关键词: 慢加急性肝衰竭, 预后营养指数, 全身免疫炎症指数, 预后, 诊断

Abstract: Objective The aim of this study was to investigate the predictive performance of prognostic nutritional index (PNI) and systemic immunoinflammatory index (SII) in patients with hepatitis B associated acute-on-chronic liver failure (HBV-ACLF). Methods The clinical data of 308 patients with HBV-ACLF admitted to the First Affiliated Hospital, Naval Medical University the past eight years, were retrospectively analyzed, and the PNI and SII were calculated. The multivariate Logistic regression analysis was applied to reveal the factors impacting the prognosis, and the ROC curve was applied to evaluate the predictive efficacy. Results At the end of 1 to 3 month treatment, 192 patients (62.3%) survived and 116 patients (37.7%) died in our series; there was no significant difference in gender between the two groups(P>0.05), while the medium age of the dead patients was significantly older than in survivals (P<0.05); the PT or INR, total serum bilirubin (TSB) level in dead patients were significantly longer or greater than in those who survived (P<0.05); the incidences of ascites, infection, hepatic encephalopathy, gastrointestinal bleeding or hepatorenal syndrome in dead patients were significantly higher than in survivals (P＜0.05); the MELD scores and SII scores in the dead patients were significantly higher than, while the PNI scores was significantly lower than in survivals (P<0.05); the multivariate Logistic regression analysis showed that the PLT counts, TSB, PNI and SII scores were the independent risk factors impacting the prognosis of patients with HBV-ACLF; the sensitivities and specificities were 53.4% and 81.2%, and 30.2% and 88.0% when the PNI=37.77 and the SII=508.55 were set as the cut-off-value, respectively, in predicting the prognosis. Conclusion The early prediction of prognosis in patients with HBV-ACLF is beneficial for appropriate management, and the PNI is an independent protective factor for good and the SII is an independent risk factor for poor outcomes, and they both have to a certain extent a prognostic efficacy.

Key words: Acute-on-chronic liver failure, Prognostic nutritional index, Systemic immunoinflammatory index, Prognosis, Prediction