The Evaluation Value Of The Model For End Stage Liver Disease Score Combined With NLR In Short-term Prognosis Of Decompensated Cirrhosis

Objective:To analyze the predictive value of Model for end stage liver disease(MELD)score combined with neutrophil to lymphocyte ratio(NLR)in the short-term prognosis of patients with decompensated cirrhosis,and To provide a reference for more accurately determining the prognosis and guiding the treatment plan for patients.Method:A retrospective analysis was conducted on 407 patients with decom-pensated cirrhosis who were treated in the Yan bian University Hospital from January 2017 to September 2020.During the follow-up period,91 patients with liver cancer,complicated with other serious systemic diseases and lost to follow-up were excluded,and a total of 316 patients were eventually included in the study.Statistical analysis for the first time in patients with cirrhosis hospitalized within 24 hours after the first laboratory biochemical indicators,including liver and kidney function,blood routine,coagulation time and serum sodium.MELD score,CTP score,MELD-Na score,iMELD score,iMELD-NLR and NLR were calculated.Follo-w-up by telephone or in our hospital medical records tracking patients discharged from hospital after 3 months of prognosis,the end time of the study is December 31,2020.A database was established for 316 patients with decompensated cirrhosis,and statistical methods were used to analyze the above data to determine the final outcome of the patients.Results:1.The patients with decompensated cirrhosis were divided into survival group and death group,259 cases in survival group and 57 cases in death group.There was no significant difference in gender,age,Hb,ALT between survival group and death group(P>0.05).2.The WBC,PT,INR,AST,TBil,Scr and neutrophil count were significantly correlated higher in the death group than in the survival group(P<0.05).3.The CTP score,MELD score,iMELD score,MELD-NA score,NLR and iMELD-NLR were significantly correlated higher in the death group than in the survival group(P<0.001).4.The lymphocyte count,serum sodium,RBC and ALB in the death group were lower than those in the survival group,and the difference was statistically significant(P<0.05).5.The incidence rate of hepatic encephalopathy and ascites in the death group was significantly higher than that in the survival group(P<0.001);The incidence of gastrointestinal bleeding was not statistically significant between the survival group and the death group(P>0.05).6.The relationship between NLR,CTP score or MELD score was discussed by rank correlation analysis,and the results showed that NLR was positively correlated with CTP score、MELD score(rs=0.236,P<0.001;rs=0.192,P<0.001).7.The logistic regression analysis showed that iMELD-NLR was an independent risk factor for short-term death in patients with decompensated cirrhosis after adjustment of CTP score,iMELD score and MELD-Na score.8.The ROC curve was used to analyze the prediction of short-term prognosis of patients with decompensated cirrhosis.Results showed that iMELD-NLR had a strong efficacy in predicting mortality after 3 months in patients with decompensa-ted cirrhosis(AUC 0.808,cutoff 34.45,specificity 73.68,sensitivity 79.54).Conclusion:1.NLR of death group was significantly higher than that of survival group.2.NLR was positively correlated with CTP score and MELD score in patients with decompensated cirrhosis.3.iMELD-NLR was an independent risk factor for 3-month mortality in patients with decompensated cirrhosis.4.MELD score combined with NLR may have a higher predictive value in evaluating the short-term prognosis of decompensated cirrhosis.