	0.30
NK [M（P25，P75），个/μl]	130.00（70.00，176.00）	108.00（75.50，140.00）	Z = 1.21	0.22
INR（ ± s）	1.87 ± 0.08	2.06 ± 0.13	t =－1.10	0.14
FIB [M（P25，P75），g/L]	2.12（1.86，2.72）	1.71（1.58，2.26）	Z = 2.30	0.02
AT-Ⅲ（ ± s，%）	64.56 ± 2.19	49.17 ± 2.63	t = 3.25	< 0.001
WBC（ ± s，× 10⁹/L）	6.55 ± 0.26	8.23 ± 0.92	t =－2.41	0.01
RBC [M（P25，P75），× 10¹²/L]	4.53（4.24，4.89）	4.48（3.56，4.80）	Z = 1.12	0.26
PLT（ ± s，× 10⁹/L）	162.00 ± 6.19	112.93 ± 13.10	t = 3.42	< 0.001
RDW [M（P25，P75），%]	14.20（13.40，14.70）	16.80（14.00，19.45）	Z =－2.40	0.02
HB（ ± s，g/L）	140.91 ± 1.82	136.40 ± 6.06	t = 0.95	0.17
MPV（ ± s，fL）	11.53 ± 0.14	11.28 ± 0.23	t = 0.81	0.21
Na [M（P25，P75），mmol/L]	137.10（135.70，138.50）	135.6（132.8，136.7）	Z = 2.58	0.01
Cr [M（P25，P75），μmol/L]	67.50（57.00，80.60）	67.40（60.50，77.85）	Z = 0.06	0.95
MELD评分（ ± s）	20.66 ± 0.54	23.00 ± 1.89	t =－1.63	0.05
MELD-Na评分（ ± s）	21.42 ± 0.58	25.25 ± 2.70	t =－2.18	0.02

指标	单因素				多因素
指标	OR值	Z值	95%CI	P值	OR值	β值	S.E.值	Wald χ²值	95%CI	P值
TBil（μmol/L）	1.01	2.60	1.00~1.01	0.01	1.00	－0.01	0.01	0.23	0.99~1.01	0.63
GGT（U/L）	1.00	－1.63	0.99~1.00	0.10	—	—	—	—	—	—
TC（mmol/L）	0.52	－1.95	0.27~1.00	0.05	—	—	—	—	—	—
ApoA（g/L）	0.01	－3.11	0.00~0.12	< 0.001	0.05	－3.00	2.21	1.85	0.00~3.76	0.17
FIB（g/L）	1.07	1.82	0.99~1.15	0.07	—	—	—	—	—	—
AT-Ⅲ（%）	0.94	－2.87	0.90~0.98	< 0.001	0.96	－0.04	0.03	2.08	0.90~1.02	0.15
WBC（× 10⁹/L）	1.27	2.21	1.03~1.58	0.03	1.39	0.33	0.20	2.78	0.94~2.06	0.10
PLT（× 10⁹/L）	0.98	－3.02	0.96~0.99	< 0.001	0.97	－0.03	0.01	4.11	0.95~0.99	0.04
RDW（%）	1.36	2.94	1.11~1.67	< 0.001	1.45	0.37	0.17	4.68	1.04~2.12	0.03
Na（mmol/L）	0.79	－2.38	0.65~0.96	0.02	0.82	－0.20	0.16	1.58	0.89~1.68	0.21
MELD-Na评分	1.08	1.83	0.99~1.18	0.07	—	—	—	—	—	—

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