Invest Clin 64(2): 196 - 205, 2023 https://doi.org/10.54817/IC.v64n2a06

Corresponding author: Guozhong Zhao. Department of Hepatobiliary Surgery, General Hospital of Ningxia Medi-

cal University, Yinchuan, Ningxia Hui Autonomous Region, China. Email: teprtg208177@163.com

Risk factors for the prognosis of patients

with decompensated hepatitis B cirrhosis

and their predictive values.

Li Li1, Jihui Zhang2, Peng Yuan3, Jianjun Song3, Zhenhui Lu3 and Guozhong Zhao3

1Department of Infectious Diseases, The First People’s Hospital of Fuyang District,

Hangzhou, Zhejiang Province, China.

2Department of Hepatobiliary Surgery, Ningxia Medical University, Yinchuan, Ningxia

Hui Autonomous Region, China.

3Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University,

Yinchuan, Ningxia Hui Autonomous Region, China.

Keywords: decompensated hepatitis b cirrhosis; prognosis; risk factor; predictive value.

Abstract. We aimed to investigate the risk factors affecting the progno-

sis of patients with decompensated hepatitis B cirrhosis and their predictive

values. The clinical data of 149 patients with decompensated hepatitis B cir-

rhosis, 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, corre-

lations among risk factors, and predictive values of these factors for death were

analyzed. Survival analysis was conducted. During a one-year follow-up, 103 pa-

tients 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). Se-

rum 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 decompen-

sated hepatitis B cirrhosis.

196 Li et al.

Investigación Clínica 64(2): 2023

Factores de riesgo para el pronóstico de pacientes con cirrosis

por hepatitis B descompensada y sus valores predictivos.

Invest Clin 2023; 64 (2): 196 – 205

Palabras clave: cirrosis por hepatitis b descompensada; pronóstico; factor de riesgo;

valor predictivo.

Resumen. Nuestro objetivo fue investigar los factores de riesgo que afectan

el pronóstico de los pacientes con cirrosis por hepatitis B descompensada y sus

valores predictivos. Se analizaron retrospectivamente los datos clínicos de 149

pacientes con cirrosis por hepatitis B descompensada tratados desde agosto de

2015 hasta junio de 2019. Estos pacientes se dividieron en grupos de muerte y

supervivencia, durante un año de seguimiento. Se compararon sus datos basales

de referencia y se analizaron los factores de riesgo que afectan la muerte, las

correlaciones entre los factores de riesgo y los valores predictivos de muerte de

estos factores. El análisis de supervivencia durante un año de seguimiento, de-

mostró que sobrevivieron 103 pacientes y fallecieron 46. La alta proporción de

neutrófilos-linfocitos (NLR), el ancho de distribución de glóbulos rojos (RDW), el

modelo para la puntuación de enfermedad hepática en etapa terminal (MELD),

la puntuación de Child-Turcotte-Pugh (CTP) y el bajo nivel de sodio sérico fueron

factores de riesgo independientes para la muerte en pacientes con cirrosis por

hepatitis B descompensada. NLR tuvo correlaciones positivas con la puntuación

CTP y la puntuación MELD (r = 0,346, p = 0,0001, r = 0,243, p = 0,0003,

respectivamente). RDW tuvo correlaciones positivas con la puntuación CTP y la

puntuación MELD (r = 0,417, p = 0,0001, r = 0,413, p = 0,0003, respectiva-

mente). El sodio sérico se correlacionó negativamente con las puntuaciones CTP

y MELD (r=-0,484, p=0,0001, r=-0,476, p=0,0001, respectivamente). La tasa

de supervivencia fue alta en pacientes con NLR <7,38, RDW <16,15%, sodio

sérico> 146,31 mmol/L, puntuación CTP <10,26 puntos y puntuación MELD

<11,31 puntos (p = 0,0001). NLR, RDW, sodio sérico, puntaje MELD y puntaje

CTP tuvieron altos valores predictivos de muerte. NLR, RDW, sodio sérico, punta-

je CTP y puntaje MELD pueden considerarse índices importantes para evaluar y

predecir el pronóstico de pacientes con cirrosis por hepatitis B descompensada.

