Zhang X, Ma L N, Wang M T, Liu H J, Tian Y L, Luo X, Ding X C
Department of Infectious Diseases, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
Ningxia Medical University, Yinchuan 750004, China.
Zhonghua Gan Zang Bing Za Zhi. 2023 Aug 20;31(8):847-854. doi: 10.3760/cma.j.cn501113-20220402-00159.
To explore the prognostic predictive value of neutrophil/lymphocyte ratio (NLR) combined with prognostic nutritional index (PNI) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Clinical data from 149 HBV-ACLF patients admitted to the infectious diseases Department of the General Hospital of Ningxia Medical University were retrospectively analyzed. Demographic data of the enrolled patients and the initial clinical-related data after admission were collected. Patients were divided into survival (93 cases) and death groups (56 cases) according to their prognostic condition 90 days after discharge. Demographic and clinical differences were compared between the two groups data. Receiver operating characteristic (ROC) curves were plotted to determine the optimal cutoff values for NLR and PNI in predicting the 90-day mortality rate of HBV-ACLF patients. The COX regression model was used to conduct univariate and multivariate analyses to investigate the correlation between NLR and PNI and the prognosis of HBV-ACLF patients. Kaplan-Meier survival analysis was used to explore the effects of NLR and PNI on the survival of HBV-ACLF patients. The death group NLR was higher than that of the survival group, while the PNI was lower than that of the survival group, with a statistically significant difference. The area under the receiver operating characteristic curve (0.842, 95% : 0.779-0.906) showed patients with adverse prognosis assessed by NLR combined with PNI had a superior prognosis than that of the Model for End-Stage Liver Disease (MELD) and its combined serum sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores. COX regression analysis showed that NLR≥3.03 and MELD score were independent risk factors affecting the prognosis of HBV-ACLF patients. PNI > 36.13 was a protective factor for evaluating the prognosis of HBV-ACLF patients. NLR combined with PNI can enhance the prognostic predictive value of HBV-ACLF.
探讨中性粒细胞/淋巴细胞比值（NLR）联合预后营养指数（PNI）对乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者的预后预测价值。回顾性分析宁夏医科大学总医院感染科收治的149例HBV-ACLF患者的临床资料。收集入选患者的人口统计学数据及入院后初始临床相关资料。根据出院后90天的预后情况将患者分为生存组（93例）和死亡组（56例）。比较两组数据的人口统计学和临床差异。绘制受试者工作特征（ROC）曲线以确定NLR和PNI预测HBV-ACLF患者90天死亡率的最佳临界值。采用COX回归模型进行单因素和多因素分析，以研究NLR和PNI与HBV-ACLF患者预后的相关性。采用Kaplan-Meier生存分析探讨NLR和PNI对HBV-ACLF患者生存的影响。死亡组的NLR高于生存组，而PNI低于生存组，差异有统计学意义。受试者工作特征曲线下面积（0.842，95%：0.779-0.906）显示，NLR联合PNI评估预后不良的患者预后优于终末期肝病模型（MELD）及其联合血清钠（MELD-Na）和Child-Turcotte-Pugh（CTP）评分。COX回归分析显示，NLR≥3.03和MELD评分是影响HBV-ACLF患者预后的独立危险因素。PNI>36.13是评估HBV-ACLF患者预后的保护因素。NLR联合PNI可提高HBV-ACLF的预后预测价值。
