Abstract
Background The aim of this study was to provide new insights into the prevalence of positive antinuclear antibody (ANA) in patients with HBV-related acute-on-chronic liver failure (ACLF) and its impact on clinical outcomes. Methods A total of 116 patients with HBV-related ACLF treated at three clinical centers were retrospectively recruited. Serum concentrations of ANA were detected using the enzyme-linked immunosorbent assay kit. Multiple nuclear dots, rim-like, and centromere patterns of ANA were detected using indirect immunofluorescence assay on HEp-2 cells. Results Among the 116 patients with HBV-related ACLF, 17 (14.66%) were ANA positive. Most patients in both ANA positive and negative groups were males (88.2% and 83.8%). Patients with negative ANA had a higher international normalized ratio, model for end-stage liver disease (MELD), and MELD-sodium scores than those with positive ANA (all P < 0.05). Multiple nuclear dot pattern was detected in half of the patients (8/17, 47.06%), rim-like/membranous pattern was found in six patients, and centromere pattern was detected in the last three patients. For patients with ANA (+), IgM was lower, and it was positively correlated with IgG. For patients with ANA (-), C3 was positively correlated with C4, and both C3 and C4 were negatively correlated with INR and MELD (all P < 0.05). In addition, TBIL, INR, WBC, and PLT, but not ANA, resulted as independent risk factors associated with 90-day mortality. Conclusion Positive ANA is frequent in HBV-related ACLF, and it does not seem to be associated with poor outcomes, but the pathogenesis of ACLF may be different between ANA (+) and ANA (−) groups.
Highlights
Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome resulting from an acute hepatic insult in patients with chronic liver diseases
Patients with negative antinuclear antibody (ANA) had higher international normalized ratio (INR), model for end-stage liver disease (MELD), and MELD-Na scores than those with positive ANA. ere was no significant difference in the incidence of spontaneous bacterial peritonitis (SBP) and hepatic encephalopathy (HE) between the two groups (P > 0.05)
Our findings indicated that the MELD score along with WBC and PLT, but not ANA, was independently associated with the overall survival in patients with HBVACLF
Summary
Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome resulting from an acute hepatic insult in patients with chronic liver diseases. Definitions of ACLF differ among European, North America, and Asian Pacific countries, it is important to emphasize that systematic inflammation has a critical role in the pathophysiology and outcome of ACLF [2]. According to the definition by the Asian Pacific Association for the Study of the Liver (APASL), intrahepatic precipitating events such as HBV reactivations are of the utmost importance, while extrahepatic disorders, including bacterial infections, are considered as a complication, but not a trigger of ACLF. It has been reported that 21% of patients with nonalcoholic fatty liver disease (NAFLD) had positive ANA [5, 6]. Another study revealed that patients with positive ANA did not exhibit histological features of autoimmune hepatitis (AIH) or developed
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