The value of NLR versus MLR in the short-term prognostic assessment of HBV-related acute-on-chronic liver failure

•Higher MLR values are associated with 90-day mortality in patients with HBV-ACLF, and MLR can be used as a novel predictive marker to predict the prognosis of HBV-ACLF.•The predictive efficacy of MLR and NLR for HBV-ACLF 90-day mortality was comparable. Compared with traditional prediction models, MLR and NLR have the advantages of reliability, economy and convenience for blood routine parameters.•Changes in lymphocyte counts in MLR values were dominated by changes in CD8 + T cells, and a decrease in CD8 + T cell counts may be associated with poor prognosis in patients with HBV-ACLF. More studies are needed in the future to confirm and explore the potential mechanisms of lymphocyte changes in the prognostic impact of HBV-ACLF patients. Systemic inflammation is associated with the development and progression of hepatitis B-associated acute-on-chronic liver failure (HBV-ACLF). The neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic biomarker in patients with HBV-ACLF. However, the role of the monocyte-to-lymphocyte ratio (MLR) as a prognostic inflammatory biomarker in multiple diseases is rarely mentioned in HBV-ACLF. We included a total of 347 patients with HBV-ACLF who met the definition of the Chinese Guidelines for the Diagnosis and Treatment of Liver Failure (2018 edition). Among them, 275 cases were included retrospectively, and 72 cases were collected prospectively. Clinical characteristics and laboratory examination data were collected from medical records within 24 h after diagnosis to calculate MLR and NLR levels, and lymphocyte subpopulation counts were collected in prospectively included patients. Of the 347 patients with HBV-ACLF, 128 patients in the non-surviving group had a mean age of 48.87 ± 12.89 years; 219 patients in the survival group had a mean age of 44.80 ± 11.80 years and a combined 90-day mortality rate of 36.9%. The median MLR was higher in the non-survivors than in the survivors (0.690 vs 0.497, P