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Abstract
BackgroundFewer than 50% of patients with acute-on-chronic liver failure (ACLF) recover spontaneously, and ACLF has high mortality without liver transplantation. Oxidative stress has been shown to mediate hepatic inflammation during acute liver failure (ALF). We wanted to see if a biomarker for oxidative stress might be used to measure the severity and prognosis of ACLF patients.MethodsA retrospective cohort of 124 ACLF patients, as well as healthy individuals, liver cirrhosis and ALF patients, was studied between January 2015 and September 2018. The levels of plasma superoxide dismutase (SOD) were detected using an ELISA commercial kit, and the Kaplan–Meier method was used for survival analysis.ResultsPatients with ACLF had statistically higher plasma SOD levels than the controls did (healthy controls and liver cirrhosis patients); however, the levels did not differ from those in patients with ALF. The plasma SOD level may be an inexpensive, easily accessible, and significant independent prognostic index for mortality on multivariate analysis (HR = 1.201, 95% CI 1.001–1.403, P < 0.01) as well as the model for end-stage liver disease (MELD) score. A level of SOD > 428 U/mL was linked to a statistically significant increase in the likelihood of death or liver transplantation in ACLF patients. Combination of plasma SOD levels and MELD scores improved performance in measuring the severity and prognosis of ACLF patients.ConclusionPatients with ACLF can be classified into high-risk and low-risk groups based on their plasma SOD levels at the time of admission to the hospital. The patient outcome is more closely connected with the combination of SOD level and MELD score than either value alone. This approach might be used to predict patient prognoses and prioritize liver transplant candidates.
Highlights
Fewer than 50% of patients with acute-on-chronic liver failure (ACLF) recover spontaneously, and ACLF has high mortality without liver transplantation
Association of plasma superoxide dismutase (SOD) levels with oxidative stress We previously found that the cytokine and chemokine levels vary during acute liver failure (ALF), and we observed a significantly decreased SOD level during the remission stage compared to the progression stage in ALF patients [8]
In the present study we found that patients with ACLF based on alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) showed increased plasma SOD with disease progression (14 days after hospital admission), while ACLF patients due to chronic hepatitis B (CHB) infection tend to recover with a decreased SOD level
Summary
Fewer than 50% of patients with acute-on-chronic liver failure (ACLF) recover spontaneously, and ACLF has high mortality without liver transplantation. Oxidative stress is believed to play an important role in liver failure [4]. Recent studies have shown that scoring systems for assessing severity and disease outcomes of ACLF have been developed [7]. All of these methods, focus on compromised liver functioning, but few research have focused on disease pathogenesis, the increased systemic oxidative stress associated with ACLF. Since reactive oxygen species (ROS) play a role in ACLF, we wonder if a biomarker for oxidative stress may aid in forecasting the disease’s severity, mortality, and prognosis
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