The Predictive Value Of NLR In The Short-term Prognosis Of Patients With HBV-related ACLF

ObjectiveTo investigate the predictive value of neutrophil-lymphocyte ratio(NLR)in the short-term prognosis(3 months)of patients with HBV-related acute-on-chronic liver failure(HBV-ACLF).MethodA total of 167 HBV-ACLF patients who were admitted to the Department of Infectious Diseases of the first affiliated hospital of Soochow university from January 2012 to December 2018 were retrospectively collected.In accordance with the prognosis of patients after 3 months of hospitalization,they were divided into survival group(n=65)and death group(n=102).General information,blood routine,biochemical and coagulation functions and other related laboratory indicators of two groups of patients were collected,NLR and MELD scores were calculated.IBM SPSS 19.0 statistical software was used to perform statistical analysis on the above indicators.The comparison of measurement data between groups was performed by one-way analysis of variance,t test or Mann-Whithey U test.The relationship between NLR and clinical indicators was analyzed by Pearson correlation analysis,factors that affected disease prognosis were analyzed by single-factor and multi-factor Logistic regression,the receiver operating characteristic curve(ROC)was drawn,and the area under the curve(AUC)was calculated to assess the predictive value of NLR,MELD score and NLR-MELD on the short-term prognosis of ACLF patients.Z test was used to compare ROC curves and P<0.05 was considered statistically significant.Result1.Through analyzing baseline data of two groups of ACLF patients at admission,it could be found that survival group and death group were significantly different in the white blood cell count(WBC),neutrophil count(NC),lymphocyte count(LC),NLR,total bilirubin(TBiL),prothrombin time(PT),international normalized ratio(INR),creatinine(CR)and MELD scores,with statistical significance(P<0.01).2.NLR level gradually increased in the early,middle and late stages of ACLF,and the difference was statistically significant(P<0.001).3.Pearson correlation analysis found that there was a positive correlation between NLR and TBiL,INR and MELD scores,with correlation coefficients of 0.325,0.233 and 0.347,respectively,with statistical differences(P<0.05).There was no correlation between NLR and ALT and AST(P>0.05).4.Single-factor Logistic regression found that TBiL,PT,AST,CR,INR,MELD score,WBC,LC,NC,NLR indicators had statistical significance in prediction of ACLF prognosis(P<0.05).While multi-factor Logistic regression showed that only NLR and MELD scores were independent factors affecting the short-term prognosis of ACLF patients(P<0.01).5.ROC curve showed that NLR and MELD scores had predictive value for the short-term prognosis of HBV-ACLF patients(P<0.01),and the corresponding AUCs were 0.803 and 0.675,respectively,with statistical differences(P<0.05),suggesting that the predictive value of NLR was better than MELD.The optimal cutoff point for NLR diagnosis from Youden index was 1.9,and its corresponding sensitivity and specificity were 88.0%and 64.3%,respectively.The optimal cutoff point for MELD diagnosis was 21.3,and its corresponding sensitivity and specificity were 48.0%and 85.1%.6.ROC curve showed that AUC of NLR combined with MELD score was 0.886,which was significantly greater than AUC of NLR(0.803),and the specificity also increased significantly(85.7%and 64.3%).It suggested that NLR combined with MELD score could improve its independent prediction performance.Conclusion1.NLR gradually increased with ACLF progress.2.NLR was an independent predictive factor of short-term prognosis in HBV-ACLF patients.3.NLR combined with MELD score could improve its independent prediction performance.