Background: Acute-on-chronic liver failure (ACLF) is characterized by rapid onset, rapid development and a high short-term mortality rate. Systemic inflammation exerts an effect on the disease progression of ACLF.
Objectives: The purposes of this study were to explore the clinical significance that the inflammatory response has on the disease process of hepatitis B virus acute-on-chronic liver failure (HBV-ACLF) patients, to further compare the values of different inflammation-related biomarkers in the prognosis evaluation of HBV-ACLF patients, and to combine inflammatory-related markers to establish a new prediction model.
Material and methods: Baseline admission data and 90-day outcomes were collected from 247 patients who met the inclusion criteria. According to the 90-day survival situation, they were divided into a survival group and a death group. The differences in baseline data and inflammation levels between the 2 groups were compared. A regression model was used to analyze the risk factors for 90-day mortality and establish a new model.
Results: The study found that the differences between the survival group and the death group were statistically significant in terms of age, total bilirubin (Tbil), prothrombin time (PT), international standardized ratio (INR), inflammation level, and model for end-stage liver disease (MELD) series scores (p < 0.05). The monocyte-to-lymphocyte ratio (MLR)-integrated iMELD model (MLR-iMELD) can effectively predict the 90-day survival rate of HBV-ACLF patients. The area under the receiver operating characteristic (ROC) curve (AUROC) of the new model was 0.792, and the best cutoff for predicting the prognosis of 90 days for patients was -0.33 (sensitivity 0.577 and specificity 0.898).
Conclusions: The higher the level of inflammation in patients with HBV-ACLF, the greater the risk of 90-day death. Compared with other inflammation-related markers, the MLR-iMELD model can better predict the 90-day survival rate of HBV-ACLF patients.
Keywords: HBV-ACLF; hepatitis B virus; inflammation; prognosis.