The Landscape And Prognostic Value Study Of Posttranslational Modifications Of HSA In Patients With Acutely Decompensated Cirrhosis And Acute-on-chronic Liver Failure

Objectives: To characterize the posttranslational modifications of human serum albumin(HSA)in patients with acutely decompensated(AD)cirrhosis and acute-on-chronic liver failure(ACLF).To translate the concept of effective albumin concentration into clinical practice as a new prognostic biomarker of mortality in ACLF.Methods: The posttranslational modifications of HSA were assessed by ultra-high performance liquid chromatography coupled to electrospray mass spectrometry.A prospective cohort study was carried out with inclusion of all the patients with acutely decompensated cirrhosis between 2016 and 2021 to collect clinical data and peripheral blood samples and investigate the characteristics of the posttranslational modifications of HSA and effective albumin concentration(eAlb).Competing risk regression analysis was used to identify prognostic value of the clinical outcome of eAlb in patients with AD cirrhosis and ACLF.Results: 542 patients with AD cirrhosis with or without ACLF at admission and 31 outpatients with compensated cirrhosis and 50 healthy controls were evaluated.The native HSA significantly declined in patients with AD cirrhosis.The circulatory HSA represented multiple posttranslational modifications in which the reversible oxidation and glycosylation were the most frequent.eAlb displayed markedly decreased with the aggravation of cirrhosis and has closely correlations with occurrence of nosocomial ACLF and predicted the risk of nosocomial ACLF.Finally,eAlb at admission predicted mortality at 28 and 90 days in hospitalized patients with AD cirrhosis.The cumulative incidence of 90-day mortality was significantly higher in AD cirrhosis patients with eAlb level below 0.4 g/L.Conclusions: HSA exists multiple structural damages and can be detected by UPLC-ESI-MS.eAlb can be measured by estimating the percentage of structure-integrated HSA in patients with AD cirrhosis and ACLF and carries strong prognostic ability.