Diagnostic value of PNI and MLR in cirrhotic patients with negative HBV DNA and positive HBV RNA:A nomogram--based evaluation model
- 1Department of Clinical Laboratory, the Second People's Hospital of Fuyang City , ,
Abstract
Introduction: To investigate the diagnostic significance of the Prognostic Nutritional Index (PNI) and the Monocyte-to-Lymphocyte Ratio (MLR) for the development of cirrhosis in patients with HBV DNA-negative, HBV RNA-positive hepatitis B, and to evaluate their clinical application value.
Methods: A total of 87 patients with HBV DNA-negative, HBV RNA-positive hepatitis B who developed cirrhosis and were admitted to the patients from the Second People's Hospital of Fuyang City between March 2024 and March 2025 were enrolled as the observation group. Additionally, 96 patients with HBV DNA-negative and HBV RNA-positive hepatitis B during the same period were selected as the control group. Liver function, AFP levels, and five-part differential blood counts were measured in both groups. The PNI and MLR were calculated and compared between the two groups. ROC curves were plotted to analyze the sensitivity and specificity of PNI and MLR in diagnosing cirrhosis in patients with HBV DNA-negative, HBV RNA-positive hepatitis B, and their correlations were assessed. Furthermore, a nomogram model was established to evaluate the predictive ability of these two indicators for concomitant cirrhosis in this patient population, and the model was validated using a diagnostic calibration curve.
Results: In No statistically significant differences were observed between the observation and control groups in terms of age, sex, ALT, ALP, or AFP levels (P > 0.05). Compared with the control group, patients in the observation group showed significantly lower levels of inflammatory markers (white blood cell, lymphocyte, and monocyte counts), nutritional markers (TP, ALB, PA), and PNI, while levels of AST, GGT and MLR were significantly higher (P < 0.05). A significant negative correlation was observed between PNI and MLR levels in the observation group (r = −0.484, P < 0.001). ROC curve analysis revealed that the areas under the curve of PNI and MLR for diagnosing cirrhosis in patients with HBV DNA-negative, HBV RNA-positive hepatitis B were 0.821 and 0.743, with sensitivities of 0.958 and 0.854, respectively (P < 0.001). The additional analyses convincingly demonstrate that PNI and MLR offer incremental clinical value beyond the widely used FIB-4 and APRI scores. Logistic regression analysis indicated that PNI overexpression was a protective factor for cirrhosis in this patient population. The calibration curve demonstrated good agreement between predicted and observed outcomes, and decision curve analysis suggested a positive net benefit for the clinical application of this model.
Conclusion: The Prognostic Nutritional Index and the monocyte-to-lymphocyte ratio can serve as sensitive and effective biomarkers for the diagnosis of cirrhosis in patients with HBV DNA-negative, HBV RNA-positive hepatitis B. The established nomogram model provides a reference for the clinical diagnosis of cirrhosis in this patient population.
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BibTeX
@article{li2026diagnostic,
title = {{Diagnostic value of PNI and MLR in cirrhotic patients with negative HBV DNA and positive HBV RNA:A nomogram--based evaluation model}},
author = {Minying Li and Yan Fang and Yuhong Han and Tuantuan Li and Yan Liu and Lichang Chen},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1919910},
url = {https://europepmc.org/article/PMC/PMC13724459},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diagnostic value of PNI and MLR in cirrhotic patients with negative HBV DNA and positive HBV RNA:A nomogram--based evaluation model
AU - Minying Li
AU - Yan Fang
AU - Yuhong Han
AU - Tuantuan Li
AU - Yan Liu
AU - Lichang Chen
PY - 2026
DA - 2026/10/19
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1919910
UR - https://europepmc.org/article/PMC/PMC13724459
AB - Introduction: To investigate the diagnostic significance of the Prognostic Nutritional Index (PNI) and the Monocyte-to-Lymphocyte Ratio (MLR) for the development of cirrhosis in patients with HBV DNA-negative, HBV RNA-positive hepatitis B, and to evaluate their clinical application value. Methods: A total of 87 patients with HBV DNA-negative, HBV RNA-positive hepatitis B who developed cirrhosis and were admitted to the patients from the Second People's Hospital of Fuyang City between March 2024 and March 2025 were enrolled as the observation group. Additionally, 96 patients with HBV DNA-negative and HBV RNA-positive hepatitis B during the same period were selected as the control group. Liver function, AFP levels, and five-part differential blood counts were measured in both groups. The PNI and MLR were calculated and compared between the two groups. ROC curves were plotted to analyze the sensitivity and specificity of PNI and MLR in diagnosing cirrhosis in patients with HBV DNA-negative, HBV RNA-positive hepatitis B, and their correlations were assessed. Furthermore, a nomogram model was established to evaluate the predictive ability of these two indicators for concomitant cirrhosis in this patient population, and the model was validated using a diagnostic calibration curve. Results: In No statistically significant differences were observed between the observation and control groups in terms of age, sex, ALT, ALP, or AFP levels (P > 0.05). Compared with the control group, patients in the observation group showed significantly lower levels of inflammatory markers (white blood cell, lymphocyte, and monocyte counts), nutritional markers (TP, ALB, PA), and PNI, while levels of AST, GGT and MLR were significantly higher (P < 0.05). A significant negative correlation was observed between PNI and MLR levels in the observation group (r = −0.484, P < 0.001). ROC curve analysis revealed that the areas under the curve of PNI and MLR for diagnosing cirrhosis in patients with HBV DNA-negative, HBV RNA-positive hepatitis B were 0.821 and 0.743, with sensitivities of 0.958 and 0.854, respectively (P < 0.001). The additional analyses convincingly demonstrate that PNI and MLR offer incremental clinical value beyond the widely used FIB-4 and APRI scores. Logistic regression analysis indicated that PNI overexpression was a protective factor for cirrhosis in this patient population. The calibration curve demonstrated good agreement between predicted and observed outcomes, and decision curve analysis suggested a positive net benefit for the clinical application of this model. Conclusion: The Prognostic Nutritional Index and the monocyte-to-lymphocyte ratio can serve as sensitive and effective biomarkers for the diagnosis of cirrhosis in patients with HBV DNA-negative, HBV RNA-positive hepatitis B. The established nomogram model provides a reference for the clinical diagnosis of cirrhosis in this patient population.
SN - 2296-858X
ER -