Abstract
Background and Aims: Acute-on-chronic liver failure (ACLF) is a rare, but dramatic clinical syndrome. There is substantial evidence suggesting that immunity-mediated inflammation plays an important role in HBV-ACLF. Our aim was to characterize the proportion and cell counts of peripheral blood lymphocyte subsets in acute-on-chronic liver failure patients caused by HBV infection.Methods: One hundred and seventeen patients were enrolled in this study, including those with HBV-related ACLF (HBV-ACLF; n = 70), and HBV related non-ACLF patients (HBV non-ACLF; n = 47). Demographics, clinical and laboratory data at hospital admission were retrospectively analyzed. The percentage and cell count of peripheral lymphocyte subsets were evaluated by flow cytometry. Comparison analysis was performed by t-test or non-parametric Mann–Whitney U-test. Actuarial probabilities of death were calculated by the Kaplan-Meier method.Results: Both circulating lymphocyte count and lymphocyte percentage were significantly reduced in patients with HBV-ACLF (P < 0.001). The CD8+ T cell, CD4+ T cell, and CD16+CD56+ NK cell counts were significantly decreased in HBV-ACLF. Consistently, flow cytometric analysis showed that CD8+ T cell counts were significantly decreased in non-survivors, while no significant differences were found in CD4+ T cell, CD19+ B cell, or CD56+CD16+ NK cell counts. Furthermore, the group with the lower CD8+ T cell count displayed a significantly higher mortality rate compared with the group with the higher CD8+ T cell count.Conclusions: The abnormal prevalence of lymphocyte subsets may be important in the pathogenesis of HBV-ACLF. The decrease in CD8+ T cell counts may be related to poor survival in HBV-ACLF patients.
Highlights
Acute-on-chronic liver failure (ACLF) is a rare, but dramatic clinical syndrome characterized by massive hepatocyte death leading to multiorgan failure in patients with pathological damage caused by chronic liver disease [1]
There were no significant differences in age, gender, creatinine, HBeAg positive ratio and hepatitis B virus (HBV) DNA load between the two groups
HBV-related ACLF patients displayed higher levels of ALT, AST, total bilirubin and international normalized ratio (INR), but lower levels of albumin and decreased platelet count compared with non-ACLF group
Summary
Acute-on-chronic liver failure (ACLF) is a rare, but dramatic clinical syndrome characterized by massive hepatocyte death leading to multiorgan failure in patients with pathological damage caused by chronic liver disease [1]. Several reports on the immune pathogenesis of chronic HBV infection have suggested that CD8+ T cells, CD4+ T cells, and NK cells as well as cytokines participate in the development of liver injury [9,10,11,12,13]. Zou et al [14] characterized lymphocyte subsets in peripheral blood and liver tissue, and reported that the abnormal distribution of circulating and liver-infiltrating immune competent cells may be an important factor for the development of HBVrelated ACLF. This study focused on the proportion and number of peripheral blood lymphocyte subsets in HBVrelated ACLF patients to characterize changes in immune status and clarify the correlation between liver injury and its immunological characteristics. Our aim was to characterize the proportion and cell counts of peripheral blood lymphocyte subsets in acute-on-chronic liver failure patients caused by HBV infection
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