Evaluation Of Severity And Prognosis Of Decompensated Hepatitis B Cirrhosis By Inflammatory Markers

BackgroundPatients with Decompensated hepatitis B cirrhosis(DeCi-HBV)often suffer from heavy economic burden due to repeated hospitalization,and most of them die of multiple organ failure due to complications of infection or disease progression.At present,the only possible cure for DeCi-HBV is liver transplantation,but most patients still die while waiting for liver transplantation.In order to improve the judgment of the severity and prognosis of DeCi-HBV patients and reduce their mortality,more and more researchers are trying to find an index or scoring system with higher accuracy in predicting the severity and prognosis of DeCi-HBV in recent years.At present,the severity and prognosis of DeCi-HBV mainly depend on the Child Turcotte Pugh grading score(CTP)and the end stage liver disease model(MELD)scoring system.The higher the CTP grade and MELD score,the greater the risk of death of DeCi-HBV patients.However,the CTP scoring system has some defects such as subjectivity,and the MELD scoring system is too complex and inconvenient for clinical application,which leads to its low accuracy in the long-term prognosis of DeCi-HBV and affects the clinical diagnosis and treatment.It is still necessary to find other indicators or scoring methods to predict the severity and prognosis of DeCi-HBV,so as to make it more suitable for the long-term prognosis prediction of DeCi-HBV.With the discovery of serum inflammatory indicators,inflammatory indicators have attracted more and more attention to predict or evaluate the severity and prognosis of some diseases.The application of inflammatory indicators to predict the severity and prognosis of DeCi-HBV is not only convenient in clinical application and reduce the economic burden of patients,but also help to guide clinical diagnosis and treatment and intervene in the development of patients with mild to moderate DeCi-HBV to severe stage in advance.ObjectiveUsing various biological inflammatory indexes and existing scoring methods to evaluate the severity and prognosis of DeCi,study the severity and prognosis of patients with DeCi,preliminarily explore the correlation between various inflammatory indexes and the severity and prognosis of DeCi-HBV,and analyze the diagnostic value of various inflammatory indexes in predicting the severity and prognosis of DeCi-HBV,To reduce the family economic burden and provide more timely treatment for patients with DeCi-HBV.MethodsFrom June 2018 to December 2021,healthy subjects and patients with DeCi-HBV were collected retrospectively in the First Affiliated Hospital of Zhengzhou University.All subjects underwent blood routine examination,liver and kidney function,C-reactive protein(CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR),tumor markers and imaging(ascites color Doppler ultrasound or abdominal CT or abdominal magnetic resonance).A total of 315 cases were included.The patients with DeCi-HBV were classified as the experimental group,including:the experimental group was divided into group A(CTP score A),group B(CTP score B),and group C(CTP score C)by Child Turcotte Pugh grading score(CTP score);The healthy people were included into control group;CRP,ESR,PCT,platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),erythrocyte distribution width to platelet ratio(RPR),neutrophil to platelet ratio(NPR),lymphocyte to CRP ratio(LCR),C-reactive protein to albumin ratio(car)Systemic immune inflammatory index(SII),end-stage liver disease model(MELD)and serum sodium binding meld model(Na-MELD).The single sample Kolmogorov Smirnov test,i.e.normality test and homogeneity of variance test,was conducted for the counting data between the experimental group and the control group.The differences of measurement data between the experimental group and the control group were compared by using two groups of independent sample t-test(normality distribution and homogeneous variance)or Wilcoxon rank sum test(skewness distribution or uneven variance).One way ANOVA(normal distribution and homogeneous variance)or Kruskal Wallis test(skew distribution or uneven variance)were used to compare the differences of measurement data among group A,group B and group C.If the differences were statistically significant,LSD method(normal distribution and homogeneous variance)or independent sample test(skew distribution or uneven variance)in nonparametric test were used for paired comparison.Spearman correlation analysis was used to evaluate whether the above inflammatory indexes were correlated with deci HBV.The receiver operating curve(ROC)was constructed to evaluate the sensitivity,specificity and diagnostic efficacy of the above inflammatory indexes in diagnosing the death of patients with deci HBV within 30 months,and the area under the curve(AUC)and 95%confidence interval(CI)were calculated.Kaplan Meier method was used to draw the survival curve,log rank method was used for univariate analysis of relevant indicators,and Cox regression model was used for multivariate analysis.P<0.05 was statistically significant.Results1.The inflammatory index values of subjects in groups A,B,C and the control group in the experimental group were tested by the single-sample Kolmogorov-Smirnov test.Medium,RPR