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ORIGINAL RESEARCH article

Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1493439
This article is part of the Research Topic World Hepatitis Day 2024: Advancing Hepatitis Elimination, Public Health Strategies and Innovations View all 5 articles

The neutrophil-lymphocyte ratio as a risk factor for all-cause mortality among individuals with resolved HBV infection: evidence from the NHANES 1999-2018

Provisionally accepted
Chen Qiu Chen Qiu 1Chaojie Yu Chaojie Yu 1Lanlan Yang Lanlan Yang 1Siqi Liu Siqi Liu 1Qian Zhang Qian Zhang 1Shengnan Jia Shengnan Jia 1Wenrui Wang Wenrui Wang 1Zhenjing Jin Zhenjing Jin 1*Dongdong Yu Dongdong Yu 2
  • 1 Department of Hepatopancreatobiliary Medicine, Second Affiliated Hospital of Jilin University, Changchun, China
  • 2 Second Clinical College of Guangzhou University of Chinese Medicin, Guangzhou, China

The final, formatted version of the article will be published soon.

    Background:Inflammation is a critical component in the process of resolved hepatitis B virus (HBV) infection. The neutrophil-to-lymphocyte ratio (NLR) serves as a sensitive indicator of systemic inflammation and immune activation. Our study aimed to investigate the correlation between elevated NLR levels and the risk of all-cause mortality in patients with resolved HBV infection. Additionally, we evaluated the potential mediating effect of diabetes mellitus (DM) on this correlation.:Our study enrolled 1146 adult patients with resolved HBV infection from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. We utilized the Restricted Cubic Splines (RCS) and Maximum Selection Rank Statistical Method (MSRSM) to analyze the relationship between the NLR and the risk of all-cause mortality. The impact of NLR was evaluated using a weighted multivariate Cox regression model, and the model's predictive accuracy was assessed using time-dependent Receiver Operating Characteristic (ROC) curves. An intermediary analysis was conducted to explore the potential influence of DM on the observed relationship.Results:During follow-up period of 103.54±4.90 months, we recorded 207 deaths among the study participants. The analysis using the RCS method revealed a significant positive correlation between the NLR and the risk of all-cause mortality.Those with elevated NLR levels faced a substantially higher mortality risk compared to those with lower levels, as indicated by a Hazard Ratio (HR) of 1.84, with a 95% Confidence Interval (CI) of 1.17 to 2.89 (p < 0.05). The predictive accuracy of the model was substantial, as evidenced by the Area Under the Curve (AUC) for ROC curves at 3, 5, and 10 years, which were 0.873, 0.870, and 0.862, respectively. Furthermore, mediation analysis indicated that DM significantly influenced the relationship between the NLR and mortality, with a mediation effect of 6.57% (95% Confidence Interval [CI]: 0.64% to 15%; p=0.02).Conclusion:Elevated NLR is significantly associated with an increased risk of all-cause mortality in patients with resolved HBV infection. Concurrently,DM acts as a partial mediator of this association.

    Keywords: Neutrophil-lymphocyte ratio, resolved HBV infection, All-cause mortality, diabetes, NHANES, HBV

    Received: 09 Sep 2024; Accepted: 23 Dec 2024.

    Copyright: © 2024 Qiu, Yu, Yang, Liu, Zhang, Jia, Wang, Jin and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Zhenjing Jin, Department of Hepatopancreatobiliary Medicine, Second Affiliated Hospital of Jilin University, Changchun, China

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