Predictive value of systemic immunoinflammatory index combined with MELD for spontaneous bacterial peritonitis andprognosis in patients with acute-on-chronic liver failure associated with hepatitis B virus
DONG Xu
XU Mingxiao
XU Aijing
GE Lingling
LIAO Wei
XUE Jianya
Abstract：Objective To explore the predictive value of systemic immunoinflammatory index(SII)combined with model for end-stage liver disease(MELD)score for spontaneous bacterial peritonitis(SBP)and prognosis in patients with hepatitis B related acute-on-chronic liver failure(HBV-ACLF).Methods The data of 308 HBV-ACLF patients admitted to Department of Infectious Disease of Changhai Hospital Affiliated to Naval Medical University were retrospectively analyzed,and the risk factors of SBP were analyzed by univariate and multivariate analysis.Receiver operating characteristic(ROC)curve was used to evaluate the performance of SII combined with MELD score in predicting SBP and prognosis.The patients were divided into low SII group and high SII group according to the best cut-off value of SII,and the prognosis of the 2 groups was compared.Kaplan-Meier curves were used for 90 d survival analysis.Results The overall infection rate of HBV-ACLF was 39.3%,of which SBP accounted for 75.2%.There were differences in age,white blood cell count,neutrophil count,platelet count,prothrombin time,international standardized ratio,total bilirubin,alanine aminotransferase,glutamic oxalic aminotransferase,glutamyl transpeptidase,albumin,hepatic encephalopathy,hepatorenal syndrome,gastrointestinal hemorrhage,ascites,MELD score,and SII between the two groups(P＜0.05).Binary Logistics regression analysis results showed that SII(OR=1.003,95%CI:1.000-1.005,P=0.02),combined ascites(OR=13.948,95%CI:4.617-42.140,P＜0.01),and MELD score(OR=1.184,95%CI:0.995-1.410,P=0.018)were independent risk factors for HBV-ACLF complicated with SBP.ROC curve results showed that the AUC of SII combined with MELD score for predicting HBV-ACLF complicated with SBP was 0.774,sensitivity was 80.2%,and specificity was 65.1%,while the AUC for predicting clinical prognosis was 0.814,sensitivity was 75%,and specificity was 76.2%.HBV-ACLF patients in high SII group were more likely to be complicated with SBP,hepatorenal syndrome and gastrointestinal bleeding during the course of disease,and the clinical outcome was worse(P＜0.05).The short-term survival rate of low SII and MELD group was higher(P＜0.01).Conclusions SII,combined with ascites and MELD score are independent risk factors for HBV-ACLF complicated with SBP,and SII combined with MELD score is a good predictor of SBP occurrence and prognosis in patients with HBV-ACLF.
Keywords：systemic immunoinflammatory indexmodel for end-stage liver diseasehepatitis b virusacute-on-chronic liver failurespontaneous bacterial peritonitisprognosisforecast
Publication Date：2023-12-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 503-508 )