Huang Zuxiong, Wang Ning, Huang Shuiwen, Chen Yi, Yang Shida, Gan Qiaorong, Ye Hanhui, Liu Baorong, Pan Chen
Department of Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
Department of Hepatology, Affiliated Infectious Disease Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
Gastroenterol Res Pract. 2019 May 2;2019:3467690. doi: 10.1155/2019/3467690. eCollection 2019.
Soluble urokinase plasminogen activator receptor (suPAR) reflects the immune activation in circumstances of inflammation and infection. It has been considered as a risk biomarker associated with poor outcome in various low-grade inflammation and infectious diseases. The study is aimed at investigating whether suPAR has a predictive value with short-term survival in patients with hepatitis B-related acute-on-chronic liver failure (HB-ACLF).
Serum suPAR expression was compared among patients with different states of chronic hepatitis B virus infection. Sixty HB-ACLF patients were recruited as the training cohort and followed up for 90 days. Serum suPAR level and the clinical relevance with short-term outcome were investigated. The temporal dynamics of suPAR were evaluated in 50 HB-ACLF patients with available serum sequentially at baseline, week 2 and week 4. Another 167 HB-ACLF patients were enrolled to validate the predictive value of suPAR with respect to the prognosis.
Serum suPAR level was significantly increased in HB-ACLF patients compared to non-ACLF patients. In the training set of HB-ACLF, we observed higher suPAR level, INR, MELD score, and more complications in nonsurvivors than survivors. Longitudinal analysis revealed an increased trend of suPAR level in nonsurvivors during week 0 to week 4 and the modest decline in survivors. It showed that the synchronous suPAR level was higher in nonsurvivors at all indicated time points. Elevated suPAR level at baseline was identified as a strong predictor of a 90-day mortality of HB-ACLF patients. It was confirmed suPAR > 16.26 ng/ml had a positive predictive value of 72.22% and a negative predictive value of 77.88% for poor outcome in the validation cohort.
Serum suPAR level increases significantly in HB-ACLF patients and associated with a 90-day mortality. It suggests that suPAR might be a potential biomarker to predict the prognosis of HB-ACLF patients.
可溶性尿激酶型纤溶酶原激活物受体（suPAR）反映炎症和感染情况下的免疫激活。它被认为是与各种低度炎症和感染性疾病不良预后相关的风险生物标志物。本研究旨在调查suPAR对乙型肝炎相关慢加急性肝衰竭（HB-ACLF）患者短期生存是否具有预测价值。
比较不同慢性乙型肝炎病毒感染状态患者的血清suPAR表达。招募60例HB-ACLF患者作为训练队列，并随访90天。研究血清suPAR水平及其与短期预后的临床相关性。在50例基线、第2周和第4周有可用血清的HB-ACLF患者中评估suPAR的时间动态变化。另外纳入167例HB-ACLF患者以验证suPAR对预后的预测价值。
与非ACLF患者相比，HB-ACLF患者的血清suPAR水平显著升高。在HB-ACLF训练组中，我们观察到非幸存者的suPAR水平、国际标准化比值（INR）、终末期肝病模型（MELD）评分更高，并发症更多。纵向分析显示，非幸存者在第0周和第4周期间suPAR水平呈上升趋势，而幸存者则略有下降。结果表明，在所有指定时间点，非幸存者的同步suPAR水平更高。基线时suPAR水平升高被确定为HB-ACLF患者90天死亡率的有力预测指标。在验证队列中证实，suPAR>16.26 ng/ml对不良预后的阳性预测值为72.22%，阴性预测值为77.88%。
HB-ACLF患者血清suPAR水平显著升高，并与90天死亡率相关。这表明suPAR可能是预测HB-ACLF患者预后的潜在生物标志物。
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