in experimental group B,CAR in experimental group C,Na-MELD score in experimental group A and C,and age in control group,experimental group B and C all conform to normal distribution(P>0.05),other parameters did not conform to normal distribution(P<0.05).2.Comparison between the experimental group and the control group:there were significant differences in inflammatory indexes,age and gender between the experimental group and the control group(P<0.05).The CRP,ESR,PCT,AFP,NLR,MLR,RPR,NPR,CAR,and age were all greater than those in the control group,and the PLR,LCR,and SII in the control group were all greater than those in the experimental group.3.The comparison results of inflammatory indicators in patients with different severity of DeCi-HB V showed that the differences in CRP,ESR,PCT,MELD,PLR,MLR,RPR,NPR,LCR,CAR,and Na-MELD among the experimental groups were statistically significant(P<0.05),but there were no significant differences in AFP,NLR,SII,age and gender among the experimental groups(P>0.05).Pairwise comparison results showed that CRP:group A<group B<group C;ESR:group A<group B<group C;PCT:group A<group B<group C;MELD:group A<group B<group C;PLR:Group A ≈>Group B>Group C;MLR:Group A<Group B<Group C;RPR:Group A<Group B<Group C;NPR:Group A<Group B<Group C;LCR:Group A>Group B>Group C;CAR:Group A<Group B<Group C;Na-MELD:Group A<Group B<Group C,between groups A and B,the differences in the above inflammatory indicators between groups A and C were all There was statistical significance(P<0.05).but there was no significant difference in other inflammatory indicators between group B and group C except for MELD,NPR,and Na-MLED(P>0.05).4.The correlation analysis results of various inflammatory indicators and the severity of DeCi-HB V showed that:CRP,ESR,PCT,MLED,MLR,RPR,NPR,CAR,Na-MELD were positively correlated with the severity of DeCi-HB V,PLR,LCR and DeCi-HBV were positively correlated.The severity of DeCi-HBV was negatively correlated with statistical significance(P<0.05).There was no significant correlation between AFP,NLR,SII and the severity of DeCi-HBV(P>0.05).CRP,ESR,PCT,MELD,AFP,NLR,NPR,CAR,Na-MELD,CTP were positively correlated with the mortality risk of DeCi-HBV patients,and LCR was negatively correlated with the mortality risk of DeCi-HBV patients,and all of them were statistically significant(P<0.05).There was no significant correlation between PLR,MLR,RPR,SII and the mortality risk of DeCi-HBV patients(P>0.05).5.The results of ROC curve analysis showed that PLR,MLR,RPR and SII had no statistical significance in predicting the risk of death of DeCi-HBV patients(P>0.05),and other inflammatory indicators had statistical significance(P<0.05)..When the cut-off value was 18.55,ESR had the highest performance in predicting the risk of death in DeCi-HBV patients,with a sensitivity of 0.67 and a specificity of 0.80.Among them,the inflammatory indicators CRP,ESR,PCT and CAR are more effective in predicting the risk of death in DeCi-HBV patients than the CTP scoring system;inflammatory indicators CRP,ESR,PCT and CAR predict the risk of death in DeCi-HBV patients The efficiency is higher than that of MELD and Na-MELD scoring systems.When the inflammatory indicators NLR,NPR,LCR,and CAR were used in combination,the AUC for predicting the risk of death in DeCi-HBV patients was 0.681,which was slightly lower than ESR,but better than other inflammatory indicators.6.Analysis of prognostic factors:Univariate and multivariate survival analysis of all DeCi-HBV patients showed:CTP score ≥ 7.5,CRP≥4.37mg/L,ESR≥18.55mm/h,PCT≥0.13ng/ml,MELD Score≥58.39,AFP≥14.45ng/ml,NLR≥2.88,MLR ≥ 0.46,RPR ≥0.14,NPR ≥0.03,CAR ≥ 0.21,Na-MELD ≥ 49.94 are the prognosis affecting the overall survival of DeCi-HBV patients within 30 months Risk factors(P<0.05).However,PLR,LCR and SII had no significant effect on the overall survival of DeCi-HBV patients(P>0.05).When NLR ≥ 2.88(HR 1.818,95%CI[1.008～3.279],P=0.047),RPR≥0.14(HR 2.174,95%CI[1.228～3.848],P=0.008),AFP ≥ 14.45(HR 3.553,95%CI[2.250～5.612],P=0.000),ESR≥18.55(HR 4.084,95%CI[2.445～6.824],P=0.000),PCT≥0.13(HR 1.612,95%CI[1.010～2.573],P=0.045)was an independent risk factor for overall survival of DeCi-HBV patients.Conclusion1.In DeCi-HBV patients,most inflammatory indicators,such as CRP,ESR,PCT,AFP,NLR,MLR,RPR,NPR,and CAR,were higher than those in normal healthy people,but PLR,LCR,and SII were higher than those in the experimental group.2.Based on the CTP scoring system,the inflammatory index NPR increased with the severity of DeCi-HBV.The change trend of other inflammatory indexes was not obvious with the increase of the severity of DeCi-HBV.3.CRP,ESR,PCT,MLR,RPR,NPR,CAR,PLR,LCR are correlated with the severity of DeCi-HBV,CRP,ESR,PCT,AFP,NLR,NPR,CAR,LCR and DeCi-HBV The mortality risk of DeCi-HBV patients is correlated,suggesting that the observation of the above-mentioned inflammatory indicators can guide the clinical treatment and prognosis of DeCi-HBV patients.4.When the inflammatory indicators NLR,NPR,LCR,and CAR are used in combination,the performance of predicting the risk of death in DeCi-HBV patients is slightly lower than that of ESR,but better than other inflammatory indicators.5.NLR≥2.88,RPR≥0.14,AFP≥14.45,ESR≥18.55,and PCT≥0.13 were independent risk factors for overall survival of DeCi-HBV patients.