Published in PLOS One on 2026-01-20, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original study title: Prognostic value of the white blood cell-to-hemoglobin ratio (WBC/Hb) for inhospital mortality: Insights from a retrospective cohort study in Uganda
Original authors: Changhui Wu, Kuule Julius Kabbali, Kamugisha Richard, John Wanyama, Gemagaine Godfrey, Odong Christopher
Source: PLOS One • DOI 10.1371/journal.pone.0340363
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The 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.
We 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.
Overall, 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).
WBC/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.
Introduction
Accurate and timely prognostication is fundamental for effective clinical decision-making, particularly in resource-limited settings where access to advanced diagnostics is constrained [1]. Among routine laboratory measurements, complete blood count(CBC) provides substantial clinical information [2]. Hemoglobin and white blood cell (WBC) counts [2,3] are independently recognized as biomarkers of disease severity and poor outcomes across a spectrum of illnesses, ranging from sepsis to hematologic disorders [3,4]. Despite this extensive evidence, the prognostic interaction between these two parameters specifically their ratio remains largely underexamined.
The ratio of WBC count to hemoglobin levels has been identified as a promising composite marker that reflects both inflammation and anemia [4,5], reflecting an individual’s capacity to respond to critical illness [4,6]. While WBC count is a well-established indicator of systemic inflammation, elevated in conditions such as infections, trauma, or malignancies [7], hemoglobin indicates the body’s ability to carry oxygen and its overall physiological health [4]. Taken together, WBC-to-hemoglobin(WBC/Hb) ratio may offer unique prognostic value [4], particularly in low-resource settings where sophisticated diagnostic modalities are unavailable [8,9]. However, evidence supporting its clinical utility remains sparse, and no study has systematically evaluated its prognostic relevance in low-resource health systems.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Changhui Wu, Kuule Julius Kabbali, Kamugisha Richard, John Wanyama, Gemagaine Godfrey, Odong Christopher. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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