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. 2025 Apr 29:13:e19379.
doi: 10.7717/peerj.19379. eCollection 2025.

Clinical significance of platelet-to-white blood cell ratio in patients with Wilson disease: a retrospective cohort study

Hao-Jie Zhong #  1   2 , Jun-Yi Chen #  2 , Wei-Ming Wu  1 , Xing-Xiang He  2 , Yong-Qiang Zhan  1
Affiliations

Clinical significance of platelet-to-white blood cell ratio in patients with Wilson disease: a retrospective cohort study

Hao-Jie Zhong et al. PeerJ. .

Abstract

Objective: To assess the correlation between the platelet-to-white blood cell ratio (PWR) and the severity of liver dysfunction, hepatic complications, and prognosis in Wilson disease (WD) patients.

Methods: A retrospective analysis was conducted on medical records from January 1, 2016, to March 30, 2022. Both univariate and multivariate analyses were performed to examine the impact of a low PWR (<26.3) on WD severity, liver complications, and disease progression. Additionally, the effect of splenectomy on PWR was evaluated.

Results: The study included 315 patients with WD, among whom 105 had a low PWR and 210 had a high PWR. Those with low PWR exhibited significantly elevated levels of bilirubin, international normalized ratio, prothrombin time, procollagen type-III N-terminal propeptide, type IV collagen, hyaluronic acid, and portal vein diameter. Conversely, they had lower levels of albumin, total cholesterol, low-density lipoprotein cholesterol, and triglycerides (all P < 0.05). A low PWR correlated with a greater incidence of splenomegaly/hypersplenism, esophagogastric varices, and ascites (all P < 0.05). Furthermore, low PWR independently predicted hepatic decompensation (P < 0.05), and splenectomy led to a marked increase in PWR among WD patients (P < 0.001).

Conclusion: A low PWR in WD patients is linked to heightened disease severity, increased risk of liver complications, and rapid progression to decompensation. The results imply that splenectomy, by enhancing PWR, may serve as a viable strategy to slow WD progression.

Keywords: Blood platelets; Hepatolenticular degeneration; Leukocytes; Liver cirrhosis; Splenectomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Receiver operating characteristic (ROC) curves of platelets, WBCs, or PWR for hepatic decompensation in patients with WD.
PWR, platelet-to-white blood cell ratio; WBC, white blood cell; WD, Wilson disease.
Figure 2
Figure 2. Impact of splenectomy on PWR in patients with WD.
(A) Comparison of PWR between WD patients with splenomegaly who underwent splenectomy (n = 32) and those who did not (n = 144). (B) Pre-and post-splenectomy PWR analysis in WD patients (n = 9) PWR, platelet-to-white blood cell ratio; WD, Wilson disease.
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