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Received Nov 28, 2017; Revised Mar 13, 2018; Accepted Apr 2, 2018
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1. Introduction
Acute-on-chronic liver failure (ACLF) is a critical clinical syndrome involving acute hepatic insult manifesting as jaundice and coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease [1, 2]. Approximately 350 million persons are chronically infected with hepatitis B (HBV) in the world. Chronic HBV infection is the major cause of ACLF in China. ACLF has a high short-term mortality which exerts a heavy economic toll on patients and society [3, 4]. The model of end-stage liver disease (MELD) score is developed to classify patients with cirrhosis awaiting transplantation according to the severity of their liver disease and is based on variables related to both liver and renal function. Increasing MELD score was reported to be associated with increasing severity of hepatic dysfunction and increased three-month mortality risk in patients. However, the widely used MELD score could not take into account the inflammation.
Platelet to white blood cell ratio (PLT/WBC) refers to a hematologic marker of the systemic inflammatory response. Recently, PWR has been validated not only to forecast risk of infectious complications in patients undergoing radical nephrectomy for renal malignancy, but also to predict outcomes in ischemic stroke patients with intravenous thrombolysis [5, 6]. In addition, PWR is a reliable infectious indicator that even could differentiate between infection and the normal response after splenectomy for trauma [7]. Patients with ACLF had a significantly higher white cell count and low platelet count. However, whether PWR, a combination of platelet and white blood cell, might prognosticate survival of HBV-related ACLF is not explored. We also investigated the association between the severity of liver and PWR in ACLF patients.
2. Materials and Methods
2.1. Subjects
We retrospectively reviewed the demographic and baseline characteristics of patients with ACLF who were admitted to Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University in China, between February 1, 2013, and June 1, 2015. Several patients with ACLF have been reported [8]. The inclusion criteria...