Monocyte-to-HDL ratio predicts 30-day mortality in middle-aged and elderly patients with HBV-related decompensated cirrhosis

To evaluate the prognostic value of monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for 30-day mortality in middle-aged and elderly patients with hepatitis B virus-related decompensated cirrhosis (HBV-DeCi). This single-center and retrospective cohort study analyzed 244 middle-aged and elderly patients with HBV-DeCi. We compared routine blood parameters, coagulation, hepatic, and renal function parameters between survivors and non-survivors. Feature selection was performed using LASSO regression, with independent risk factors subsequently identified through multivariate logistic regression analysis. Among the cohort (median age 55 years), non-survivors exhibited significantly elevated MHR (monocyte-to-HDL ratio) levels (median 2.62 vs. 0.43, p < 0.001). Multivariate analysis confirmed MHR as an independent 30-day mortality predictor (Odds Ratio (OR) = 1.862, 95% confidence interval (CI): 1.354–2.561, p < 0.001). An integrated model combining the Model for End-Stage Liver Disease (MELD) score with MHR demonstrated superior predictive performance (area under the curve (AUC) = 0.917) in this middle-aged and elderly population, though the difference did not reach statistical significance (DeLong test, p > 0.05). MHR serves as a potential prognostic biomarker in middle-aged and elderly HBV-DeCi patients. The Model for End-Stage Liver Disease (MELD) + MHR model provides enhanced risk stratification for this vulnerable age group, which may facilitate early intervention and optimize resource allocation.