Combinations of inflammatory markers, soluble (s)CD163, mannose receptor (sMR) and neutrophil gelatinase associated lipocalin (NGAL), predicts mortality in patients with acute-on-chronic liver failure

Abstract Background Systemic inflammatory response is closely related to the development and prognosis of liver failure. This study aimed to establish a new model combing the inflammatory markers including neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) with several hematological testing indicators to assess the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods A derivation cohort with 421 patients and a validation cohort with 156 patients were recruited from three hospitals. Retrospectively collecting their clinical data and laboratory testing indicators. Medcalc-15.10 software was employed for data analyses. Results Multivariate analysis indicated that RDW, NLR, INR, TBIL and Cr were risk factors for 90-day mortality in patients with HBV-ACLF. The risk assessment model is COXRNTIC = 0.053 × RDW + 0.027 × NLR + 0.003 × TBIL+ 0.317 × INR + 0.003 × Cr (RNTIC) with a cut-off value of 3.08 (sensitivity: 77.89%, specificity: 86.04%). The area under the receiver operating characteristics curve (AUC) of the RNTIC was 0.873 [95% CI(0.837–0.903)], better than the predictive value of MELD score [0.732, 95% CI(0.687–0.774)], MELD-Na [0.714, 95% CI(0.668–0.757)], CTP[0.703, 95% CI(0.657–0.747)]. In the validation cohort, RNTIC also performed a better prediction value than MELD score, MELD-Na and CTP with the AUC of [0.845, 95% CI(0.778–0.898)], [0.768, 95% CI (0.694–0.832)], [0.759, 95% CI(0.684–0.824)] and [0.718, 95% CI(0.641–0.787)] respectively. Conclusions The inflammatory markers RDW and NLR could be used as independent predictors of 90-day mortality in patients with HBV-ACLF. Compared with MELD score, MELD-Na and CTP, RNTIC had a more powerful predictive value for prognosis of patients with HBV-ACLF.

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A novel predictive model based on inflammatory markers to assess the prognosis of patients with HBV-related acute-on-chronic liver failure: a retrospective cohort study

10.21203/rs.2.14221/v1 ◽

2019 ◽

Author(s):

Li Qiang ◽

Jiao Qin ◽

Changfeng Sun ◽

Yunjian Sheng ◽

Wen Chen ◽

...

Keyword(s):

Liver Failure ◽

Predictive Value ◽

Inflammatory Markers ◽

Validation Cohort ◽

Meld Score ◽

Chronic Liver ◽

Assessment Model ◽

Operating Characteristics ◽

Chronic Liver Failure ◽

Distribution Width

Abstract Backgrounds: Systemic inflammatory response is closely related to the development and prognosis of liver failure. This study aimed to establish a new model combing the inflammatory markers including neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) with several hematological testing indicators to assess the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods: A derivation cohort with 421 patients and a validation cohort with 156 patients were recruited from three hospitals. Retrospectively collecting their clinical data and laboratory testing indicators . Medcalc-15.10 software was employed for Data analyses.Results: Multivariate analysis indicated that RDW, NLR, INR, TBIL and Cr were risk factors for 90-day mortality in patients with HBV-ACLF. The risk assessment model is COX RNTIC =0.053× R DW+0.027× N LR+0.003× T BIL+0.317× I NR+0.003× C r (RNTIC) with a cut-off value of 3.082 (sensitivity: 77.89%, specificity: 86.04%). The area under the receiver operating characteristics curve (AUC) of the RNTIC was 0.873 [95%CI (0.837–0.903)], better than the predictive value of RDW [0.675, 95%CI (0.628–0.719)], NLR [0.693, 95%CI (0.646–0.737)] and MELD score [0.732, 95%CI (0.687–0.774)]. In the validation cohort, RNTIC also performed a better prediction value than RDW, NLR, and MELD score with the AUC of [0.845, 95%CI (0.778-0.898)], [0.670, 95%CI (0.591-0.744)], [0.732, 95%CI (0.655-0.799)] and [0.768, 95%CI (0.694-0.832)], respectively.Conclusions: The inflammatory markers RDW and NLR could be used as independent predictors of 90-day mortality in patients with HBV-ACLF. Compared with MELD score, RNTIC had a more powerful predictive value for prognosis of patients with HBV-ACLF.

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