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. 2024 Aug 29;24(1):888.
doi: 10.1186/s12879-024-09769-0.

Low platelet to high-density lipoprotein ratio predicts poor short-term prognosis in hepatitis B-related acute-on-chronic liver failure

Linxiang Liu #  1 , Chenkai Huang #  1 , Yuan Nie  1 , Yue Zhang  1 , Juanjuan Zhou  2 , Xuan Zhu  3
Affiliations

Low platelet to high-density lipoprotein ratio predicts poor short-term prognosis in hepatitis B-related acute-on-chronic liver failure

Linxiang Liu et al. BMC Infect Dis. .

Abstract

Background: Acute-on-chronic liver failure (ACLF) is characterized by a systemic inflammatory response, predominantly associated with hepatitis B virus in the Asia-Pacific region, with a high short-term mortality rate. The platelet to high-density lipoprotein ratio (PHR) has been used to predict the prognosis of patients with various inflammatory diseases. We aim to is to use the PHR to predict the short-term prognosis of patients with HBV-ACLF.

Method: In this study, we retrospectively analyzed clinical data from 270 HBV-ACLF patients. Using logistic regression, we identified independent risk factors for short-term mortality and developed a prognostic model. This model was then validated, compared, and its clinical utility assessed via decision curve analysis (DCA).

Results: Among the 270 HBV-ACLF patients, 98 patients died within 28 days. The deceased group exhibited a higher proportion of severe hepatic encephalopathy and ascites. Additionally, there was a statistically significant difference (P = 0.046) in the novel inflammation scoring system, PHR, between the two groups. Following stringent variable selection, PHR was identified as a predictive factor for short-term mortality in HBV-ACLF patients using logistic regression analysis (OR: 0.835 (0.756-0.999), P = 0.009), and it exhibited a synergistic effect with certain traditional scores. The prognostic model constructed based on PHR demonstrated a superior ability to predict short-term mortality compared to traditional scores such as Child-Turcotte-Pugh (AUC: 0.889). Evaluation using calibration curves and decision curve analysis (DCA) suggested its practical utility.

Conclusion: PHR can predict short-term mortality in patients, with a low PHR upon admission being associated with an increased risk of death.

Keywords: Acute-on-chronic liver failure; Hepatitis B virus; Inflammation score; Platelet to high-density lipoprotein ratio; Risk stratification.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Design diagram of this study
Fig. 2
Fig. 2
Box plots of various indicators for the survival and death groups. A: Comparison of CTP in the survival and death group at 28 days. B: Comparison of MELD in the survival and death group at 28 days. C: Comparison of MELD-Na in the survival and death group at 28 days. D: Comparison of COSSH-ACLF IIs in the survival and death group at 28 days. E: Comparison of PHR in the survival and death group at 28 days
Fig. 3
Fig. 3
Parameters of the prognostic model. A, B and C: Confusion matrix of the prognostic mode
Fig. 4
Fig. 4
Validation of the prognostic model. A: Calibration curve of the prognostic model. B: Probability-Actual Outcome Curve
Fig. 5
Fig. 5
AUROC analysis of the prognostic model. The AUROC of (A) CTP, (B) MELD, (C) MELD-Na and (D) COASS-ACLF IIs comparison with the prognostic model, statistical comparison using the DeLong method
Fig. 6
Fig. 6
Clinical utility analysis. DCA curves of different prognostic models
See this image and copyright information in PMC

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