A nomogram for predicting prognostic value of inflammatory biomarkers in patients with acute-on-chronic liver failure

Clin Chim Acta. 2018 Mar:478:7-12. doi: 10.1016/j.cca.2017.12.018. Epub 2017 Dec 13.


Background: Hepatitis 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.

Methods: The 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.

Results: A 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.

Conclusions: The proposed nomogram with NLR resulted in more accurate prognostic prediction for patients with HBV-related ACLF.

Keywords: HBV-related ACLF; Neutrophil to lymphocyte ratio; Nomogram.

MeSH terms

  • Acute-On-Chronic Liver Failure / diagnosis*
  • Acute-On-Chronic Liver Failure / mortality
  • Acute-On-Chronic Liver Failure / pathology
  • Acute-On-Chronic Liver Failure / virology
  • Adult
  • Biomarkers / analysis*
  • Cell Count
  • China
  • Hepatitis B virus
  • Humans
  • Lymphocyte Count
  • Middle Aged
  • Neutrophils / cytology
  • Nomograms*
  • Prognosis
  • Retrospective Studies
  • Survival Rate


  • Biomarkers