Xu Huaqian, Li Xue, Zhuo Yue, Li Chunyan, Bai Chengzhi, Chen Jie, Tang Shanhong
Department of Gastroenterology, The General Hospital of Western Theater Command, Chengdu, China.
Adv Clin Exp Med. 2025 Jul;34(7):1131-1138. doi: 10.17219/acem/192624.
Acute-on-chronic liver failure (ACLF) is characterized by rapid onset, rapid development and a high short-term mortality rate. Systemic inflammation exerts an effect on the disease progression of ACLF.
The purposes of this study were to explore the clinical significance that the inflammatory response has on the disease process of hepatitis B virus acute-on-chronic liver failure (HBV-ACLF) patients, to further compare the values of different inflammation-related biomarkers in the prognosis evaluation of HBV-ACLF patients, and to combine inflammatory-related markers to establish a new prediction model.
Baseline admission data and 90-day outcomes were collected from 247 patients who met the inclusion criteria. According to the 90-day survival situation, they were divided into a survival group and a death group. The differences in baseline data and inflammation levels between the 2 groups were compared. A regression model was used to analyze the risk factors for 90-day mortality and establish a new model.
The study found that the differences between the survival group and the death group were statistically significant in terms of age, total bilirubin (Tbil), prothrombin time (PT), international standardized ratio (INR), inflammation level, and model for end-stage liver disease (MELD) series scores (p < 0.05). The monocyte-to-lymphocyte ratio (MLR)-integrated iMELD model (MLR-iMELD) can effectively predict the 90-day survival rate of HBV-ACLF patients. The area under the receiver operating characteristic (ROC) curve (AUROC) of the new model was 0.792, and the best cutoff for predicting the prognosis of 90 days for patients was -0.33 (sensitivity 0.577 and specificity 0.898).
The higher the level of inflammation in patients with HBV-ACLF, the greater the risk of 90-day death. Compared with other inflammation-related markers, the MLR-iMELD model can better predict the 90-day survival rate of HBV-ACLF patients.
慢加急性肝衰竭（ACLF）具有起病急、进展快及短期死亡率高的特点。全身炎症反应对ACLF的疾病进展有影响。
本研究旨在探讨炎症反应对乙型肝炎病毒慢加急性肝衰竭（HBV-ACLF）患者疾病进程的临床意义，进一步比较不同炎症相关生物标志物在HBV-ACLF患者预后评估中的价值，并结合炎症相关标志物建立新的预测模型。
收集247例符合纳入标准患者的基线入院数据及90天结局。根据90天生存情况，将其分为生存组和死亡组。比较两组基线数据及炎症水平的差异。采用回归模型分析90天死亡率的危险因素并建立新模型。
研究发现，生存组与死亡组在年龄、总胆红素（Tbil）﹑凝血酶原时间（PT）、国际标准化比值（INR）、炎症水平及终末期肝病模型（MELD）系列评分方面差异有统计学意义（p<0.05）。单核细胞与淋巴细胞比值（MLR）联合iMELD模型（MLR-iMELD）能有效预测HBV-ACLF患者的90天生存率。新模型的受试者工作特征曲线（ROC）下面积（AUROC）为0.792，预测患者90天预后的最佳截断值为-0.33（灵敏度0.577，特异度0.898）。
HBV-ACLF患者炎症水平越高，90天死亡风险越大。与其他炎症相关标志物相比，MLR-iMELD模型能更好地预测HBV-ACLF患者的90天生存率。
