Expression and Clinical Significance of Decoy Receptor 3 in Acute-on-Chronic Liver Failure

Abstract

Aims: To explore the expression level and clinical significance of decoy receptor 3 (DcR3) in patients with acute-on-chronic liver failure (ACLF).

Methods: Serum DcR3 levels were measured by enzyme-linked immunosorbent assay (ELISA) in 76 patients with ACLF and 41 non-ACLF patients with chronic liver disease. Blood routine and liver functions were accessed for their correlations with DcR3.

Results: Serum DcR3 in ACLF patients was significantly higher than that in non-ACLF patients. It was positively correlated with neutrophilic granulocyte, aspartate aminotransferase, prothrombin time, and international standardized ratio, but negatively correlated with platelet and serum albumin. At the early stage, the level of DcR3 was not significantly different between the survival and nonsurvival group of ACLF. However, at the late stage, DcR3 increased in nonsurvival and gradually decreased in survivals. The baseline DcR3 could not sufficiently predict the outcome of ACLF, while the change of DcR3 within the first week displayed a better predictive value than model for end-stage liver disease (MELD) score.

Conclusions: DcR3 was highly expressed in patients with ACLF and correlated with several clinical indices. Dynamic change of DcR3 might predict the prognosis of ACLF.

Figure 1

DcR3 level correlated with MELD score. Seventy-six patients with ACLF were divided into two groups, nonsurvival or survival group, and, then based on their MELD score, further divided into the score ≥ 20 and <20 groups. The DcR3 levels were compared among these groups. Only in the MELD score ≥20 group, there was the difference of DcR3 statistically significant.

Figure 2

Dynamic alterations of DcR3 and MELD score. Of 76 ACLF patients, 43 patients were studied for both serum DcR3 level and MELD score. The DcR3 level on admission was slightly lower in nonsurvival (1.27±1.54 ng/mL) than in survival (1.80±2.06ng/mL); the difference was not statistically significant. However, after 7 days of admission, the patients in nonsurvival group had a steady increase of serum DcR3. The increase was positively correlated with MELD score. The DcR3 decreased along with MELD score in the patients of survival group.