Abstract: Objective To explore the diagnostic and predictive value of peripheral blood neutrophil to lymphocyte ratio (NLR) and neutrophil CD64 (nCD64) in the secondary infection and short-term prognosis of hepatitis B virus-related chronic and acute liver failure (HBV-ACLF).Methods The clinical data of 85 HBV-ACLF patients admitted between July 2018 and July 2020 was retrospective analyzed. They were divided into an infected group (45 cases) and a non-infected group (40 cases) according to whether they had secondary infection. Patients in the infected group were further divided into an improved group (29 cases) and a non-improved group (16 cases) based on the short-term prognosis of them after 3 months’ treatment. The peripheral blood samples of all patients within 24 hours after admission were collected to detect the levels of NLR and nCD64. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value and short-term prognostic value of the combined detection of peripheral blood NLR and nCD64 for secondary infection in HBV-ACLF patients.Results The levels of peripheral blood NLR [(10.33±3.16)%] and nCD64[(74.41±19.06)%] in the infected group were significantly higher than those in the non-infected group [(6.53±1.14)% vs (43.49±13.27)%] , The difference was statistically significant (P<0.05). ROC curve shows that peripheral blood NLR and nCD64 have a certain diagnostic value for secondary infection in HBV-ACLF patients (AUC=0.756, 0.789, P<0.01), and the combination of the two (AUC=0.837, P<0.01) has a higher diagnostic value. The peripheral blood NLR[(9.24±2.46)%] and nCD64[(72.67±15.71)%] levels of HBV-ACLF patients in the improved group were significantly lower than those in the non-improved group [(11.54±3.11)% vs (85.89±12.43)%], The difference was statistically significant (P<0.05). ROC curve shows that peripheral blood NLR and nCD64 have a certain predictive value for the short-term prognosis of secondary infection in HBV-ACLF patients (AUC=0.784, 0.765, P<0.01), and the combination of the two (AUC=0.823, P<0.01) has a higher predictive value.Conclusion Peripheral blood NLR and nCD64 can be used as indicators for the diagnosis of secondary infection in HBV-ACLF patients, and for the assessment of their short-term prognosis, and the efficacy is higher with a combined detection.

Key words: Peripheral blood, Neutrophil to lymphocyte ratio, Neutrophil CD64, Hepatitis B virus-related chronic acute liver failure, Secondary infection, Prognosis