Increased Serum Soluble Urokinase Plasminogen Activator Receptor Predicts Short-Term Outcome in Patients with Hepatitis B-Related Acute-on-Chronic Liver Failure

Abstract EN

Aims.

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).

Methods.

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.

Results.

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.

Conclusions.

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.