Abstract: Objective The aim of this study was to investigate the value of red blood cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) model (RNM) for a short-term prognosis of patients with hepatitis B virus-induced acute-on-chronic liver failure (HBV-ACLF). Method A retrospective analysis was performed on 102 patients with HBV-ACLF, and the patients were followed up for 90 days. Univariate and multivariate analysis were applied to evaluate the risk factors influencing the prognosis. A short-term prognostic model, RNM was established. The receiver operating characteristic curve (ROC) was drawn and the area under the ROC curve(AUC) was compared to evaluate the predictive value of every parameter on prognosis of death. Result Out of our series, 48 survived, and 54 (52.9%) died at 90 day treatment; the univariate analysis showed that the infection, RDW, white blood cell(WBC), neutrophil(NEU), NLR, total bilirubin (TBIL), international standardization ratio(INR), creatinine(Cr), and MELD scores in the dead group were significantly higher than in the survival group (P <0.05), while the lymphocyte(LY) counts, albumin (ALB), sodium (NA⁺), prothrombin time activity (PTA) were significantly lower than in the survival group(P<0.05); multivariate analysis showed that RDW(OR=1.410, 95% CI, 1.149 to 1.730), NLR(OR=1.155, 95% CI, 1.001 to 1.333) and MELD scores(OR=1.128, 95% CI, 1.001 to 1.271) were the independent risk factors for poor prognosis; the ROC curve analysis showed that RDW(AUC=0.826), NLR(AUC=0.818), MELD scores(AUC=0.791), and RNM model(AUC=0.888) all had predictive value for the prognosis of patients with liver failure, and the RNM model had the best predictive value. Conclusion A short-term prognosis model for patients with CHB-ACLF based on RDW and NLR, namely, RNM, has a good predictive value for 90-day prognosis, which needs further investigation.

Key words: Acute-on-chronic liver failure, Red blood cell distribution width-neutrophil/lymphocyte ratio model, Prognosis