CD45 erythroid progenitor cells as potential biomarkers for disease progression in hepatitis B virus-related acute-on-chronic liver failure.

BACKGROUND

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is characterized by immune dysregulation and systemic inflammation, which lead to high mortality. Although immunosuppressive CD45 erythroid progenitor cells (EPCs) percentages are elevated in chronic hepatitis B (CHB) and are associated with disease progression, their role in HBV-ACLF remains unclear. This study aims to evaluate the impact of CD45 EPCs on disease progression in patients with HBV-ACLF.

METHODS

In this retrospective study, we analyzed the data of 102 patients with CHB and 65 patients with HBV-ACLF receiving standard drugs treatment from the Third Affiliated Hospital of Sun Yat-sen University between January 2021 and December 2023. HBV-ACLF diagnosis followed the Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure criteria, with strict exclusion of comorbidities. Peripheral blood mononuclear cells (PBMCs) were isolated via density gradient centrifugation, and CD45 EPCs (CD45 CD71 CD235a) were quantified using flow cytometry. Liver tissue EPCs were assessed by immunofluorescence in biopsy/transplant specimens. Receiver operating characteristic (ROC) and multivariable logistic regression analyses identified prognostic factors associated with disease progression.

RESULTS

Our findings revealed that patients with HBV-ACLF had significantly elevated percentages of CD45 EPCs compared with those with CHB. We also observed strong correlations between CD45 EPC percentages and creatinine concentration, leukocyte count, and neutrophil-to-lymphocyte ratio (NLR). The area under the ROC curve for CD45 EPCs was 0.718, indicating a significant predictive value [95% confidence interval (CI): 0.586-0.851, p = 0.004]. High CD45 EPC percentage was associated with a greater incidence of hepatic encephalopathy (30.8% vs. 10.3%, p = 0.037) and higher rates of disease progression (73.1% vs. 35.9%, p = 0.003). Multivariate logistic regression analysis identified international normalized ratio (INR) and NLR as independent predictors of poor 28-day outcomes (INR odds ratio [OR] = 6.098, p < 0.001; NLR OR = 1.354, p = 0.005).

CONCLUSIONS

The percentage of CD45 EPCs in PBMCs may be a potential biomarker for predicting 28-day disease progression in patients with HBV-ACLF. These findings highlight their possible clinical utility for risk stratification.