Abstract
Objective To identify markers that predict the progression to hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods We recruited 125 patients with chronic hepatitis B (CHB) between September 2013 and March 2017. During hospitalization, 25 patients progressed to LF and were classified as the LF group, while the remaining 100 patients were classified as the non-LF (NLF) group. We compared the kinetic changes in clinical and immune indicators including age, total bilirubin level, prothrombin time, model for end-stage liver disease score, interleukin (IL)-6, IL-8, and IL-10 cytokine levels, and number of T helper 17 and regulatory T cells between groups to determine their association with progression to HBV-ACLF. The prognostic value of clinical and immune indicators was determined using the area under the receiver operating characteristic curve (AUC) value. Results Cox regression analysis suggested that the plasma IL-6 level could predict CHB progression to HBV-ACLF (relative risk = 1.082, 95% confidence interval: 1.006–1.164; P=0.034). The AUC value, sensitivity, and specificity of baseline IL-6 level for predicting HBV-ACLF were 82.63%, 83.3%, and 82.9%, respectively (P=0.001). Conclusion A high plasma IL-6 level in CHB patients could be an early biomarker for HBV-ACLF.
Highlights
Chronic hepatitis B virus (HBV) infection may potentially precipitate to fatal liver diseases, thereby imposing a heavy global public health burden
chronic hepatitis B (CHB) patients diagnosed with HBV-acute-onchronic LF (ACLF) from September 2013 to March 2017 admitted to the Department of Infectious Diseases, e ird Affiliated Hospital, Sun Yat-sen University, were recruited for the present study
Several studies have suggested that injury due to an overactive immune system can trigger HBV-ACLF
Summary
Chronic hepatitis B virus (HBV) infection may potentially precipitate to fatal liver diseases, thereby imposing a heavy global public health burden. As high as 80% of liver failure (LF) cases are related to chronic HBV infection in China [1]. Asymptomatic chronic HBV can be rapidly exacerbated and cause liver injury and frequently progress to acute-onchronic LF (ACLF) [2]. Despite the high mortality rate of HBV-ACLF of approximately 70% [2], its underlying mechanisms have not been characterized [3,4,5]. Alternative treatments, including antiviral nucleoside analogues, stem cell transplantation, therapeutic plasma exchange, glucocorticoids, and artificial liver support devices, cannot prevent ACLF but can alleviate the disease, block progression, and improve disease prognosis in the pre- or early LF stage [6,7,8,9,10,11]
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