• Jiao Gong, Wenying Zhou, Cuicui Xiao, Yusheng Jie, Shuguang Zhu, Jun Zheng, Yutian Chong, and Bo Hu.
• Department of Laboratory Medicine, Third Affiliated Hospital, Sun Yat-sen University, PR China.
• Clin. Chim. Acta. 2018 Mar 1; 478: 7-12.

BackgroundHepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) in china is a critical clinical syndrome with a high short-term mortality. This study aimed to construct and validate a model for neutrophil to lymphocyte ratio (NLR)-based nomogram for 3-month mortality estimation for patients with ACLF.MethodsThe nomogram was based on a retrospectively study of 96 patients with ACLF. The predictive accuracy and discriminative ability of nomogram were evaluated by a concordance index (C-index), and calibration curve, comparing with model for end-stage liver disease (MELD) score. The results were validated using bootstrap resampling and an external cohort of 88 patients.ResultsA total of 184 patients with ACLF were enrolled, with 3-month mortality of 40.76%. The cut-off value for NLR was 5.7 using X-tile program. Patients with NLR>5.7 had significantly higher mortality (p<0.001). On multivariate analysis of the training cohort, independent factors for survival were age, NLR and total bilirubin, which were all selected into the nomogram. The calibration curve for probability of survival showed optimal agreement between prediction by nomogram and actual observation. The C-index of nomogram was higher than that of MELD score for predicting survival (0.72 vs 0.56). The results were confirmed in validation cohort.ConclusionsThe proposed nomogram with NLR resulted in more accurate prognostic prediction for patients with HBV-related ACLF.Copyright © 2017 Elsevier B.V. All rights reserved.

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