Monocyte-to-Platelet Ratio Shows Modestly Improved Discrimination Over Model for End-Stage Liver Disease (MELD) 3.0 in Predicting 1-Year Mortality in Patients With Chronic Liver Failure and Hepatic Encephalopathy.

Background This study aimed to develop a noninvasive prognostic model to predict 1-year mortality in patients with chronic liver failure (CLF) and hepatic encephalopathy (HE). Methods Clinical data from 285 patients with CLF and HE admitted between January 2010 and April 2024 were analyzed. Multivariate logistic regression analysis was performed to identify independent risk factors associated with 1-year mortality. Results Among the 285 patients, 99 (34.7%) died within one year of follow-up. Compared with survivors, non-survivors were older (Z = 3.585, P < 0.01) and had significantly higher Model for End-Stage Liver Disease (MELD), MELD sodium (MELD-Na), and MELD 3.0 scores (Z = 2.863, 2.768, and 2.849, respectively; all P < 0.01). Multivariate regression analysis identified age, monocyte-to-platelet ratio (MPR), lymphocyte count, and alanine aminotransferase (ALT) levels as independent predictors of 1-year mortality (all P < 0.01). A novel prognostic model, Model_age_MPR_Lym_ALT, was developed, demonstrating superior discriminatory power compared to Child-Pugh, MELD, MELD-Na, and MELD 3.0 scores (all P < 0.01). Based on an optimal cutoff value of 0.352, patients were stratified into low-risk (<0.352) and high-risk (≥0.352) groups, with 1-year mortality rates of 21.38% (34/159) and 51.59% (65/126), respectively. Additionally, stratification by age (≥65 years vs. <65 years) demonstrated that the novel model outperformed the traditional scores in the older subgroup. Conclusion The proposed noninvasive model, incorporating age, MPR, ALT, and lymphocyte count, may serve as a practical and reliable tool for predicting 1-year mortality in patients with chronic liver failure and hepatic encephalopathy. However, given the retrospective, single-center design, these findings lack external validation and require confirmation in prospective multicenter studies.