Abstract: Objective To explore the predictive value of neutrophil-to-lymphocyte ratio (nlr) and international normalized ratio (INR) in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF),aiming to provide simple and practical early assessment indicators for clinical use. Method A retrospective study was conducted on 210 patients with HBV-ACLF who were admitted to the Department of Hepatology at Chengdu Public Health Clinical Medical Center from January 2021 to December 2022. Based on the 28-day follow-up outcomes, the patients were divided into the survival group (n=148) and non-survivor group (n=62). Clinical characteristics and laboratory parameters were compared between the two groups. Multivariate logistic regression analysis was performed to identify factors influencing treatment outcomes in HBV-ACLF patients. Result Compared to the survival group, the non-survival group exhibited significantly higher incidences of complications such as hepatic encephalopathy, gastrointestinal bleeding, and ascites, along with elevated levels of INR and NLR (P<0.05). Multivariate logistic regression analysis identified NLR, INR, and hepatic encephalopathy as independent risk factors influencing short-term prognosis in HBV-ACLF patients. Further analysis based on NLR and INR quartiles revealed that patients with NLR >6.73 and INR >2.45 had significantly increased 28-day mortality rates. Even after adjusting for confounding factors such as age, sex, and complications, NLR and INR remained independent predictors of short-term mortality in HBV-ACLF patients. Conclusion NLR,INR,and hepatic encephalopathy are independent risk factors for short-term prognosis in HBV-ACLF patients. NLR and INR can serve as simple and effective predictive indicators for assessing the early mortality risk in HBV-ACLF patients.

Key words: Neutrophil-to-lymphocyte ratio, International normalized ratio, Hepatitis B virus, Acute-on-chronic liver failure, Prognosis