急性重型病毒性肝炎患者CAR、CLR、SIRI变化及其对不良预后的评估效能OA

Objective To investigate the trends in levels of C-reactive protein/albumin ratio(CAR),C-reactive pro-tein/lymphocyte ratio(CLR),and systemic inflammatory response index(SIRI)and their efficacy in assessing adverse out-comes in patients with acute severe viral hepatitis.Methods This study is a prospective observational study.A total of 115 patients with acute severe viral hepatitis diagnosed and treated in the Department of Critical Infectious Diseases,the First Affil-iated Hospital of Xinjiang Medical University from June 2023 to March 2025 were selected as the study subjects.Based on their prognosis within 3 months after treatment,they were divided into a good prognosis group(n=81)and a poor prognosis group(n=34).Clinical data and the expression levels of neutrophil-to-lymphocyte ratio(NLR),SIRI,C-reactive protein(CRP),albumin(ALB),CAR,and CLR were measured and compared between the two groups.Spearman correlation analysis and multivariate logistic regression analysis were used to identify risk factors for short-term poor prognosis in patients with acute severe viral hepatitis,and the combined assessment efficacy of these risk factors was evaluated.Results The proportion of patients with hepatic encephalopathy,as well as the levels of ALT,CRP,CAR,CLR,and SIRI,were significantly higher in the poor prognosis group compared to the good prognosis group.In contrast,prothrombin activity(PTA)and ALB levels were significantly lower(x2/t/P=4.338/0.037,6.137/＜0.001,6.093/＜0.001,6.001/＜0.001,8.193/＜0.001,5.998/＜0.001,6.990/＜0.001,9.023/＜0.001).Spearman correlation analysis revealed that the presence of hepatic encephalopathy,ALT,CRP,CAR,CLR,and SIRI levels were positively correlated with short-term poor prognosis,whereas PTA and ALB levels were negatively correlated(rs/P=0.194/0.038,0.294/0.003,-0.299/0.001,0.492/＜0.001,-0.366/＜0.001,0.439/＜0.001,0.484/＜0.001,0.440/＜0.001).Ele-vated CAR,CLR,and SIRI were identified as significant independent risk factors for short-term poor prognosis[OR(95％CI)=2.788(1.036-5.756),4.413(1.665-7.701),3.185(2.757-5.790)].The areas under the curve(AUC)for CAR,CLR,SIRI,and their combination in predicting short-term poor prognosis were 0.777,0.806,0.779,and 0.948,respectively.The combined pre-dictive model demonstrated the highest efficacy(Z=5.321,5.013,5.320;all P＜0.001).Conclusion Higher levels of CAR,CLR,and SIRI in patients with acute severe viral hepatitis are closely associated with short-term poor prognosis.Close moni-toring of these indicators can effectively assess the clinical outcomes of these patients and holds value in guiding clinical treat-ment.