Prealbumin as a Predictor of Short-Term Prognosis in Patients with HBV-Related Acute-on-Chronic Liver Failure

Hao Zhang; Kai Yang; Qin Wang; Lei Jin; Ling-Mei Wang; Xing-Yu Fan; Xiu Wang; Qiang Zhou; Yuan-Hong Xu

doi:10.2147/IDR.S402585

Prealbumin as a Predictor of Short-Term Prognosis in Patients with HBV-Related Acute-on-Chronic Liver Failure

Infect Drug Resist. 2023 May 1:16:2611-2623. doi: 10.2147/IDR.S402585. eCollection 2023.

Authors

Hao Zhang^{1

2}, Kai Yang³, Qin Wang², Lei Jin⁴, Ling-Mei Wang², Xing-Yu Fan², Xiu Wang², Qiang Zhou², Yuan-Hong Xu¹

Affiliations

¹ Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China.
² Department of Clinical Laboratory, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People's Republic of China.
³ Department of Medical Technology, Anhui Medical College, Hefei, Anhui, 230601, People's Republic of China.
⁴ Department of Infectious Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People's Republic of China.

Abstract

Purpose: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a serious medical condition with a high short-term mortality rate, making accurate prognostic assessment essential for informed clinical decision-making. In this study, we aimed to develop a simple and effective prognostic model for predicting short-term mortality in patients with HBV-ACLF.

Patients and methods: To achieve our objective, we enrolled both a cross-sectional cohort (n = 291) and a retrospective cohort (n = 185) in this study. We collected laboratory and clinical data from these cohorts and performed univariate and multivariate logistic regression analyses to identify independent predictors of short-term mortality. Subsequently, we developed a novel prognostic score for HBV-ACLF, which was validated and assessed using receiver operating characteristic (ROC) curve analysis to determine its performance.

Results: Our analysis revealed that the admission prealbumin (PAB) level was a robust independent predictor of 30-day mortality, with an area under the receiver operating characteristic (AUROC) of 0.760. Moreover, we developed the HIAPP score, a prognostic-score model based on PAB. The HIAPP score was significantly lower in survivors compared to non-survivors (-2.80±0.21 vs 0.97±0.41, P < 0.001). The HIAPP score's AUROC value was 0.899, which was found to be superior to the MELD score (AUROC = 0.795) and the CLIF-C ACLF score (AUC =0.781) and comparable to the COSSH-ACLF II score (AUC =0.825) for predicting 30-day mortality. These findings were also validated in a separate cohort, further supporting the utility of the HIAPP score as a prognostic tool for HBV-ACLF patients.

Conclusion: Our study identifies the admission PAB level as a simple and valuable predictive index for 30-day mortality in HBV-ACLF patients. Furthermore, the HIAPP score, which incorporates PAB, PLT, INR, HE, and age, is an easy-to-use and pragmatic prognostic score in predicting short-term mortality.

Keywords: hepatitis B virus related acute on chronic liver failure; prealbumin; prognostic model; short term prognosis.

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China (81902056), the Provincial Natural Science Research Project of Anhui Colleges (KJ2019A0276) and the Research Fund Project of Anhui Medical University (2021xkj050).