Hepatol Res. 2018 Sep 24. doi: 10.1111/hepr.13251. [Epub ahead of print]
Prognostic Utility of Novel Biomarkers in Acute-on-chronic Liver Failure (ACLF) Associated with Hepatitis B: A Multicenter Prospective Study.
Zhao R1, Wu W1, Zhou Z2, Zheng X3, Sun W4, Shi Y5, Yu H1,6, Wang F7, Zhao H1, Sun S1, Jin L1, Sheng J1, Shi Y1.
Author information
1
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
2
Department of Infectious Diseases, Shulan Hospital, Hangzhou, 310004, China.
3
Department of Hepatology, Ningbo No.2 Hospital, School of Medicine, Ningbo University, Ningbo, 315010, China.
4
Department of Epidemiology and Health Statistics, Zhejiang University School of Public Health, Hangzhou, 310058, China.
5
Department of Infectious Diseases, Yuyao People's Hospital, Yuyao, 315400, China.
6
Department of Infectious Diseases, Yiwu Central Hospital, Yiwu, 322000, China.
7
Department of Infectious Diseases, Ningbo Beilun People's Hospital, Beilun, 315800, China.
Abstract
BACKGROUND:
Flare-ups of chronic hepatitis B (CHB) can sometimes be severe and even progress to acute-on-chronic liver failure (ACLF), with high short-term mortality. A timely estimation of the risk of death should be initiated early. The aim of the present study was to determine whether novel biomarkers add prognostic information beyond current clinical scoring systems.
METHODS:
Patients with HB-ACLF were prospectively enrolled from five hospitals between August 2017 and March 2018. Their plasma was screened for sCD163, Neutrophil gelatinase-associated lipocalin (NGAL) and copeptin. The association between these biomarkers and mortality was analyzed. And the performance of MELD, APASL-ACLF Research Consortium score (AARC-ACLF score) and the CLIF Consortium ACLF score (CLIF-C ACLFs) with or without biomarkers were compared.
RESULTS:
151 patients were enrolled. Advanced ACLF patients had significantly higher levels than early ACLF individuals of plasma biomarkers sCD163 (P=0.001), NGAL (P=0.006) and copeptin (P=0.049). 34 deaths occurred during the 28-day follow-up period (22.5%). sCD163 and NGAL showed a strong independent association with 28-day mortality, while copeptin did not. Scoring systems incorporating sCD163 and NGAL had better discrimination and calibration, as measured by AuROCs, the Akaike information criteria (AIC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
CONCLUSIONS:
sCD163 and NGAL are independently associated with short-term mortality in hepatitis B-associated ACLF. Use of a combination of sCD163 and NGAL improves prognostication.
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