Received: 08-07-2022 Accepted: 17-12-2022

INTRODUCTION

Liver cirrhosis is a chronic progressive

liver disease that involves histopathological

changes such as hepatocyte necrosis, re-

generative nodules, diffuse liver fibrosis and

formation of pseudolobules due to multiple

causes 1. Hepatitis B is one of the common

causes of liver cirrhosis 2. The decompen-

sated stage is the end stage of liver cirrho-

sis, manifested as portal hypertension and

liver damage in clinical practice 3. Addition-

ally, abdominal organ injury can induce vari-

ous complications such as ascites, hemor-

rhages due to varicose vein rupture, hepatic

encephalopathy and secondary infections,

which seriously affect the prognosis of pa-

tients and cause a high mortality rate. The

Prognostic evaluation of decompensated hepatitis B cirrhosis 197

Vol. 64(2): 196 - 205, 2023

five-year mortality rate of patients with de-

compensated cirrhosis who have not under-

gone liver transplantation is up to 85%, of

which the one-year mortality rate of those

complicated with gastrointestinal bleeding

and ascites as well as renal failure and in-

fection is 57%, 20% and 67%, respectively 4.

Hence, it is of great significance to under-

stand comprehensively the causes of death

and risk factors in patients with decompen-

sated hepatitis B cirrhosis5.

In this study, the risk factors affecting

the prognosis of patients with decompensat-

ed hepatitis B cirrhosis and the predictive

value of these factors for the prognosis were

analyzed, aiming to provide reliable bases

for early clinical identification, disease judg-

ment and prognostic evaluation.

MATERIALS AND METHODS

Subjects

The clinical data of 149 patients with

decompensated hepatitis B cirrhosis treated

in our hospital from August 2015 to June

2019 were collected and retrospectively ana-

lyzed. According to the Diagnostic Criteria

for Chronic Hepatitis B in 2015 6, the diag-

nostic criteria included: a) clear evidence

for etiology of hepatitis B virus (HBV) infec-

tion, and no other common causes of liver

cirrhosis, b) confirmed evidence of liver cir-

rhosis through histology, clinical manifes-

tations, and imaging: morphology showing

liver fibrosis, regenerative nodules and pseu-

dolobules, clinical manifestations exhibit-

ing portal hypertension, liver insufficiency,

and B-ultrasound, computed tomography,

magnetic resonance, and radionuclide im-

aging indicating signs of liver cirrhosis;

and c) complications such as hepatic en-

cephalopathy, hemorrhages caused by rup-

ture of esophageal and gastric varices, and

ascites. The inclusion criteria were set as

follows: a) patients who met the above diag-

nostic criteria, b) those with no recent ac-

tive infection, c) those with complete clini-

cal data, and d) those who and whose family

members signed the informed consent and

could cooperate to complete the follow-up.

The exclusion criteria involved: a) patients

with acute liver failure, b) those who were

complicated with severe heart, lung, or kid-

ney diseases, c) those who were complicated

with primary liver cancer or other malignant

tumors, d) those who were complicated with

history of brain diseases, metabolic enceph-

alopathy or toxic encephalopathy, e) those

who received glucocorticoid or immunosup-

pressive therapy, or f) cases undergoing liver

transplantation. This study was approved by

the Medical Ethics Committee of our hos-

pital. The number of samples included in

factor analysis is about 5-10 times that of

variable factors. There were 20 variable fac-

tors in this study, so the number of included

samples should have been >100. Finally, 149

cases were included (Fig. 1).

Data collection and scoring

The medical records were reviewed to

collect the gender, age and physical examina-

tion results of every patient. After admission,

the patient’s first laboratory examination data

were recorded, including routine blood tests,

coagulation function, liver function, and

kidney function. Child-Turcotte-Pugh (CTP)

score 7: ascites, hepatic encephalopathy, se-

rum total bilirubin (TBil), albumin (Alb), and

prothrombin time (PT) were scored accord-

ing to the severity of the disease, namely 1,

2 and 3 points, respectively. The score of 5

items was added, and 5-6 points were Grade

A, indicating liver function compensation;

7-9 points were Grade B, indicating liver func-

tion decompensation; and 10-15 points were

Grade C, indicating severe decompensation

of liver function. The Model for end-stage liv-

er disease (MELD) was utilized to assess the

patients’ liver function 8. The MELD score was

calculated with the formula: 3.8 × ln [biliru-

bin (mg/dL)] + 11.2 × ln [prothrombin in-

ternational normalized ratio (INR)] + 9.6 ×

ln [creatinine (mg/dL)] + 6.4.

