Abstract
Background: Mean corpuscular volume (MCV) is major used as an indicator for the differential diagnosis of anemia. Macrocytic anemia in decompensated cirrhosis is common. However, the relationship between macrocytic anemia and decompensated hepatitis B virus (HBV) associated cirrhosis has not been fully addressed. Methods: In this cross-sectional study, a total of 457 patients diagnosed decompensated HBV associated cirrhosis who met all inclusion criteria from 2011 to 2018 were analyzed. Association between macrocytic anemia and the liver damaged (Model for End Stage Liver Disease (MELD) score) were examined using multiple logistic regression analyses and identified using smooth curve fitting. Results: Compared with normocytic anemia, MCV and MELD are significantly positively correlated in macrocytic anemia (p < 0.001). A non-linear relationship of MCV and MELD association was found though the piecewise linear spline models in patients with decompensated HBV associated cirrhosis. MCV positive correlated with MELD when the MCV was greater than 98.2 fl (regression coefficient = 0.008, 95% CI 0.1, 0.4). Conclusion: Macrocytic anemia may be a reliable predictor for mortality because it is closely related to the degree of liver damage in patients with decompensated HBV associated cirrhosis.
Highlights
Liver cirrhosis is a frequent end stage of liver disease, which itself results from a long-term process of fibrosis and sustained inflammation and leads to chronic liver disease (Schuppan and Afdhal, 2008)
We found significantly higher expression levels of serum bilirubin, international normalized ratio (INR) and model for End Stage Liver Disease (MELD) score in macrocytic anemia when compared to normocytic or microcytic anemia
No significant differences were found in age, gender, smoking, drinking, diabetes, hypertension, systolic blood pressure, diastolic blood pressure, creatinine, Estimated GFR (eGFR), albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltranspeptidase (γ-GT)
Summary
Liver cirrhosis is a frequent end stage of liver disease, which itself results from a long-term process of fibrosis and sustained inflammation and leads to chronic liver disease (Schuppan and Afdhal, 2008). Hepatitis B virus (HBV) infection remains a very common liver disease (Nguyen et al, 2020), over 70% of infected cases are diagnosed as liver cirrhosis in China (Xiao et al, 2019). The exact mechanisms behind the relationship between MCV and liver function damage degree in patients with decompensated hepatitis B virus-related cirrhosis is still unknown. It had been considered to be an important predictor of survival for end-stage liver disease caused by many etiologies and was considered an organ allocation strategy for liver transplantation more accurate than Child-Pugh score since its application in the United States in 2002 (Wiesner et al, 2003; Bambha et al, 2004). The relationship between macrocytic anemia and decompensated hepatitis B virus (HBV) associated cirrhosis has not been fully addressed
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