Value Of NLR And RDW Combined With MELD Score In Evaluating The Prognosis Of Patients With Acute On Chronic Liver Failure

Research background and purposeAcute on chronic liver failure(ACLF)is a clinical syndrome characterized by acute decompensation of chronic liver disease and high short-term mortality.Because the survival rate of ACLF is extremely low(28-day mortality:22%-77%),stratifying patients based on prognosis is critical to determine the urgency of liver transplantation(LT).Although the end-stage liver disease model(MELD)is the most widely used method for assessing patients with ACLF,it lacks indicators of clinical events such as ascites,hyponatremia,hepatorenal syndrome,and other complications.With the continuous emergence of new therapies for liver disease in recent years,it is urgent to develop new indicators and improve the index system for evaluating the severity and prognosis of patients with ACLF.Red blood cell distribution width(RDW)is a simple and inexpensive parameter that reflects the degree of volume heterogeneity of red blood cells.It is traditionally used in laboratory hematology to differentially diagnose anemia.Recently,RDW has received widespread attention as a prognostic marker for various diseases such as sepsis,acute myocardial infarction,heart failure,autoimmune diseases,and liver disease.In recent years,more and more studies have been performed on peripheral blood neutrophil-lymphocyte ratio(NLR)as a marker of systemic inflammation,especially considering its rapid,extensive,and relatively inexpensive evaluation by conventional blood cell count.NLR has been shown to be an independent prognostic factor for a variety of solid tumors,including lung,colorectal,pancreatic,breast,ovarian,and gastric cancers.However,there are few studies on the value of NLR and RDW combined with MELD scores in assessing the prognosis of ACLF.This paper retrospectively analyzes the risk factors that affect the prognosis of ACLF and discusses the value of NLR and RDW combined with MELD scores in assessing the prognosis of ACLF.MethodsA total of 141 patients with ACLF who were admitted to the Department of Infectious Diseases of the First Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were selected and then grouped according to their prognosis.Among them,76 patients with exacerbations were in the study group and 65 patients with improvement were the control group.Compare the general information,complications,and clinical hematology parameters of the two groups of patients,analyze the risk factors that affect the prognosis of ACLF,and explore the evaluation value of NLR and RDW combined with the MELD score on the prognosis of ACLF.All data were analyzed using SPSS 21.0 software,and the difference was considered statistically significant at P<0.05.Results1.The patients with worsening ACLF group were more likely to have ascites,spontaneous peritonitis,hepatic encephalopathy,gastrointestinal bleeding,electrolyte disturbance,hepatorenal syndrome,and infection when they were admitted to the hospital.The difference was statistically significant(P<0.05).2.In terms of hematological indicators,the leukocyte count,RDW,NLR,urea,creatinine,total bilirubin,activated partial thromboplastin time,D-dimer,thrombin time,C-reactive protein,and MELD scores in the worsening ACLF group were all higher than those in ACLF improvement group.The difference was statistically significant(P<0.05).The red blood cell count,hemoglobin,alanine aminotransferase,glutamyl transpeptidase,fibrinogen,and serum sodium in the ACLF worsening group were lower than those in the ACLF improvement group,and the differences were statistically significant(P<0.05).3.Correlation analysis showed that there was a positive correlation between NLR and MELD score,white blood cell count,urea,creatinine,uric acid,total bilirubin,and activated partial thromboplastin time,and a negative correlation with serum sodium.The difference was statistically significant(P<0.05).RDW was positively correlated with MELD score and mean platelet volume,and negatively correlated with hemoglobin.The difference was statistically significant(P<0.05).4.Multivariate binary logistic regression analysis showed that NLR(OR=1.293,P=0.006),RDW(OR=1.467,P<0.001),age(OR=1.056,P=0.012),hepatic encephalopathy(OR=4.375,P=0.018)and infection(OR=7.472,P=0.001)were the risk factors affecting the prognosis of ACLF.5.The area under the ROC curve of NLR,RDW,MELD score,MELD score combined with NLR,MELD score combined with RDW,and MELD score combined with NLR and RDW on the poor prognosis of ACLF is 0.740,0.756,0.686,0.759,0.786,0.846.The best cutoff points for NLR,RDW,and MELD scores are 4.194,18.55%,and 23.5,respectively.When it is greater than the optimal cutoff point,it is likely that ACLF has a poor prognosis;The sensitivity of the MELD score combined with NLR and RDW is 67.1%and the specificity is 90.8%,which were greater than the MELD score alone and the MELD score combined with NLR and MELD score combined with RDW.Conclusion1.Patients in the worsening ACLF group often have ascites,spontaneous peritonitis,hepatic encephalopathy,gastrointestinal bleeding,electrolyte disorders,hepatorenal syndrome,and infection.2.MELD score combined with NLR and RDW can improve the sensitivity and specificity of predicting the prognosis of ACLF,and its predictive value is greater than MELD score alone,MELD score combined with NLR,MELD score combined with RDW.