Value Of Neutrophil-lymphocyte Ratio In Evaluating The Short-time Prognosis Of Patients With Acute-on-chronic Liver Failure

Objective To investigate the effect of neutrophil-lymphocyte ratio(NLR)on the 28-day prognosis of patients with HBV associated acute-on-chronic liver failure(HBV-ACLF).Methods A total of 100 patients with HBV-ACLF who were admitted to The Second Affiliated Hospital of Anhui Medical University from January 2015 to December 2016 were enrolled,and according to their prognosis on 28-day,they were divided into death group and survival group.The data on sex,age,laboratory markers,Model for End-Stage Li-ver Disease(MELD)score,and clinical complications were collected for univariate analysis.The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups.The Chi square test was used for comparison of categorical data between two groups.Binary logistic regression was used for multivariate analysis.Pearson correlation analysis was used to investigate the correlation between MELD score and NLR.The receiver operating characteristic(ROC)curve was used to analyze the value of indices in predicting the prognosis of HBV-ACLF.The Z-test was used for comparison of ROC between groups.Results The analysis of 100 patients with HBV-ACLF showed that there were significant differences between the survival group and the death group in age,albumin,alanine transami-nase,serum creatinine,white blood cell count,neutrophil count,lymphocyte count,monocyte count,international normalized ratio,total bilirubin,NLR,and MELD score(all P<0.05).The survival group had lower incidence rates of hepatic encephalopathy,hemorrhage,ascites,and infection than the death group,but there were no significant differences between the two groups(all P>0.05).The binary logistic regression analysis showed that NLR and MELD score were independent predictive factors for28-day mortality in HBV-ACLF patients(P<0.001 and P=0.022),and NLR was positively correlated with MELD score(r=0.264,P=0.008).The ROC curve analysis showed that NLR had a significantly larger area under the ROC curve than MELD score(0.889vs0.728,P=0.0267).The NLR and MELD scores under the ROC curve were 0.934 and 0.709 for the early HBV-ACLF prognosis,and the difference was statistically significant(P=0.029).The NLR and MELD scores for the mid-term HBV-ACLF prognosis were 0.878 and 0.680,but the difference was not statistically significant(P = 0.134).The NLR and MELD scores for the late HBV-ACLF prognosis were 0.792 and 0.764,,but the difference was not statistically significant(P = 0.879).Conclusion NLR is an independent predictive factor for the short-term prognosis of HBV-ACLF patients.