Department of Infectious Diseases, the First Affiliated Hospital, Nanchang University, Nanchang, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Clin Mol Hepatol. 2022 Oct;28(4):912-925. doi: 10.3350/cmh.2022.0121. Epub 2022 Jul 28.
BACKGROUND/AIMS: Acute-on-chronic liver failure (ACLF) is a catastrophic illness. Few studies investigated the prognostic value of vitamin D-binding protein (VDBP) for hepatitis B virus (HBV)-related ACLF (HBV-ACLF) resulted in conflicting results.
Two prospective HBV-ACLF cohorts (n=287 and n=119) were enrolled to assess and validate the prognostic performance of VDBP.
VDBP levels in the non-survivors were significantly lower than in the survivors (P<0.001). Multivariate Cox regression demonstrated that VDBP was an independent prognostic factor for HBV-ACLF. The VDBP level at admission gradually decreased as the number of failed organs increased (P<0.001), and it was closely related to coagulation failure. The areas under the receiver operating characteristic curve (AUCs) of the Child-Pugh-VDBP and chronic liver failuresequential organ failure assessment (CLIF-SOFA)-VDBP scores were significantly higher than those of Child-Pugh (P<0.001) and CLIF-SOFA (P=0.0013). The AUCs of model for end-stage liver disease (MELD)-VDBP were significantly higher than those of MELD (P= 0.0384) only in the case of cirrhotic HBV-ACLF patients. Similar results were validated using an external multicenter HBV-ACLF cohort. By longitudinal observation, the VDBP levels gradually increased in survivors (P=0.026) and gradually decreased in non-survivors (P<0.001). Additionally, the VDBP levels were found to be significantly decreased in the deterioration group (P=0.012) and tended to be decreased in the fluctuation group (P=0.055). In contrast, they showed a significant increase in the improvement group (P=0.036).
The VDBP was a promising prognostic biomarker for HBV-ACLF. Sequential measurement of circulating VDBP shows value for the monitoring of ACLF progression.
背景/目的：急性肝衰竭（ACLF）是一种灾难性疾病。很少有研究调查维生素 D 结合蛋白（VDBP）对乙型肝炎病毒（HBV）相关 ACLF（HBV-ACLF）的预后价值，导致结果存在争议。
纳入了两个前瞻性的 HBV-ACLF 队列（n=287 和 n=119），以评估和验证 VDBP 的预后性能。
非幸存者的 VDBP 水平明显低于幸存者（P<0.001）。多变量 Cox 回归表明，VDBP 是 HBV-ACLF 的独立预后因素。入院时的 VDBP 水平随着衰竭器官数量的增加而逐渐降低（P<0.001），与凝血功能衰竭密切相关。Child-Pugh-VDBP 和慢性肝脏衰竭序贯器官衰竭评估（CLIF-SOFA）-VDBP 评分的受试者工作特征曲线（AUC）面积明显高于 Child-Pugh（P<0.001）和 CLIF-SOFA（P=0.0013）。在肝硬化 HBV-ACLF 患者中，MELD-VDBP 模型的 AUC 明显高于 MELD（P=0.0384）。使用外部多中心 HBV-ACLF 队列进行了验证。通过纵向观察，幸存者的 VDBP 水平逐渐升高（P=0.026），而非幸存者的 VDBP 水平逐渐降低（P<0.001）。此外，在恶化组中发现 VDBP 水平显著降低（P=0.012），在波动组中 VDBP 水平有降低趋势（P=0.055）。相比之下，在改善组中 VDBP 水平显著升高（P=0.036）。
VDBP 是 HBV-ACLF 有前途的预后生物标志物。循环 VDBP 的连续测量对 ACLF 进展的监测具有价值。
