A Novel Systemic Inflammation-Based Model for Predicting Mortality in HBV-Related ACLF

Excessive inflammation and immune activation are strongly associated with unfavorable outcomes and elevated mortality rates in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). However, the role of the C-reactive protein to lymphocyte ratio (CLR) as a prognostic inflammatory biomarker in multiple diseases is rarely mentioned in HBV-ACLF. This investigation aimed to assess the utility of the CLR and additional parameters in identifying high-risk progression in HBV-ACLF patients. A cohort of 639 hospitalized patients diagnosed with HBV-ACLF based on the APASL criteria was divided into two cohorts: 447 cases in the training set and 192 cases in the validation set. Logistic regression analysis was employed to identify the XY-model. The results of multiple factor analysis showed that the incidence of liver cirrhosis, age, CLR, serum total bilirubin, calcium, prothrombin activity, and alpha fetoprotein affect the prognosis of HBV-ACLF. CLR emerged as a significant independent risk factor for disease progression in patients with ACLF (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04, p < 0.05). The novel model based on seven predictors could accurately predict short-term mortality in patients with HBV-ACLF, which is promising for guiding clinical management and addressing the etiological differences in Asian populations.