Assessment of patients with platelet to white blood cell ratio associated with long term adverse outcomes in patients with acute deterioration of chronic liver disease presenting in Tertiary Care Hospital of Karachi, Pakistan.

Objective: To determine the low and high values of platelet to white blood cell ratio (PWR) in patients experiencing acute deterioration of chronic liver disease (CLD) at a tertiary care hospital and assess their association with predicting long-term (28-day) adverse outcomes such as death. Stud Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: April 2024 to December 2024. Methods: A total of 195 patients of both genders with age between 40 to 65 years, and admitted with acute deterioration of CLD were analyzed. Calculation of PWR was done within 24-h of admission according to clinical variables. Platelets counts were divided by WBCs findings to calculate the PWR. The 28-days adverse outcome (mortality) was evaluated for association with PWR level. Cox proportional hazard regression analysis was done to see association of PWR level with adverse outcome. P≤0.05 was considered as significant. Results: Among 195 patients, 115 (59.0%) were male. Significant associations of PWR with gender (p<0.000), hepatic encephalopathy (p<0.000), GI bleeding (p=0.010), bacterial infection (p<0.000), and survival status (p=0.019) were found. A higher probability of low PWR was observed in individuals with bacterial infections compared to those without (aOR=3.546, p=0.001). Conclusion: Association of 28-day outcome (death) was observed with low ratio of PWR among patients who are suffering with cirrhosis and acute decompensation.