[Application value of NRS-2002 combined with L3-SMI in the prognosis of patients with hepatitis B-related acute-on-chronic liver failure].

Abstract

Objective: To explore the predictive value of nutrition risk screening score 2002 (NRS-2002) and L3 skeletal muscle index (L3-SMI) for mortality within 90 days in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF). Methods: A retrospective analysis was conducted on 162 cases with HBV-ACLF who were diagnosed and treated at the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2023. Patients were divided into a survival and death group according to the 90-day survival status following diagnosis, and the clinical data between the two groups were compared. Binary logistic regression analysis was used to screen out the influencing factors related to the occurrence of mortality events. The receiver operating characteristic (ROC) curve was plotted to compare the predictive value of NRS-2002 and L3-SMI for mortality within 90 days in patients with HBV-ACLF. Results: There were statistically significant differences in lymphocyte count (LY), platelet (PLT), total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, international normalized ratio (INR), total bilirubin (TBil), urea, model for end-stage liver disease (MELD) score, NRS-2002 score, and L3-SMI between the death and the survival group (P<0.05). Multivariate analysis showed that higher levels of INR [odds ratio (OR)=4.412, 95% confidence interval (CI): 1.974-9.959, P<0.001], TBil (OR=1.004, 95%CI: 1.001-1.007, P<0.05), MELD score (OR=1.148, 95%CI: 1.071-1.232, P<0.001), NRS-2002 score (OR=1.526, 95%CI: 1.194-1.950, P<0.05), and lower levels of LY (OR=0.351, 95%CI: 0.103-0.755, P<0.01), and L3-SMI (OR=0.902, 95%CI: 0.854-0.953, P<0.001) were independent risk factors for 90-day mortality in patients with HBV-ACLF. The ROC curve showed that AUCL3-SMI was 0.706 and AUCNRS-2002 was 0.712. Multivariate logistic analysis showed that the optimal cutoff point for the prediction of 90-day mortality was 0.5. The area under the ROC curve was 0.841 (95%CI: 0.763-0.926), which was significantly higher than the single application of the MELD, NRS-2002, and L3-SMI indicators. Conclusion: The 90-day mortality risk has a correlation with low L3-SMI and high NRS-2002 scores in patients with HBV-ACLF. The SNM model has a certain predictive value for mortality within 90 days in patients with HBV-ACLF.