| Research background and purpose:With the progression of liver cirrhosis,acute on chronic liver failure(ACLF)may occur.The disease has the clinical characteristics of acute onset,rapid progression,poor prognosis,and lack of liver transplantation donors,with a high short-term mortality.Studies have shown that early identification of chronic HBV infection with liver failure tendency and early and effective intervention can prevent the disease from progressing to ACLF and reduce the mortality of ACLF patients.In recent years,a number of studies have shown that inflammatory response plays an important role in the occurrence and progression of HBV-ACLF,and neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),Mean platelet volume(MPV)and platelet-to-white blood cell ratio(PWR)as biomarkers of inflammatory response have attracted more and more attention.NLR,MLR,MPV?PWR,model for end-stage liver disease score(MELD)and other indicators were included in this study.To explore the predictive value of inflammatory biomarkers such as NLR and MLR in the severity of cirrhosis and the early diagnosis and prognosis of acute-on-chronic liver failure,in order to find simple,convenient and effective clinical indicators for the early diagnosis and treatment of the disease.Materials and Methods:A total of 324 patients with hepatitis B cirrhosis who were hospitalized in the First Affiliated Hospital of Chengdu Medical College from January 2015 to October 2022 were enrolled.General data,clinical hematological parameters,and complications were collected at admission.According to whether ACLF progressed to ACLF within 28 days after admission,the patients were divided into HBV-ACLF group and Non-ACLF group.The ACLF group was divided into early ACLF group,middle ACLF group and late ACLF group.All data were analyzed by SPSS 26.0 software.Result:1.The HBV-ACLF group had a higher incidence of spontaneous peritonitis and hepatorenal syndrome,more serious degree of ascites and hepatic encephalopathy,and more infection sites(p < 0.05).But there was no significant difference in the incidence of gastroesophageal varices and red sign between the two groups(p > 0.05).2.Compared with the Non-ACLF group,HBV-ACLF group had higher white blood cell count,neutrophil count,monocyte count,NLR,MLR,MPV,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),conjugated bilirubin(CBIL),creatinine(CR),C-reactive protein,thrombin time(PT),D-dimer,alpha-fetoprotein and HBV-DNA positive rate,while lower PWR,albumin(ALB),serum sodium(p < 0.05).There was no significant difference in lymphocyte count,urea nitrogen,blood potassium,procalcitonin and blood ammonia between the two groups(p > 0.05).The HBV-ACLF group had higher MELD score,MELD-Na score and CTP score(p < 0.05).3.Correlation analysis showed that NLR in HBV-ACLF patients was positively correlated with CR and MELD-Na score,and negatively correlated with ALT,ALB and Na;MLR was positively correlated with CR,and negatively correlated with ALT and Na.MPV was positively correlated with ALT,ALB and Na,PWR was positively correlated with ALT and Na,negatively correlated with PT and MELD-Na score,and had no correlation with other indexes.4.Risk factor analysis showed that high levels of MLR,TB,PT,MELD score at admission and hepatorenal syndrome were independent risk factors for progression to HBV-ACLF in patients with HBV-related liver cirrhosis.5.ROC curve analysis showed that in predicting the occurrence of ACLF,the area under the curve ranked as MLR+MELD score(0.901)> MELD score(0.887)> MLR(0.694),and pairwise differences were statistically significant(p < 0.05).The sensitivity and specificity of MLR combined with MELD score were 78.2% and 87.8%,respectively.The optimal MLR cut-off point was 0.569,and the MELD score was10.912.6.Compared with the early,middle and late ACLF groups,the MELD and MELD-Na scores showed an increasing trend,and the difference was statistically significant.When ACLF entered the late stage,NLR and MLR increased significantly,and the difference was statistically significant(p < 0.05).There was no correlation between MLR and MELD score.Conclusion:1.MLR is an independent risk factor for ACLF in patients with HBV-related liver cirrhosis,which is independent of MELD score.The predictive efficacy of MLR combined with MELD score is better than that of MELD score alone.2.The increase of NLR and MLR can reflect the severity of ACLF and early predict the progression of ACLF patients. |
