title: Plasma cell-free DNA for predicting outcomes of patients with HBV-related acute-on-chronic liver failure: a pilot study.
abstract: OBJECTIVE
  Cell-free DNA (cfDNA) was shown to be a prognostic marker for diverse pathological states in the Intense Care Unit, but little is known of the role of cfDNA in HBV-related acute-on-chronic liver failure (ACLF). We hypothesize that cfDNA can also be a promising prognostic as well as a diagnostic marker in patients with HBV-related ACLF.
  
  
  METHODS
  Thirty-eight patients with HBV-related ACLF admitted in the Intense Care Unit were enrolled in the study. The patients were divided, according to the improvement of liver function at discharge, into favorable prognosis group (group 1, n=17) and poor prognosis group (group 2, n=19). Plasma samples were collected from each patient at hospitalization and at discharge to measure cfDNA by real-time quantitative PCR. MELD score was calculated at the same time points.
  
  
  RESULTS
  The average level of cfDNA of group 1 was lower than that of group 2 both at the time of hospitalization (P=0.044) and at discharge (P<0.001). There was no difference in MELD score between the two groups at hospitalization. Significant correlations were found of cfDNA levels with the MELD score, TBIL, CRE and INR both at hospitalization (γ=0.662, P<0.001; γ=0.356, P=0.033; γ=0.360, P=0.031; γ=0.570, P<0.001, respectively) and at discharge (γ=0.854, P<0.001; γ=0.821, P<0.001; γ=0.650, P<0.001; γ=0.638, P<0.001, respectively). The ROC curve showed that cfDNA level at discharge was optimal in diagnosing ACLF with an area under curve (AUC) value of 0.96, followed by δcfDNA (AUC value of 0.923) and cfDNA level at hospitalization (AUC value of 0.667). The MELD scores had an AUC value of only 0.545 at the time of hospitalization.
  
  
  CONCLUSIONS
  cfDNA may serve as a promising prognostic and diagnostic marker for predicting in-hospital prognosis of HBV-related ACLF within 2 to 8 weeks.
authors.affiliation: Medical School of Chinese PLA, Beijing 100853, China.E-mail: lifan30207@126.com.
authors.forename: Fan
authors.initials: F
authors.lastname: Li
authors.forename: Tao
authors.initials: T
authors.lastname: Yan
authors.forename: Ke
authors.initials: K
authors.lastname: Li
authors.forename: Jinsong
authors.initials: J
authors.lastname: Mu
authors.forename: Haibin
authors.initials: H
authors.lastname: Su
authors.forename: Huifen
authors.initials: H
authors.lastname: Wang
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis* / Q000821:virology; D000328:Adult; D004279:DNA, Viral / Q000097:blood*; D058625:End Stage Liver Disease / Q000175:diagnosis; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010949:Plasma / Q000737:chemistry; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D004279:DNA, Viral