Prognostic Value Of Keratin 18 For The Patients Of Hepatitis B Virus-related Acute-on-chronic Liver Failure

Objective:To analyze the levels of serum keratin 18 for the patients with hepatitis B virus-related acute-on-chronic liver failure and its association with prognosis.Methods:From December 2012 to March 2014,40 patients came to our hospital and diagnosed of HBV-ACLF were enrolled, 20 chronic hepatitis B patients and 20 healthy controls were enrolled with similar gender ratio and age.To detect their keratin18(M30、M65),collect the demographic,clinical data and analyse the differeces among the three groups.Collecting 120 patients of HBV-ACLF(included 40 patients mentioned above),following up for 6 months and then divided them into two groups(death groups and survival groups),to detect their M30 、 M65,collect the laboratory parameters and commanded statistical analysis between the two groups.The 180 days’ survival curve was analyzed in Kaplan-Meier method and the independent risk factors were determined by Binary Logistic regression analysis.To construct a logistic regressiong model and validate its diagnosic value with 51 HBV-ACLF patiens enrolled from April 2014 to October 2014.Result:The laboratory parameters WBC、PLT、ALB、TBIL、ALT、AST、Na+、PTA 、 M30 、 M65 and M30/M65 had significant differeces among the three groups(P<0.001).After following up for 3 months of 120 patients with HBV-ACLF,46 of them were dead,the mortality rate was 33.3%.Analyzing the M30/M65 ratio and MELD score of the 120 patients with ROC curve, results indicated that the AUC of the M30/M65 was 0.871,AUC of MELD was 0.668.P value of the both were less than 0.05.Through the z-test,z=3.011,P<0.001.The diagnostic value of M30/M65 was better than MELD score.The LRM identified 5 independent factors associated with survival of patients with HBV-ACLF:age, hepatic encephalopathy, upper gastrointestinal hemorrhage,DBIL,M30/M65.The model constructed was LRM=0.061×age+0.69×HE+4.11 × upper gastrointestinal hemorrhage+3.201 × ln(DBIL)-3.875 ×ln(M30/M65)-24.248.Enrolling another 51 patients with HBV-ACLF,following up for 3 months and calculated their LRM and MELD score.The AUC of LRM was 0.889,AUC of MELD was 0.858,the results further validated that the diagnostic value of LRM was not inferior to the MELD score(z=0.417,P>0.5).Conclusion:Keratin 18(M65 and M30) are strongly associated with liver disease severity. The M30/M65 ratio may be a potential prognostic marker for the patients of HBV-related ACLF.The logistic regression model(LRM)which contains M30/M65 we developed have a high value to predict the short-term prognosis of patients with HBV-related ACLF.