The Prognosis Models Of Liver Failure And MELD Score Combined With Neutrophil-lymphocyte Ratio For Short-term Prognosis In Patients With Acute-on-chronic Hepatitis B Liver Failure

Objective: A retrospective analysis was performed for the clinical data of HBV-ACLF patients who were admitted to The Affiliated Hospital of Southwest Medical University,collect basic data and clinical indicators,and study the following questions:(1)The Evaluation of Hepatic Failure Stage,Child-Pugh Grade(CTP Grade),and Model for End-Stage Liver Disease(MELD Score)in Assessing the Short-term Prognosis of Chronic Hepatitis B-associated Patients with Acute Hepatic Failure;(3)To investigate the value of Model for End-Stage Liver Disease(MELD)score combined with neutrophil-lymphoyte ratio(NLR)in predicting the shortterm prognosis of patients withHBV-ACLF;(3)The value of MELD score combined with neutrophil-lymphocyte ratio(NLR)and i MELD score model for assessing the short-term prognosis of patients with HBV-ACLF.Through this studies,we are hope to find a more effective and more appropriate short-term prognosis assessment model for HBV-ACLF patients,and provide effective support for guiding clinical practice and improving the survival rate of HBV-ACLF patients.Methods and materials:A retrospective analysis of 266 patients with HBV-ACLF admitted to the Affiliated Hospital of Southwestern Medical University from June 2014 to October 2017 was performed in accordance with the Guide to the diagnosis and treatment of liver failure(2012).The survival of HBV-ACLF patients was followed up for 3 months.Those who improved their condition and were discharged from the hospital and were stable for 3 months were included in the survival group(n=114).Those who died after being discharged from the hospital or who died within 3 months were included in the death group(n=152).(1)Collection of clinical basic data: gender,age(years),family history,hepatic encephalopathy,hepatorenal syndrome,ascites,upper gastrointestinal bleeding,electrolyte imbalance(excluding pneumonia,peritonitis,sepsis)In patients with bacterial or fungal infections,record the time from the first admission to the death of the patient;(2)Collect 24 h clinical testing indicators: including serum bilirubin(TBil),plasma albumin(ALB),and prolongation of prothrombin Time(s)and(or)prothrombin ratio,serum creatinine(Cr),international normalized ratio(INR);(3)calculate CTP score,MELD score,i MELD score.(4)Statistical analysis:(1)The t-test was used to compare the measurement data sets;the total survival function of patients with HBV-ACLF was plotted by Kaplan-Meier method,and the survival function was plotted by using liver failure staging,CTP classification,and MELD score as single factors;The receiver operating characteristic curve(ROC curve)was used to analyze the area under the ROC curve(AUC)of liver failure staging,CTP classification,and MELD score to evaluate the value of predicting death in HBV-ACLF patients,and calculate the area under the curve corresponding to each index.(2)Multi-factor two-class logistic regression analysis of the relationship between the relevant factors and the outcome of HBV-ACLF patients.The receiver operating characteristic curve(ROC curve)was plotted to analyze the MELD score combined with the area under the ROC curve(AUC)of the NLR to evaluate the predictive value of the MELD score combined with the NLR value for the short-term prognosis of patients with HBV-ACLF.(3)The collected clinical data was scored by iMELD,and the receiver operating characteristic curve(ROC curve)was plotted to analyze the area under the ROC curve(AUC)and the iMELD score(AUC)of the MELD score combined with NLR to evaluate two scoring systems for HBV-The predictive value of short-term prognosis in patients with ACLF.Results:(1)In stages of liver failure,CTP classification,and MELD scores,the higher the stage(points)of each scoring model,the higher the TBiL,Cr,PTA,CTPscores and MELD scores in each group(F values are 6.596,5.182,and 47.876,respectively).28.115,65.923,P all <0.01).Of the 266 patients,152 died.The 3-month cumulative survival rate was 42.8%,and the median survival time was 57.27 days(95% confidence interval,53.21-61.32).The MELD score was higher than the AUC of hepatic failure and CTP classification,which were 0.777,0.698,and 0.701,respectively.(2)Age of death group,TBil,Cr,PT,INR,MELD score,NLR were higher than survival group,PTA was smaller than survival group(t-5.58,-2.064,-3.707,-3.517,-3.410,-5.908,respectively.,-2.830,P value <0.05).Age,Cr,MELD scores,PTA and NLR were risk factors for predicting the prognosis of patients with HBV-ACLF [odds ratio(OR)were 1.110,1.092,0.872,1.305,1.289,respectively,P<0.05].PTA was a predictor of HBV-ACLF The protective factors of prognosis(OR=0.872,P<0.05).The MELD score was 0.777 and 0.680 higher than that of NLR,respectively.The AUC of PTA was 0.304.The AUC of NLR combined with MELD was 0.843.When PTA=35%,the MELD score was 23.29,and the NLR was 2.06,the corresponding Youden index was the highestare 0.32,0.28 and 0.43 respectively.When the MELD score was 23.29 and the NLR value was 2.06,the death probability was 92.6%.(3)The AUC of MELD score combined with NLR and i MELD score was 0.843 and 0.837,respectively.There was no statistical difference between the two groups.Conclusions:(1)The MELD score has higher accuracy in predicting the short-term prognosis of patients with HBV-ACLF than liver failure staging and CTP classification.(2)MELD score combined with NLR value has better value in predicting short-term prognosis of patients with HBV-ACLF.(3)MELD score combined with NLR value and iMELD assessment iMELD score can better predict the short-term clinical prognosis of patients with HBV-ACLF,the value of the two to determine the prognosis was not statistically different.