198 Li et al.

Investigación Clínica 64(2): 2023

Follow-up and grouping

The date of patients admitted to the

hospital with a confirmed diagnosis of de-

compensated hepatitis B cirrhosis for the

first time was regarded as the start of follow-

up. The last follow-up or death was set as the

end event. The follow-up period was not less

than one year. During the one-year follow-up

period, the dead patients were selected as

the death group, while the surviving patients

were enrolled as the survival group.

Statistical analysis

The SPSS 16.0 software was used for sta-

tistical analysis. The measurement data con-

forming to normal distribution were expressed

as means ± standard deviations, and the in-

dependent t-test was used for comparison be-

tween groups. If the data did not conform to

the normal distribution, they were expressed as

medians (lower quartiles and higher quartiles)

[M (P25, P75)], and the rank sum test was

used for comparison between the groups. The

numerical data were expressed as percentages

(%), and the χ2 test was used for comparison be-

tween groups. The Multivariate COX regression

analysis was utilized to explore the risk factors

for the death of patients with decompensat-

ed hepatitis B cirrhosis, and the correlations

among indices were analyzed by the Spearman

correlation test. The Long-rank χ2 test was

used to analyze the death of patients, and the

Kaplan-Meier method was adopted to draw the

survival curve. The positive and negative pre-

dictive values of these factors for the death of

patients were analyzed by the receiver operat-

ing characteristic (ROC) curve, and the area

under the curve (AUC) was calculated. The in-

spection level was α=0.05. p<0.05 indicated

that the difference was statistically significant.

RESULTS

Among the 149 patients with decom-

pensated hepatitis B cirrhosis, there were

86 males and 63 females, aged 46-70 years

old, with an average of 56.42 ± 6.45. During

the one-year follow-up, 103 patients survived

(69.13%), and 46 died (30.87%).

No statistically significant differences

were found in gender, aspartate amino-

transferase (AST), alanine aminotrans-

ferase (ALT), alkaline phosphatase (ALP)

and platelet (PLT) between the two groups

(p>0.05). The age, total bilirubin (TBil),

white blood cell count (WBC), neutrophils

(N), neutrophil-lymphocyte ratio (NLR), red

cell distribution width (RDW), serum creati-

nine (Scr), PT, INR, CTP score, and MELD

score were higher. Body mass index (BMI),

Alb, lymphocyte (L), and serum sodium were

lower in the death group than those in the

survival group, suggesting statistically sig-

nificant differences (p<0.05) (Table 1).

Among the variables with statistically

significant differences between the survival

and death groups, TBil, Alb, PT, INR, Scr,

N, and L displayed multiple linear relation-

ships with the CTP, MELD, and NLR scores,

so they were excluded from the multivariate

COX regression analysis. Finally, the mul-

tivariate COX regression analysis included

age, BMI, WBC, NLR, RDW, serum sodium,

MELD, and CTP scores. The results exhib-

ited that high NLR, RDW, MELD score and

CTP score, and low serum sodium were in-

dependent risk factors for death in patients

with decompensated hepatitis B cirrhosis

(Table 2).

Fig. 1. Study enrollment flowchart.

Prognostic evaluation of decompensated hepatitis B cirrhosis 199

Vol. 64(2): 196 - 205, 2023

Table 1

Baseline data of survival and death groups.

