Abstract
BACKGROUND: Primary biliary cholangitis (PBC) patients in the decompensated stage face poor prognoses, with recompensation being crucial for improving long-term outcomes. AIM: This study aims to evaluate the predictive value of the lymphocyte-to-monocyte ratio (LMR) for recompensation in decompensated PBC patients. METHODS: We retrospectively analysed 410 patients with PBC-related decompensated cirrhosis receiving ursodeoxycholic acid (UDCA) treatment. The association between the LMR and recompensation was examined using Cox regression analysis, with additional trend analysis performed based on LMR quartiles. The predictive accuracy of the LMR, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) was evaluated using receiver operating characteristic (ROC) curve analysis. Sensitivity analyses were conducted to confirm the robustness of the findings. RESULTS: During follow-up, among 401 patients with decompensated cirrhosis (age: 60.0 [IQR: 53.0-69.0] years; 88.3% female), 105 patients (26.18%) achieved recompensation. Multivariate Cox regression analysis showed that higher LMR was an independent promoting factor for recompensation after adjusting for all confounding factors in the model (HR = 1.415, 95% CI: 1.264-1.585, p < 0.001), with a linear positive correlation trend. ROC curve analysis demonstrated that LMR had superior predictive performance compared to other inflammatory markers (SII, PLR, NLR), with an area under the curve (AUC) of 0.787 (95% CI: 0.736-0.838, p < 0.001). CONCLUSION: LMR serves as a robust independent predictor for recompensation in decompensated PBC patients.