Abstract
Background: HBV-related acute-on-chronic liver failure (HBV-ACLF) has a high short-term mortality and urgently needs an early warning system with simplicity and high accuracy. Previous studies show that sex hormones play potential roles in the progression of HBV-related liver diseases.Aims: To explore the effect of testosterone and estradiol on the occurrence and prognosis of HBV-ACLF.Methods: A prospective cohort of 300 chronic hepatitis B (CHB) patients was enrolled among which 108 were diagnosed with HBV-ACLF at admission and 20 developed to HBV-ACLF during hospitalization. We compared the level of serum testosterone and estradiol of patients with varied ACLF background, disease severity and cirrhosis conditions and analyzed the predictive ability of short-term prognosis. A novel prognostic model involving testosterone was developed and further validated in the HBV-ACLF group.Results: The baseline estradiol level of HBV-ACLF group was significantly higher while testosterone was lower than that of non-ACLF group. The estradiol level increased while the testosterone level decreased as the number of organ failures increased. Testosterone had high accuracy in predicting the short-term mortality in HBV-ACLF (AUROC = 0.726) and estradiol did better in predicting the occurrence of ACLF during hospitalization (AUROC = 0.695). The novel prognostic model involving testosterone (TATIM model) was proved to have considerable prediction efficiency in HBV-ACLF cohort with or without cirrhosis.Conclusion: Testosterone could be utilized as short-term prognostic indicator for HBV-related ACLF and estradiol can help to predict its occurrence. TATIM model is a novel prognostic model for HBV-related ACLF with simplicity and good performance irrespectively of liver cirrhosis.Clinical Trial Registration Number: This study was based on a sub-cohort from the prospective multicenter cohort (NCT02457637).
Highlights
Acute-on-chronic liver failure (ACLF) is a rapid-developing clinical syndrome with a high short-term mortality [1]
Acute liver injury was defined as alanine aminotransferase (ALT) >3 NL, aspartate aminotransferase (AST) >3 NL or total bilirubin (TBil) ≥2 NL
The exclusion criteria included: [1] age>80 or
Summary
Acute-on-chronic liver failure (ACLF) is a rapid-developing clinical syndrome with a high short-term mortality [1]. HBV-related ACLF leads to approximately 120 000 deaths every year and takes up massive medical resources. Even though it has poor outcomes, timely and aggressive clinical intervention could save a considerable proportion of patients’ lives [4, 5]. Most of the existing studies focus on cirrhosis, NAFLD or HCC, it remains unclear whether sexual hormones are associated with HBV-ACLF. HBV-related acute-on-chronic liver failure (HBV-ACLF) has a high short-term mortality and urgently needs an early warning system with simplicity and high accuracy. Previous studies show that sex hormones play potential roles in the progression of HBV-related liver diseases
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