title: Fibronectin predicts the outcome of acute-on-chronic hepatitis B liver failure.
abstract: BACKGROUND
  Acute-on-chronic hepatitis B liver failure (ACHBLF) is a serious condition with varied etiologies and manifestations, and is associated with a high mortality rate. Fibronectin is involved in a number of biological processes, including cellular adhesion, motility, differentiation, apoptosis, hemostasis, wound healing and ischemic injury. Serum fibronectin concentrations may provide prognostic information in ACHBLF; however, as a prognostic marker of mortality in patients with ACHBLF, it needs further validation.
  
  
  METHODS
  The aim of this study was to examine whether admission levels of fibronectin in ACHBLF patients are correlated with outcomes. In this prospective study, 78 ACHBLF patients were compared to 70 matched healthy controls. Fibronectin levels were determined using a commercial enzyme-linked immunosorbent assay kit to determine the prognostic value of fibronectin levels on admission.
  
  
  RESULTS
  The median (range) fibronectin level at admission for ACHBLF patients was significantly reduced compared with that of healthy controls (142 [62-275] mg/l vs 265 [190-346] mg/l, respectively; p<0.001). Fibronectin levels were significantly higher in surviving patients than in those who died (155 [70-275] mg/l vs 119 [62-235] mg/l; p=0.020). Receiver operating characteristic curve analysis showed that a cut-off level of 135 mg/l was the best prognostic indicator, yielding positive and negative predictive values of 60% (18/30) and 71% (30/42), respectively.
  
  
  CONCLUSIONS
  Our results suggested that decreased serum fibronectin levels in patients with ACHBLF were correlated to hepatic injury and inflammation. However, because of the lack of specificity, the use of fibronectin as an independent prognostic indicator is limited.
authors.affiliation: The First Affiliated Hospital, College of Medicine, Zhejiang University, Clinical Laboratory, Hospital Management Office, Hangzhou, China Chenyiyi975022@sian.com.
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: The First Affiliated Hospital, College of Medicine, Zhejiang University, Clinical Laboratory, Hospital Management Office, Hangzhou, China.
authors.forename: Zhexin
authors.initials: Z
authors.lastname: Shao
authors.affiliation: The Second Affiliated Hospital of Zhejiang Chinese Medical University, Clinical Laboratory, Hangzhou, China.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Yin
authors.affiliation: The Second Affiliated Hospital of Zhejiang Chinese Medical University, Department of Gastroenterology, Hangzhou, China.
authors.forename: Zhuxiu
authors.initials: Z
authors.lastname: Jiang
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000097:blood* / Q000401:mortality; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005353:Fibronectins / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D005353:Fibronectins
keywords: China; Fibronectin; Hepatitis B; Liver failure; Prognostic indicators