Decreased vitamin D-binding protein level portends poor outcome in acute-on-chronic liver failure caused by hepatitis B virus.
Decreased vitamin D-binding protein level portends poor outcome in acute-on-chronic liver failure caused by hepatitis B virus.
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DOI：
10.3350/cmh.2022.0121
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发表时间：
2022-10
影响因子：
8.9
通讯作者：
Sun, Zeyu
中科院分区：
文献类型：
--
作者：
Wu, Daxian;Rao, Qunfang;Xie, Zhongyang;Zhu, Xiaoqing;Che, Yuanmei;Wu, Jian;Gao, Hainv;Zhang, Jingyu;Hou, Zhouhua;Cheng, Xiaoyu;Sun, Zeyu
慢性加急性肝衰竭（ACLF）是一种灾难性疾病。维生素D结合蛋白（VDBP）对B型肝炎病毒（HBV）相关ACLF（HBV-ACLF）预后价值的研究较少，结果相互矛盾。入组了两个前瞻性HBV-ACLF队列（n=287和n=119），以评估和验证VDBP的预后性能。死亡组的VDBP水平明显低于存活组（P<0.001）。多因素考克斯回归分析显示VDBP是HBV-ACLF的独立预后因素。入院时VDBP水平随衰竭器官数目的增加而逐渐降低（P<0.001），且与凝血功能衰竭密切相关。Child-Pugh-VDBP和慢性肝功能衰竭-序贯器官衰竭评估（CLIF-SOFA）-VDBP评分的受试者工作特征曲线下面积（AUC）均显著高于Child-Pugh（P<0.001）和CLIF-SOFA（P=0.0013）。终末期肝病模型（MELD）-VDBP的AUC仅在HBV-ACLF患者中显著高于MELD（P= 0.0384）。使用外部多中心HBV-ACLF队列验证了类似的结果。纵向观察，存活组VDBP水平逐渐升高（P=0.026），死亡组逐渐降低（P<0.001）。此外，发现恶化组的VDBP水平显著降低（P=0.012），波动组有降低趋势（P=0.055）。相比之下，在改善组中它们显示出显著增加（P=0.036）。VDBP是HBV-ACLF有希望的预后生物标志物。循环VDBP的连续测量显示了ACLF进展监测的价值。
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 failure-sequential 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.
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