Index Survival group (n=103) Death group (n=46) χ2/Z/t p

Gender (male/female, case) 69/34 28/18 0.524 0.469

Age (year, x

±SD) 54.06 ± 5.40 61.72± 5.41 7.995 0.0001

BMI (kg/m2, x

±SD) 22.03±1.09 19.44±1.00 13.736 0.0001

AST (U/L, x

±SD) 47.86±5.42 49.23±5.51 1.418 0.158

ALT (U/L, x

±SD) 52.45±7.39 53.82±7.44 1.043 0.299

ALP (U/L, x

±SD) 146.72±15.83 147.61±16.09 0.315 0.753

TBil (μmol/L, [M(P25,P75)]) 28.95(21.36~42.07) 64.52(25.48~113.65) 26.596 0.0001

Alb (g/L, x

±SD) 32.75±4.61 25.13±3.48 10.003 0.0001

WBC (109/L, x

±SD) 6.34±0.75 7.49±0.94 7.978 0.0001

N (109/L, [M(P25,P75)]) 6.27(3.65~8.49) 8.13(5.08~10.97) 7.328 0.0001

L (109/L, x

±SD) 1.48(0.72~2.13) 0.75(0.49~1.06) 5.267 0.0001

NLR (x

±SD) 5.78(1.71~11.79) 11.38(4.79~14.63) 13.586 0.0001

RDW (%, [M(P25,P75)]) 15.68(14.05~17.26) 17.29(14.97~19.38) 6.419 0.0001

PLT (109/L, x

±SD) 76.85±23.19 75.37±22.68 0.362 0.718

Scr (mg/L, x

±SD) 0.76±0.25 1.64±0.82 9.941 0.0001

Serum sodium (mmol/L, x

±SD) 139.29±7.79 126.27±7.35 9.587 0.0001

PT (s, [M(P25,P75)]) 15.14(12.96~17.03) 18.73(15.42~20.91) 8.693 0.0001

INR (x

±SD) 1.41±0.35 1.98±0.62 7.140 0.0001

CTP score (point, x

±SD) 9.53±0.85 12.54±0.97 19.104 0.0001

MELD score (point, x

 ±SD) 9.34±2.51 17.54±3.31 16.636 0.0001

Body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase

(ALP), serum total bilirubin (TBil), albumin (Alb), white blood cell count (WBC), neutrophils (N), lymphocyte

(L), neutrophil-lymphocyte ratio (NLR), red cell distribution width (RDW), platelet (PLT), serum creatinine (Scr),

prothrombin time (PT) international standard ratio (INR).

Table 2

Risk factors for death in patients with decompensated hepatitis B cirrhosis.

Factor βSE Wald p OR 95%CI

Age 0.975 0.826 1.257 0.482 0.893 0.568~1.347

BMI -0.824 0.672 1.438 0.519 1.275 0.641~1.852

WBC 1.356 1.198 2.065 0.237 1.684 0.753~2.469

NLR 2.249 1.863 3.521 0.0001 3.536 2.384~4.728

RDW 0.832 0.754 1.849 0.021 2.048 1.276~3.514

Serum sodium -0.765 0.627 1.232 0.035 1.952 1.597~3.863

CTP score 2.493 2.182 4.574 0.009 4.376 3.458~5.692

MELD score 2.608 2.379 4.683 0.004 4.715 3.629~5.847

The independent variables were assigned values with the median as the cut-off point: age: >57 years old=1, <57

years old=0, BMI: >21.2 kg/m2=1, <21.2 kg/m2=0, WBC: >6.65×109/L=1, <6.65×109/L=0, NLR: >7.38=1,

<7.38=0, RDW: >16.15%=1, <16.15%=0, serum sodium: >135.39 mmol/L=1, <135.39 mmol/L=0, CTP score:

>10.26 points=1, <10.26 points=0, MELD score: >11.31 points=1, <11.31 points=0.

200 Li et al.

Investigación Clínica 64(2): 2023

NLR had positive correlations with the CTP

score and MELD score (r=0.346, p=0.0001,

r=0.243, p=0.0003). RDW had positive rela-

tions to CTP score and MELD score (r=0.417,

p=0.0001, r=0.413, p=0.0003). Serum sodi-

um was negatively associated with CTP score

and MELD score (r=-0.484, p=0.0001, r=-

0.476, p=0.0001) (Fig. 2).

According to the independent risk

factors obtained in the multivariate COX

regression analysis, the indices were cat-

egorized into more than the median group

and less than the median group. The sur-

vival rate was 89.47% in NLR<7.38 group

and 47.95% in NLR>7.38 group, suggest-

ing a statistically significant difference

(χ2=30.090, p=0.0001). It was 82.89% in

the RDW<16.15% group and 54.79% in the

RDW>16.15% group, suggesting a statis-

tically significant difference (χ2=13.777,

p=0.0001). It was 94.59% in the serum so-

dium>146.31 mmol/L group and 44.00% in

the serum sodium<146.31 mmol/L group,

suggesting a statistically significant differ-

ence (χ2=44.678, p=0.0001). Besides, the

survival rate was 86.67% in the CTP score

<10.26 points group and 51.35% in the CTP

score >10.26 points group, suggesting a sta-

tistically significant difference (χ2=21.768,

p=0.0001). It was 90.67% in the MELD

score<11.31 points group and 47.30% in

the MELD score>11.31 points group, sug-

gesting a statistically significant difference

(χ2=32.829, p=0.0001) (Fig. 3).

