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. 2022 Jun 25;22(1):312.
doi: 10.1186/s12876-022-02371-1.

Prognostic value of plasma level of superoxide dismutase in HBV-related acute-on-chronic liver failure

Naijuan Yao #  1 , Yajuan He #  2 , Yuchao Wu  1 , Fei Wang  2 , Zhen Tian  3   4   5
Affiliations

Prognostic value of plasma level of superoxide dismutase in HBV-related acute-on-chronic liver failure

Naijuan Yao et al. BMC Gastroenterol. .

Abstract

Background: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is the most prevalent type of ACLF in China. The mortality rate of HBV-ACLF has decreased in recent years due to advances in treatment therapies; however, it is still above 50%. Many cases of HBV-ACLF are caused by HBV reactivation due to discontinuation of nucleoside analog treatment. The present study focused on plasma levels of superoxide dismutase (SOD) in HBV-ACLF patients and investigated whether the plasma level of SOD is a useful biomarker in assessing disease severity and predicting outcomes of HBV-ACLF patients, including patients treated with Entecavir (ETV) and patients who were withdrawn from ETV treatment.

Methods: Plasma samples and clinical data from 200 HBV-ACLF patients and from age- and sex-matched cirrhotic and healthy controls were collected and analyzed. Plasma levels of SOD were measured using an ELISA commercial kit.

Results: Among the HBV-ACLF patients, in the ETV withdrawal group, the mortality rate was higher than in the ETV group (69.95% vs 46.71%, P < 0.05). Moreover, HBV-DNA and SOD plasma levels were higher in the ETV withdrawal group than in the ETV group (Log10(HBV-DNA): 6.49 ± 0.24 vs 4.79 ± 0.14, P < 0.01; SOD: 463.1 ± 27.61 U/mL vs 397.2 ± 10.97 U/mL, P < 0.05). The mortality and liver transplantation rates were significantly higher in HBV-ACLF patients with plasma levels of SOD > 428 U/mL than in patients with plasma SOD levels ≤ 428 U/mL.

Conclusions: Reactivation of HBV and elevated oxidative stress caused by discontinuation of ETV treatment are crucial factors in the pathogenesis of HBV-ACLF. Plasma level of SOD may serve as a useful biomarker in estimating disease severity and predicting outcomes of HBV-ACLF patients who stop ETV treatment.

Keywords: Acute on chronic liver failure; Entecavir; HBV; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Clinical characteristics of controls and ACLF patients. a Kaplan–Meier survival analysis in ACLF patients; b Serum HBV-DNA levels in ACLF patients; c Serum SOD levels in controls and ACLF patients. *P < 0.05, **P < 0.01, #P > 0.05
Fig. 2
Fig. 2
Kaplan–Meier survival analysis according to the MELD score at admission. a ROC curve of the MELD score; b Survival of ACLF patients in the ETV group according to the MELD score; c Survival of ACLF patients in the ETV withdrawal group according to the MELD score
Fig. 3
Fig. 3
Kaplan–Meier survival analysis according to SOD level at admission. a ROC curve of plasma SOD; b Survival of ACLF patients in the ETV group according to plasma SOD level; c Survival of ACLF patients in the ETV withdrawal group according to plasma SOD level
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