Value of Model for End-Stage Liver Disease score combined with neutrophil-lymphocyte ratio in predicting the short-term prognosis of patients with HBV-related acute-on-chronic liver failure

Objective To investigate the value of Model for End-Stage Liver Disease ( MELD) score combined with neutrophil-lymphocyte ratio ( NLR) in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure ( HBV-ACLF) . Methods A retrospective analysis was performed for the clinical data of 133 HBV-ACLF patients who were admitted to The Affiliated Hospital of Southwest Medical University from June 2014 to December 2016, and according to the prognosis at 3 months after treatment, these patients were divided into death group with 72 patients and survival group with 61 patients. NLR, hepatic and renal function, and coagulation function were measured within 24 hours after admission, and the MELD score was also determined. The t-test was used for comparison of continuous data between groups, and a multivariate dichotomous logistic regression analysis was used to identify the association of related factors with the prognosis of HBV-ACLF patients. The receiver operating characteristic ( ROC) curve was used to analyze the area under the ROC curve ( AUC) of MELD score combined with NLR, in order to evaluate the value of MELD score combined with NLR in predicting the short-term prognosis of HBV-ACLF patients. Results Compared with the survival group, the death group had significantly higher age, total bilirubin, creatinine ( Cr) , prothrombin time, international normalized ratio, MELD score, and NLR and a significantly lower prothrombin time activity ( PTA) ( t =-5. 888, -2. 064, -3. 707, -3. 517, -3. 410, -5. 908, -2. 830 and 4. 169, all P<0. 05) . Age ( odds ratio [OR]= 1. 110) , Cr ( OR = 1. 092) , MELD score ( OR = 1. 305) , and NLR ( OR = 1. 289) were risk factors for the prognosis of HBV-ACLF patients, while PTA was a protective factor ( OR = 0. 872, P < 0. 05) . MELD score had a higher AUC than NLR ( 0. 777 vs 0. 680) ; PTA had an AUC of 0. 304, and NLR combined with MELD score had an AUC of 0. 843. PTA, MELD score, and NLR had the highest Youden index of 0. 32, 0. 28, and 0. 43, respectively, at cut-off values of 35%, 23. 29, and 2. 06. The probability of death was 92. 6% when the MELD score exceeded 23. 29 and NLR exceeded 2. 06. Conclusion MELD score combined with NLR has a good value in predicting the short-term prognosis of patients with HBV-ACLF.