ArticlePloS one2026
Prognostic value of the white blood cell-to-hemoglobin ratio (WBC/Hb) for inhospital mortality: Insights from a retrospective cohort study in Uganda.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe white blood cell-to-hemoglobin ratio(WBC/Hb), composite marker derived from routine laboratory parameters, may offer unique prognostic value by integrating systemic inflammation and physiological reserve. This study investigates its association with inhospital mortality(IHM) in a resource-limited medical setting.
methodsWe retrospectively enrolled patients admitted to medical ward of Naguru regional referral Hospital-Uganda, between January and June 2024. Data on demographics, clinical status, and lab results, including WBC-count and hemoglobin, were extracted on admission. The primary outcome was IHM. Patients were categorized into three WBC/Hb subgroups. Hazard ratios(HR) and Area Under the Curve(AUC) assessed its prognostic value, adjusting fully for age, sex, comorbidities, and admission diagnoses.
resultsOverall, 226 patients were included(mean age 45.35 ± 18.85yrs, 54.4% female). The mean WBC/Hb ratio was 1.04 ± 1.22 × 10⁹ cells/L per g/dL, and IHM rate was 19.9%. Per-standard increase of WBC/Hb(2.22 × 10⁹ cells/L per g/dL) was associated with high-risk of IHM (HR 1.19, 95% CI 1.00-1.44; p = 0.012). The Results were similar when stratified into three groups (<0.55, 0.55-1.00, and ≥1.00 × 10⁹ cells/L per g/dL), compared with the reference group(<0.55), 0.55-1.00 group (HR 2.81, 95% CI 1.06-7.43; p = 0.037) and ≥1.00 group (HR 2.82, 95% CI 1.05-7.57; p = 0.040) had significantly high-risks of IHM. WBC/Hb demonstrated predictive value for IHM with AUC of 0.701 (95% CI 0.550-0.718).
conclusionWBC/Hb, readily available and cost-effective marker, was associated with IHM. Incorporated into routine clinical assessments could improve risk stratification, especially in resource-limited settings. Prospective studies are needed to validate these findings and assess its broader utility.
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