[The application value of NRS-2002 combined with L3-SMI in the prognosis of HBV-ACLF patients]

Objective: To explore the significance of nutrition risk screening 2002 (NRS-2002) and L3 skeletal muscle index (L3-SMI) in predicting 90-day mortality in patients with hepatitis B-related acute-on-chronic liver failure (HBV-ACLF). Methods: A retrospective analysis was conducted on 162 patients with HBV-ACLF who were treated at the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2023. Based on their survival status within 90 days of diagnosis, patients were divided into two groups: the survival group and the death group. A binary logistic regression model was used to identify factors associated with mortality, and receiver operating characteristic (ROC) curves were used to assess the predictive value of NRS-2002 and L3-SMI for 90-day mortality in HBV-ACLF patients. Results: There were statistically significant differences in lymphocyte count(LY), platelets (PLT), total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, international normalized ratio(INR), total bilirubin(TBil), urea, model for end-stage liver disease,MELD, NRS-2002, and L3-SMI between the two groups (P<0.05). Multivariate analysis revealed that independent risk factors for 90-day mortality in HBV-ACLF patients included higher INR(OR=4.412, 95%CI: 1.974-9.959, P<0.001), higher TBil(OR=1.004, 95%CI: 1.001-1.007, P=0.002), higher MELD score (OR=1.148, 95%CI: 1.071-1.232, P<0.001), and higher NRS-2002 score (OR=1.526, 95%CI: 1.194-1.950, P<0.001), lower LY (OR=0.351, 95%CI: 0.103-0.755, P<0.001), and L3-SMI (OR=0.902, 95%CI: 0.854-0.953,P<0.001). TThe ROC curve analysis showed an AUC of 0.706 for L3-SMI and 0.712 for NRS-2002. The optimal cutoff point for the mortality of 90-day mortality prediction model, based on multivariate logistic analysis, was 0.5, with an AUC of 0.841 (95%CI: 0.763-0.926), which was significantly higher than when MELD, NRS-2002, and L3-SMI were used individually. Conclusion: the lower L3-SMI and higher NRS-2002 are associated with the risk of 90-day death in patients with HBV-ACLF. The SNM model has predictive value for 90-day mortality in these patients.