title: Combining serum cystatin C with total bilirubin improves short-term mortality prediction in patients with HBV-related acute-on-chronic liver failure.
abstract: OBJECTIVE
  HBV-related acute-on-chronic liver failure (HBV-ACLF) is a severe liver disease which results in a high mortality in China. To early predict the prognosis of the patients may prevent the complications and improve the survival. This study was aimed to develop a new prognostic index to estimate the survival related to HBV-ACLF.
  
  
  METHODS
  Consecutive patients with HBV-ACLF were included in a prospective observational study. Serum Cystatin C concentrations were measured by using the particle-enhanced immunonephelometry assay. All of the patients were followed for at least 3 months. Cox regression analysis was carried out to identify which factors were predictive of mortality. The area under the receiver operating characteristic curve (AUC) was used to evaluate the efficacy of the variates for early predicting mortality.
  
  
  RESULTS
  Seventy-two patients with HBV-ACLF were recruited between January 2012 and January 2013. Thirty patients died (41.7%) during 3-months followed up. Cox multivariate regression analysis identified serum cystatin C (CysC) and total bilirubin (TBil) were independent factors significantly (P < 0.01) associated with survival. Our results further showed that new prognostic index (PI) combining serum CysC with TBil was a good indicator for predicting the mortality of patients with HBV-ACLF. Specifically, the PI had a higher accuracy than the CTP, MELD, or MELD-Na scoring for early prediction short-term survival of HBV-ACLF patients with normal levels of serum creatinine (Cr). The survival rate in low risk group (PI < 3.91) was 94.3%, which was markedly higher than those in the high-risk group (PI ≥ 3.91) (17.4%, P < 0.001).
  
  
  CONCLUSIONS
  We developed a new prognostic index combining serum CysC with TBil which early predicted the short-term mortality of HBV-ACLF patients.
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Zhihong
authors: Z
authors: Wan
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Yichen
authors: Y
authors: Wu
authors: Department of Health Statistics and Information Management, School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors: Jing
authors: J
authors: Yi
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Shaoli
authors: S
authors: You
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Hongling
authors: H
authors: Liu
authors: Clinical Laboratory Center, Beijing 302 Hospital, Beijing, China.
authors: Zhiqiang
authors: Z
authors: Sun
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Bing
authors: B
authors: Zhu
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Hong
authors: H
authors: Zang
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Chen
authors: C
authors: Li
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Fangfang
authors: F
authors: Liu
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Dongze
authors: D
authors: Li
authors: Clinical Laboratory Center, Beijing 302 Hospital, Beijing, China.
authors: Yuanli
authors: Y
authors: Mao
authors: Liver Failure Treatment and Research Center, Beijing 302 Hospital, Beijing, China.
authors: Shaojie
authors: S
authors: Xin
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000209:etiology* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D055815:Young Adult
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D001663:Bilirubin
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