Prognostic predictive value of indocyanine green 15-minute retention rate combined with plasma ammonia and end-stage liver disease model score in patients with HBV-associated slow plus acute liver failure

Corresponding author: WU Yunan, wufly2000@163.com

DOI: 10.12201/bmr.202507.00064

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  Abstract: Abstract:Objective: To evaluate the 90-day prognostic effect of indocyanine green retention rate at 15 minutes (ICG-R15) in combination with plasma ammonia and Model for End-Stage Liver Disease score (MELD score) in patients with Hepatitis B Virus-induced Slow plus Acute Liver Failure (HBV-ACLF). Methods: One hundred patients with HBV-ACLF admitted to the Department of Hepatology of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from July 2021 to November 2024 were retrospectively analyzed and divided into the survival group (n=70) and the death group (n=30) according to the 90-day survival outcome. Independent risk factors were screened by univariate and multivariate regression analyses, and the correlation between indicators was analyzed by Spearman analysis. Subjects work characteristic curves (ROC) were plotted to assess the predictive efficacy of single indicators and joint prediction models. Results: The age, TBIL, PT, INR, ICG-R15, blood ammonia concentration, and MELD score of patients in the death group were significantly higher than those in the survival group (P < 0.05). Multifactorial analysis confirmed that ICG-R15, blood ammonia, and MELD score were independent risk factors for 90-d death in HBV-ACLF patients (P < 0.05). Correlation studies showed that MELD score was positively correlated with ICG-R15 (r=0.314, P<0.01) and blood ammonia (r=0.237, P<0.05), as well as positively correlated between blood ammonia and ICG-R15 (r=0.268, P<0.01).ROC analysis showed that the AUCs for predicting 90-day prognosis for ICG-R15, blood ammonia and MELD score were 0.800, 0.831, and 0.803, respectively. In the two-by-two model, the AUCs of MELD+ICG-R15 and MELD+blood ammonia were elevated to 0.881 and 0.864, respectively, and the combination of the three had the highest AUC (0.914), with the sensitivity of 0.900, specificity of 0.857, and the Jordon index of 0.757 (95% CI: 0.850~0.979). 0.979). Conclusion: Elevated ICG-R15, blood ammonia and MELD score were closely associated with poor prognosis of HBV-ACLF, and the combined three-test model demonstrated high predictive value in short-term prognostic assessment.

  Key words: Acute-on-Chronic Liver Failure; Indocyanine Green 15-minute Retention Rate; Model for End-Stage Liver Disease Score; Prognostic Prediction; Combined Detection

  Submit time: 23 July 2025

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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