A Systemic Inflammation Response Index (SIRI)-based nomogram for predicting the prognosis of hepatitis B virus-related acute-on-chronic liver failure: a retrospective cohort study

Systemic inflammatory response is closely linked to the development and prognosis of liver failure. This study aimed to establish a prognostic model incorporating inflammatory markers, including the systemic inflammation response index (SIRI), defined as neutrophil count × monocyte count / lymphocyte count, to assess outcomes in patients with hepatitis B virus–related acute-on-chronic liver failure (HBV-ACLF). A retrospective analysis was conducted on HBV-ACLF patients admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2019 to December 2022. Patients were classified by 28-day and 90-day outcomes. Baseline clinical data, hematologic, biochemical, and coagulation parameters were collected. Univariate logistic regression was first performed, followed by multivariate logistic regression with a backward stepwise approach. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. A total of 321 patients (86.6% male; mean age 46.21 ± 12.46 years) were included, with 28-day and 90-day mortality rates of 16.51% and 24.92%. Non-survivors were older and had higher SBP, SIRI, Cr, BUN, INR, and higher rates of hypertension, decompensated cirrhosis, hepatic encephalopathy, and bacterial infection (all P < 0.05). Multivariate analysis identified SBP, SIRI, Cr, BUN, and INR as independent predictors of both outcomes, while age, lower HDL, and LDL were additionally associated with 90-day mortality. Nomograms showed good calibration and discrimination (AUCs 0.866 and 0.897) and high clinical utility. SIRI remained independently associated with mortality after full adjustment. SIRI is significantly associated with the risk of HBV-ACLF mortality, and the nomogram provides an objective tool for identifying high-risk patients and supporting individualized management.