In predicting the death of patients with

decompensated hepatitis B cirrhosis, the

area under the NLR curve was 0.836, the 95%

confidence interval (CI) was 0.770-0.903, the

optimal cut-off value was 7.49, the sensitivity

was 81.1%, the specificity was 86.7%, and the

Fig. 2. Correlations of NLR, RDW, and serum sodium with CTP score and MELD score.

Prognostic evaluation of decompensated hepatitis B cirrhosis 201

Vol. 64(2): 196 - 205, 2023

Youden’s index was 0.678. The area under the

RDW curve was 0.752, the 95% CI was 0.670-

0.834, the optimal cut-off value was 16.22%,

the sensitivity was 78.4%, the specificity was

78.7%, and the Youden’s index was 0.571.

The area under the serum sodium curve was

0.774, 95% CI was 0.695-0.853, the optimal

cut-off value was 120.95 mmol/L, the sensi-

tivity was 75.7%, the specificity was 85.3%,

and the Youden index was 0.610. Besides, the

area under the CTP score curve was 0.883,

95% CI was 0.823-0.942, the optimal cut-off

value was 10.34 points, the sensitivity was

86.5%, the specificity was 90.7%, and the

Youden’s index was 0.772. The area under the

MELD score curve was 0.894, the 95% CI was

0.839-0.948, the optimal cut-off value was

11.35 points, the sensitivity was 87.8%, the

specificity was 88.0%, and the Youden’s index

was 0.758 (Fig. 4 and Table 3).

DISCUSSION

Patients with decompensated cirrhosis

are prone to malnutrition, with an inci-

dence rate of up to 60-100% in the advanced

stage 9. Verma et al. reported that the nutri-

tional indices, BMI and Alb, significantly de-

clined in the patients with poor prognosis,

so both of them can be used to predict the

prognosis of patients with decompensated

cirrhosis 10. Likewise, we herein found that

the BMI and Alb of the death group were

significantly lower than those of the survival

group. Probably, lipids and proteins are ab-

normally synthesized due to liver damage,

which induces malnutrition, especially in

patients with decompensated cirrhosis. As

a result, the synthesis and decomposition

of apolipoproteins and blood lipids are af-

fected 11.

WBC count is usually employed to

evaluate the inflammatory response. Gener-

ally, the count increases when the inflamma-

tory response is enhanced 12. Consistently,

this study exhibited that the count of WBC

was significantly higher in the death group.

Zhang et al. reported that NLR had a high pre-

dictive value for the occurrence of hepatitis

B-related liver failure 13. Additionally, Kalra

et al. reported that NLR was an independent

predictor for the 30-day death of patients

with decompensated hepatitis B cirrhosis 14.

The above conclusions are consistent with

the results of this study. During the progres-

sion of chronic liver disease into the end

Fig. 3. Independent risk factors for survival of patients with decompensated hepatitis B cirrhosis.

202 Li et al.

Investigación Clínica 64(2): 2023

stage, the excessive immune response stimu-

lates the activation of T and B-lymphocytes

to release a large number of inflammatory

mediators to induce inflammation, oxidative

stress, and chemotaxis. As a result, neutro-

phils stored in the liver sinusoids are largely

released into the blood, then increasing the

neutrophil count in the peripheral blood 15.

In addition, the long-term malnutrition of

patients with chronic liver disease not only

hinders lymphocyte synthesis but also pro-

motes lymphocyte apoptosis, thus reducing

the lymphocyte count and ultimately in-

creasing NLR 16.

Zhang et al. reported that RDW was posi-

tively associated with decompensated hepati-

tis B cirrhosis and gastrointestinal bleeding

as an independent factor 17. Besides, Ferdous

et al. reported that RDW was significantly

increased in patients with hepatitis B and

Table 3

Parameters of predictive efficiency.

