Objective To investigate the association between mean platelet volume( MPV) and prognosis of hepatitis B virus-associated acute-on-chronic liver failure( HBV-ACLF) and the value of MPV in prognostic evaluation. Methods A retrospective analysis was performed for the clinical data of 37 patients with hepatitis B cirrhosis,44 patients with HBV-ACLF,and 27 patients with chronic hepatitis B,who were admitted to Department of Infectious Diseases,The First Affiliated Hospital of Soochow University,from January 2015 to December 2019,as well as 24 individuals who underwent physical examination during the same period of time. Related clinical data included sex,age,total bilirubin( TBil),creatinine( Cr),blood urea nitrogen( BUN),albumin( Alb),blood ammonia( NH3),routine blood test results,Model for End-Stage Liver Disease( MELD) score,and blood coagulation parameters. According to prognosis,the patients with HBV-ACLF patients were divided into improvement group with 19 patients and non-improvement group with 25 patients,and the patients were followed up for 3 months. The Kruskal-Wallis H test was used for comparison between multiple groups,and the Wilcoxon rank sum test was used for comparison within each group,the Mann-Whitney U test was used for comparison between two groups; a binary logistic regression analysis was used to investigate the independent influencing factors for prognosis,and the receiver operating characteristic( ROC)curve was used to predict the accuracy of variables. Results There were significant differences in MPV,platelet count,prothrombin time( PT),international normalized ratio( INR),Alb,BUN,TBil,and MELD score between the liver cirrhosis group,the HBV-ACLF group,the chronic hepatitis group,and the healthy group( χ2= 39. 031,75. 837,59. 894,56. 033,22. 760,83. 353 and 70. 299,all P <0. 001). Further comparison of MPV between two groups showed that the HBV-ACLF group had a significantly higher MPV than the healthy group and the chronic hepatitis group( Z = 9. 076 and 4. 435,both corrected P < 0. 001),and the liver cirrhosis group had a significantly higher MPV than the healthy group( Z = 2. 646,corrected P = 0. 049). For the patients with HBV-ACLF,there were significant differences in MPV,age,PT,INR,and MELD score between the improvement group and the non-improvement group( Z =-3. 710,-2. 726,-2. 678,-2. 322 and-2. 610,all P < 0. 05),and further binary logistic regression analysis showed that MPV( odds ratio [OR]= 1. 175,95%confidence interval [CI]: 1. 067-2. 756,P = 0. 026) and MELD score( OR = 1. 643,95% CI: 1. 021-2. 644,P = 0. 041) were independent influencing factors for the prognosis of HBV-ACLF. MPV alone,MELD score alone,and MPV combined with MELD score had an area under the ROC curve of 0. 742,0. 731,and 0. 791,respectively,in predicting the prognosis of HBV-ACLF,and MPV combined with MELD score had relatively high sensitivity( 0. 72) and specificity( 0. 895). Conclusion MPV is an independent influencing factor for the prognosis of HBV-ACLF and has a good value in predicting prognosis. MPV combined with MELD score has advantages over MPV or MELD score alone in predicting the prognosis of HBV-ACLF.
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