Abstract
BACKGROUND/OBJECTIVES: The prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is significantly affected by inflammatory state and immune dysregulation. The systemic inflammatory response index (SIRI), which reflects neutrophil, monocyte, and lymphocyte dynamics, has emerged as a potential marker of immune-inflammatory status. However, its role in predicting HBV-ACLF outcomes remains unclear. This research aims to elucidate the prognostic value of SIRI and its dynamic changes combined with disease severity scores in predicting the outcomes of HBV-ACLF. METHODS: The study included HBV-ACLF patients enrolled in a multicenter clinical study between July 2019 and April 2024. Based on 90-day outcomes, the participants were categorized into survival and death groups. Clinical data and SIRI values were collected on days 0 (baseline), 3, 7, and 14. Independent prognostic factors were identified using Cox regression and least absolute shrinkage and selection operator (LASSO) analysis. The predictive value of dynamic SIRI changes combined with disease severity scores was evaluated using receiver operating characteristic (ROC) curves. RESULTS: A total of 153 patients with HBV-ACLF were analyzed, including 104 in the survival group and 49 in the death group. SIRI values were significantly lower in the survival group than in the death group across all time points. Multivariate Cox regression analysis identified that an increased ΔSIRI at day 3 (ΔSIRI3), a higher MELD score, and a lower albumin level were independently associated with increased 90-day mortality. The combination of SIRI on day three (SIRI3) and MELD-Na score on day three (MELD-Na3) demonstrated the highest predictive performance, with an AUC of 0.817 (95% CI: 0.750-0.883). CONCLUSIONS: The combination of the SIRI and MELD-Na score on day three provides a strong predictive value for the short-term prognosis of HBV-ACLF, highlighting its potential utility in early prognostic evaluation.