Increased Serum Soluble Urokinase Plasminogen Activator Receptor Predicts Short-Term Outcome in Patients with Hepatitis B-Related Acute-on-Chronic Liver Failure.

Zuxiong Huang,Hanhui Ye,Ning Wang,Qiaorong Gan,Chen Pan,Baorong Liu,Shida Yang,Yi Chen,Shuiwen Huang

doi:10.1155/2019/3467690

Abstract

Aims Soluble urokinase plasminogen activator receptor (suPAR) reflects the immune activation in circumstances of inflammation and infection. It has been considered as a risk biomarker associated with poor outcome in various low-grade inflammation and infectious diseases. The study is aimed at investigating whether suPAR has a predictive value with short-term survival in patients with hepatitis B-related acute-on-chronic liver failure (HB-ACLF). Methods Serum suPAR expression was compared among patients with different states of chronic hepatitis B virus infection. Sixty HB-ACLF patients were recruited as the training cohort and followed up for 90 days. Serum suPAR level and the clinical relevance with short-term outcome were investigated. The temporal dynamics of suPAR were evaluated in 50 HB-ACLF patients with available serum sequentially at baseline, week 2 and week 4. Another 167 HB-ACLF patients were enrolled to validate the predictive value of suPAR with respect to the prognosis. Results Serum suPAR level was significantly increased in HB-ACLF patients compared to non-ACLF patients. In the training set of HB-ACLF, we observed higher suPAR level, INR, MELD score, and more complications in nonsurvivors than survivors. Longitudinal analysis revealed an increased trend of suPAR level in nonsurvivors during week 0 to week 4 and the modest decline in survivors. It showed that the synchronous suPAR level was higher in nonsurvivors at all indicated time points. Elevated suPAR level at baseline was identified as a strong predictor of a 90-day mortality of HB-ACLF patients. It was confirmed suPAR > 16.26 ng/ml had a positive predictive value of 72.22% and a negative predictive value of 77.88% for poor outcome in the validation cohort. Conclusions Serum suPAR level increases significantly in HB-ACLF patients and associated with a 90-day mortality. It suggests that suPAR might be a potential biomarker to predict the prognosis of HB-ACLF patients.

Highlights

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality [1]
The results showed CHB patients with hepatic inflammation displayed higher Soluble urokinase plasminogen activator receptor (suPAR) level than healthy controls (p = 0 047), and ACLF patients had the highest level than all other groups (p ≤ 0 001)
To explore potential influence factors, we investigated the correlation of suPAR with various clinical parameters

Summary

Introduction

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality [1]. Systemic inflammation (SI) has been considered as the primary driver involved in ACLF [2,3,4]. Systemic inflammation hypothesis was proposed on the basis of the CANONIC study. Gastroenterology Research and Practice (DAMPs) from the diseased liver or another organ. Severity of SI at enrolment and progression or regression of SI during hospitalization is closely associated with short-term prognosis [4, 5]. The optimal indicator of systemic inflammation is still scarce and it is a work in progress [5]

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Conclusion