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Background <p>Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is associated with dyslipidemia and inflammatory responses. However, the association between a novel comprehensive lipid parameter, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), and clinical outcomes in HBV-ACLF remains unclear. This study aimed to investigate the relationship between NHHR and 28- and 90-day transplant-free (TF) mortality among patients with HBV-ACLF.</p> Methods <p>This study retrospectively enrolled 452 patients with HBV-ACLF from the First Affiliated Hospital of Anhui Medical University between January 2017 and June 2024. Clinical data at admission and follow-up outcomes at 28 and 90 days were collected. Multivariable Cox regression and restricted cubic splines (RCS) were employed to investigate the association between NHHR and 28- and 90-day TF mortality. A segmented Cox proportional hazards model was applied to examine the threshold effect. Stratified analysis was conducted to evaluate the relationship between NHHR and prognosis across different subgroups. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of NHHR with other lipid indicators. Kaplan–Meier survival curves were compared between groups using the log-rank test.</p> Results <p>Multivariable Cox regression and RCS analyses revealed a nonlinear relationship between NHHR and the risk of mortality. A segmented Cox model was exploratorily fitted to approximate the apparent change in slope, yielding estimated change-points of 10.87 for 28-day and 11.21 for 90-day TF mortality. The findings remained generally consistent across subgroup analyses. Compared with conventional lipid parameters, NHHR showed the highest AUC for predicting 28-day and 90-day TF mortality (0.756 and 0.748), with similar 1,000-bootstrap optimism-corrected AUCs (0.757 and 0.749), and its performance was not significantly different from the MELD or COSSH-ACLF II scores (all DeLong <i>P</i> &gt; 0.05).</p> Conclusion <p>Elevated NHHR was significantly associated with 28- and 90-day TF mortality in patients with HBV-ACLF. As an easily calculated index, NHHR may aid early risk stratification alongside established prognostic scores.</p> Clinical trial number <p>Not applicable.</p>

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Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and short-term outcomes in hepatitis B virus-related acute-on-chronic liver failure

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月21日

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  • Zhenxing Li,
  • Shucheng Du,
  • Chao Zhang,
  • Chenyue Shen,
  • Yufeng Gao

摘要

Background

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is associated with dyslipidemia and inflammatory responses. However, the association between a novel comprehensive lipid parameter, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), and clinical outcomes in HBV-ACLF remains unclear. This study aimed to investigate the relationship between NHHR and 28- and 90-day transplant-free (TF) mortality among patients with HBV-ACLF.

Methods

This study retrospectively enrolled 452 patients with HBV-ACLF from the First Affiliated Hospital of Anhui Medical University between January 2017 and June 2024. Clinical data at admission and follow-up outcomes at 28 and 90 days were collected. Multivariable Cox regression and restricted cubic splines (RCS) were employed to investigate the association between NHHR and 28- and 90-day TF mortality. A segmented Cox proportional hazards model was applied to examine the threshold effect. Stratified analysis was conducted to evaluate the relationship between NHHR and prognosis across different subgroups. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive performance of NHHR with other lipid indicators. Kaplan–Meier survival curves were compared between groups using the log-rank test.

Results

Multivariable Cox regression and RCS analyses revealed a nonlinear relationship between NHHR and the risk of mortality. A segmented Cox model was exploratorily fitted to approximate the apparent change in slope, yielding estimated change-points of 10.87 for 28-day and 11.21 for 90-day TF mortality. The findings remained generally consistent across subgroup analyses. Compared with conventional lipid parameters, NHHR showed the highest AUC for predicting 28-day and 90-day TF mortality (0.756 and 0.748), with similar 1,000-bootstrap optimism-corrected AUCs (0.757 and 0.749), and its performance was not significantly different from the MELD or COSSH-ACLF II scores (all DeLong P > 0.05).

Conclusion

Elevated NHHR was significantly associated with 28- and 90-day TF mortality in patients with HBV-ACLF. As an easily calculated index, NHHR may aid early risk stratification alongside established prognostic scores.

Clinical trial number

Not applicable.