title: Circulating cell death biomarker: good candidates of prognostic indicator for patients with hepatitis B virus related acute-on-chronic liver failure.
abstract: Investigations on survival of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) are sparse and urgently needed. The current study aimed to evaluate the prognostic value of circulating cell death biomarkers (M30-anigen, M65-antigen and HMGB1) for HBV ACLF. In this prospective study (2/2013-8/2014), 94 patients including 54 HBV-ACLF and 40 chronic hepatitis B (CHB) patients were recruited. 40 healthy controls (HC) were also recruited. HBV-ACLF were followed up for 3 months for short-term mortality. All three biomarkers were significantly elevated in HBV-ACLF compared with CHB or HC. M30- and M65-antigens could significantly discriminate between non-survivors and survivors in HBV-ACLF. However, HMGB1 showed no prognostic value. By Cox regression analysis, M30- and M65-antigens and MELD were identified as independent predictors for short-term mortality. A novel prognostic model, MELD-CD (MELD-cell death) was established based on the multivariate results. The adjusted Harrell's C-index of MELD-CD was 0.86 (P < 0.001) and was significantly higher (P < 0.001 for all) than the currently used models, MELD (C-index, 0.71, P < 0.001), MELD-NA (0.67, P < 0.001), CTPs (0.61, P < 0.05). Dynamic analyses further confirmed the prognostic utility of M30- and M65-antigen. Future studies are warranted to validate the results.
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Zhujun
authors.initials: Z
authors.lastname: Cao
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Fengdi
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Xiaogang
authors.initials: X
authors.lastname: Xiang
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Kehui
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Yuhan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Weiliang
authors.initials: W
authors.lastname: Tang
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Lanyi
authors.initials: L
authors.lastname: Lin
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Discipline of Pathology, School of Medical Sciences and Bosch Institute, University of Sydney, Australia.
authors.forename: Shisan
authors.initials: S
authors.lastname: Bao
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Xie
authors.affiliation: Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, New Huangpu District, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000097:blood* / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000328:Adult; D015415:Biomarkers; D016923:Cell Death; D015331:Cohort Studies; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000821:virology*; D006515:Hepatitis B virus; D006801:Humans; D053538:Keratin-18 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis
chemical_list: D015415:Biomarkers; D053538:Keratin-18; C577325:M65 antigen, human; D010446:Peptide Fragments