Parameter NLR RDW Serum sodium CTP score MELD score

Sensitivity 81.1% 78.4% 75.7% 86.5% 87.8%

Specificity 86.7% 78.7% 85.3% 90.7% 88.0%

Positive predictive value 0.801 0.725 0.773 0.826 0.891

Negative predictive value 0.592 0.556 0.557 0.613 0.650

Youden’s index 0.678 0.571 0.610 0.772 0.758

AUC 0.836 0.752 0.774 0.883 0.894

95%CI 0.770~0.903 0.670~0.834 0.695~0.853 0.823~0.942 0.839~0.948

Optimal cut-off value 7.49 16.22% 120.95 mmol/L 10.34 points 11.35 points

Fig. 4. Predictive values of independent risk factors for death of patients with decompensated hepatitis B

cirrhosis.

Prognostic evaluation of decompensated hepatitis B cirrhosis 203

Vol. 64(2): 196 - 205, 2023

positively related to the disease severity 18.

Moreover, Wang et al. reported that RDW was

closely correlated with the mortality rate of

patients with hepatitis C cirrhosis 19, which

is consistent with the results of this study.

RDW increases due to nutrient (such as fo-

lic acid, vitamin B12, and iron) deficiencies,

aggravated erythrocyte destruction, inflam-

mation, and bone marrow suppression. These

conditions usually exist in patients with

chronic liver disease, especially in those with

decompensated hepatitis B cirrhosis 20. The

incidence rate of complications increases

in patients with decompensated hepatitis B

cirrhosis complicated by hyponatremia. De-

creased serum sodium levels shorten the av-

erage survival time, and the mortality rate

is elevated 21. The decreased level of serum

sodium is an independent risk factor leading

to poor prognosis of patients with decom-

pensated hepatitis B cirrhosis 22. This study

further confirmed the above results. On the

one hand, the damaged liver attenuates the

inactivation of antidiuretic hormone, which

facilitates the reabsorption of water by renal

tubules, leading to water retention. On the

other hand, the energy-rich phosphate link-

age is reduced due to liver function decline.

The sodium pump activity decreases, thereby

inhibiting the activity of Na+-K+-ATPase, and

resulting in the difficulties of K+ entering

cells and Na+ releasing from cells. Additional-

ly, plasma colloid osmotic pressure is reduced

by hypoproteinemia, which causes fluid ex-

travasation and dilutional hyponatremia 23.

CTP and MELD scores are commonly

utilized to evaluate the liver reserve func-

tion, disease severity, and prognosis of pa-

tients with cirrhosis in clinical practice.

Fernández Carrillo et al. found that the CTP

and MELD scores of patients with decom-

pensated cirrhosis were significantly higher

in the death group than those in the survival

group and could be considered as indepen-

dent risk factors for death and predictors

for prognosis 24. Similar to our study, Qiang

et al. reported that CTP and MELD scores

were positively related to NLR and RDW

and negatively associated with serum so-

dium 25. Notably, there are also differences

between the results of this study and those

mentioned above, which may be ascribed to

the differences between individuals, detec-

tion reagents, determination criteria, and

sample size.

Regardless, this study has some limi-

tations. This is a retrospective single-cen-

ter study with a small sample size, and the

indicator levels of patients with different

complications were not analyzed. Further

prospective multicenter studies with larg-

er sample sizes are ongoing in our group.

More detailed data can be obtained through

grouping based on different complications

of patients to provide reliable guidance for

clinical practice.

In conclusion, NLR, RDW, serum so-

dium, CTP score, and MELD score can be

considered as critical indices to evaluate

and predict the prognosis of patients with

decompensated hepatitis B cirrhosis.

Funding

This study was not financially supported.

Conflict of interest

The authors declare no conflicts of in-

terest.

Author’s ORCID numbers

• Li Li: 0000-0002-8278-638X

• Jihui Zhang: 0000-0001-9251-7047

• Peng Yuan: 0000-0002-4305-6499

• Jianjun Song: 0000-0003-0401-3936

• Zhenhui Lu: 0000-0002-8983-7901

• Guozhong Zhao: 0000-0001-6218-0973

The authors’ contributions

are listed below

LL: Study design and drafting of this

manuscript. JZ: Study design and perfor-

mance. PY: Study performance and data

collection. JS: Study performance and data

204 Li et al.

Investigación Clínica 64(2): 2023

analysis. ZL: Study design and significant re-

vision of this manuscript. GZ: Study design

and significant revision of this manuscript.

All coauthors have approved the submission

and publication of this manuscript.

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