Development and Validation of a New Model Including Inflammation Indexes for the Long‐Term Prognosis of Hepatitis B‐Related Acute‐On‐Chronic Liver Failure

ABSTRACT Acute‐on‐chronic liver failure (ACLF) is a severe condition characterized by a systemic inflammatory response and associated with high mortality. Currently, there is no reliable prediction model for long‐term prognosis in ACLF. This study aimed to develop and validate a prognostic model incorporating inflammation indexes to predict the long‐term outcome of patients with hepatitis B virus‐related ACLF (HBV‐ACLF). A retrospective analysis of clinical data from HBV‐ACLF patients ( n = 986) treated at the Third Affiliated Hospital of Sun Yat‐sen University between January 2014 and December 2018 was conducted. Patients were randomly divided into training ( n = 690) and validation ( n = 296) cohorts. The Least Absolute Shrinkage and Selection Operator (LASSO) and Cox regression analyses were used to identify independent risk factors for long‐term mortality. The following variables were identified as independent predictors of long‐term mortality: age, cirrhosis, hepatic encephalopathy, total bilirubin (TBIL), international normalized ratio (INR), monocyte‐to‐lymphocyte ratio (MLR), and neutrophil‐to‐platelet ratio (NPR). A novel nomogram was established by assigning weights to each variable. The C‐index of the nomogram was 0.777 (95% confidence interval [CI]: 0.752–0.802). In the training set, the area under the curve (AUC) for predicting mortality at 1, 3, and 12 months was 0.841 (95% CI: 0.807–0.875), 0.827 (95% CI: 0.796–0.859), and 0.829 (95% CI: 0.798–0.859), respectively. The nomogram demonstrated superior predictive performance for 12‐month survival compared to the model for end‐stage liver disease (MELD) score (0.767, 95% CI: 0.730–0.804, p < 0.001) and the clinical overt sepsis in acute liver failure clinical practice Guidelines‐ACLF II score (0.807, 95% CI: 0.774–0.840, p = 0.028). Finally, calibration curves and decision curve analysis (DCA) confirmed the clinical utility of the nomogram. The novel inflammation‐based scoring system, incorporating MLR and NPR, effectively predicts long‐term mortality in HBV‐ACLF patients.