The Role Of NMI In Acute-on-Chronic Liver Failure And The Correlation With Liver Disease Prognosis

Background and Aim:Acute-on-chronic liver failure(ACLF)is characterized by acute deterioration of chronic liver disease accompanied with multi-organ dysfunction.N-myc and STAT interactor(NMI),an inflammation-mediated protein,involves in inflammatory related diseases,but the role of NMI in development and prognosis in ACLF remains to be elucidatedMethods:Serum NMI level from HBV-ACLF patients(n=50),chronic hepatitis B(CHB,n=50)patients and healthy control(HC,n=20)were determined using Enzyme-Linked Immunosorbent Assay(ELISA).NMI from peripheral blood mononuclear cells(PBMCs)in HBV-ACLF patients,CHB patients and HC were determined at mRNA and protein levels NMI expression in liver were confirmed using Western-blot and immunohistochemistryResults:Serum NMI level was increased significantly from HBV-ACLF patients compared to that from HC(P<0.01)or CHB patients(P<0.01).Consistently,NMI from PBMCs was upregulated significantly from HBV-ACLF patients compared with that from HC and CHB patients at mRNA and protein levels.Hepatic NMI from HBV-ACLF patients was also increased significantly compared to that from HC or CHB patients.Serum NMI level was correlated with Model for End-stage Liver Disease(MELD),Chronic Liver Failure Consortium ACLF score(CLIF-C ACLF s).Serum NMI level from ACLF grade>2 patients was increased significantly compared to that from ACLF grade<2 patients at baseline(P<0.01).In contrast,serum NMI level was significantly decreased in HBV-ACLF ameliorated patients during follow-up;whereas serum NMI level was sustained at high levels in non-ameliorated patients.Survival rate of HBV-ACLF patients with elevated serum NMI level(NMI ? 198.5 pg/mL)were significantly reduced compared to patients with lower serum NMI level(NMI<198.5 pg/mL).Using receiver operating characteristics(ROC)curves,it was suggested that serum NMI level was a potential bio-marker in predicting prognosis of HBV-ACLF patientsConclusions:Our study highlights the potential role of NMI in assessing the development and prognosis of ACLF.Elevated NMI reversely correlates with disease severity in ACLF patients.Serum NMI level may serve as a novel prognostic biomarker of ACLF.