BACKGROUND AND AIMS

Rapid prognostic assessment of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is crucial for optimizing clinical interventions. This study aimed to explore the clinical value of combining Hepatitis B Virus (HBV) pregenomic RNA (pgRNA) with the Model for End-stage Liver Disease (MELD) score predicting the short-term outcomes in HBV-ACLF patients.

METHODS

This retrospective study enrolled 220 HBV-ACLF patients from Fuqing Hospital in Fujian Province between July 2016 and July 2024. Clinical data collected within 24 h of diagnosis included HBV pgRNA levels, complete blood counts, C-reactive protein, biochemical profiles, coagulation parameters, and MELD scores. Patients were stratified into survival and non-survival groups based on 90-day outcomes. Independent risk factors for mortality were identified through binary logistic regression.

RESULTS

During the 90-day follow-up after hospitalization and discharge, 90 patients died, and 130 survived. Nonsurvivors exhibited significantly higher HBV pgRNA levels (6.07 (5.62-6.71) log10pgRNA [IU/mL] vs. 4.12 [3.81-5.06] log10pgRNA [IU/mL],  = - 10.14,  < 0.001) and MELD scores (31.88 [27.82-34.66] vs. 21.27 [18.50-23.14],  = - 12.03,  < 0.001) compared to survivors. Multivariate analysis identified both HBV pgRNA (OR = 12.38, 95% CI = 2.68-57.25) and MELD score (OR = 3.20, 95% CI = 1.33-7.70) as independent predictors of 90-day mortality (both  < 0.01). The combined model demonstrated superior discriminative ability, with an area under the ROC curve (AUC) of 0.988 (95% CI = 0.978-0.998), significantly outperforming HBV pgRNA alone (AUC = 0.902, Z = 4.487,  < 0.001) and MELD score alone (AUC = 0.977, Z = 2.012,  = 0.044). The optimal cutoff for the pgRNA-MELD score (-42.253 + 2.516 × log10pgRNA [IU/mL] + 1.165 × MELD) was 0.302 (Youden index = 0.967). Patients with pgRNA-MELD scores ≥ 0.302 had markedly reduced survival rates (² = 253.09,  < 0.01).

CONCLUSION

The novel pgRNA-MELD score effectively predicts short-term prognosis in HBV-ACLF patients, offering enhanced clinical utility compared to individual models and guiding timely therapeutic decisions in clinical practice.