Correlation Analysis Of RLR With The Degree Of Esophageal Varices And Gastrointestinal Bleeding In Patients With HBV-related Cirrhosis

Objective:To investigate the diagnostic value of red cell distribution width（RDW）to lymphocyte ratio（RLR）for the degree of esophageal varices（EV）and gastrointestinal bleeding in patients with hepatitis B virus（HBV）-related cirrhosis.Method:A total of 148 patients with HBV-related cirrhosis and without previous history of endoscopic for treatment esophageal varices were enrolled from July 2017 to October 2020.The clinical and laboratory characteristics on admission,including RDW,platelet,lymphocyte,aspartate aminotransferase,sex,age,were recorded.All patients were divided into two groups according to EV grade assessed by gastroscope:non-EV and mild EV group and moderate EV and severe EV group.And all patients were divided into bleeding group and no bleeding group according to whether they were complicated with gastrointestinal bleeding.RLR,red cell distribution width to platelet ratio（RPR）,aspartate aminotransferase to platelet ratio（APRI）were calculated for all groups.Spearman correlation analysis and receiver operating characteristic（ROC）curve were carried out for the valuable indexes,and the area under the curve（AUC）were used to evaluate the performance of the above indexes in diagnostic the degree of EV and gastrointestinal bleeding.Results:RLR（24.04[17.89,37.76]）,RDW（15.50%[14.60%,18.10%]）,RPR（0.27[0.20,0.41]）in patients with moderate EV and severe EV were all significantly higher than thoes（9.44[7.46,12.21];14.20%[13.10%,15.35%];0.14[0.10,0.25]）with non-EV and mild EV group（all P<0.01）.However APRI had no statistical between these two groups（P=0.905）.RLR,RDW,RPR were higher in bleeding group,compared with no bleeding group.Positive associations of increased RLR,RDW,RPR and incidence of both esophageal varices,and gastrointestinal bleeding were found.No correlation of APRI with both esophageal varices and gastrointestinal bleeding were found.The AUC of RLR for diagnostic moderate EV and severe EV was 0.934,superior to RPR and RDW.The sensitivity and specificity of RLR for diagnostic moderate EV and severe EV were 0.826 and 0.970 respectively,superior to RPR（0.930,0.515）and RDW（0.974,0.424）.Similarly,the AUC of RLR for diagnostic complicating with gastrointestinal bleeding was 0.878,also superior to RPR and RDW.The sensitivity and specificity of RLR for diagnostic complicating with gastrointestinal bleeding were 0.820 and 0.780 respectively,superior to RPR and RDW.Conclusion:RLR is capable to diagnostic the degree of EV and the risk of complicated gastrointestinal bleeding in HBV-related cirrhosis patients.This routinely available index shall be considered as a new preliminarily diagnostic marker for EV and complicating gastrointestinal bleeding in HBV-related cirrhosis patients.