Expression And Clinical Significance Of Soluble Mannose Receptor In HBV-related Acute-on-chronic Liver Failure

Objective:To explore the expression of soluble mannose receptor(s MR)in patients with HBV-related acute-on-chronic liver failure(HBV-ACLF),and investigate the clinical value of s MR for predicting the 90-day mortality of patients with HBV-ACLF.Methods:Forty-three patients with HBV-ACLF,43 patients with chronic hepatitis B(CHB)and 20 healthy controls(HCs)were enrolled in the study.The serum levels of the s MR were detected by enzyme-linked immunosorbent assay(ELISA).The interleukin-6(IL-6),procalcitonin(PCT)and HBe Ag levels were detected by electrochemiluminescence.And the HBV-DNA level was detected by PCR-fluorescence probe.At the same time,the related indicators of liver function such as albumin(ALB),total bilirubin(TBIL),international normalized ratio(INR)were measured and the serum creatinine(CR)was detected.The model for end-stage liver disease(MELD)score was calculated by the formula(MELD=11.2×ln(INR)+9.6×ln[Cr(mg/dl)]+3.8×ln[TBIL(mg/dl)]+6.4).The Spearman correlation analysis was used to evaluate the correlations between the s MR level and the other clinical indicators.A multivariate logistic regression analysis was used to analyze the independent risk factors for mortality.The ROC curve and the Kaplan Meier curve were drawn to determine the clinical value of s MR in predicting the 90 day prognosis of HBV-ACLF patients.Results:The serum s MR level was significantly higher in the HBV-ACLF patients when compared with the CHB patients and HCs(both P<0.01).The levels of PCT and IL-6 in serum of patients with HBV-ACLF were significantly higher than those of patients with CHB and HCs(both P<0.01).The serum s MR levels in the early,medium,and later stage groups of the HBV-ACLF patients increased gradually(both P<0.01).The serum s MR level of the non-survivors was significantly increased and it was much higher than that of the survival group(P<0.05).The serum s MR level was positively correlated with the MELD score(r_s=0.533,P=0.001),HBV-DNA level(r_s=0.497,P=0.022),and TBIL level(r_s=0.894,P<0.001).The serum s MR level(odds ratio=1.007,95%confidence interval=1.004–1.012,P=0.001)was an independent risk factor for the 90-day mortality in the HBV-ACLF cases.The HBV-ACLF patients were stratified into two groups according to their serum s MR levels at the baseline(low risk:<99.84pg/m L and high risk:?99.84 pg/m L).The 90-day mortality rates were 27.3%in the low-risk group and 87.5%in the high-risk group.Furthermore,the s MR level significantly improved the MELD score for predicting the prognosis of the HBV-ACLF patients.Conclusion:The serum s MR level is significantly elevated in the patients with HBV-ACLF,which is significantly associated with the indicators of liver injury and the severity of the disease.And it is negatively correlated with the patients outcome.The serum s MR level may be a predictor of the prognosis of HBV-ACLF patients.