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CN 22-1108/R
Volume 37 Issue 7
Jul.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(7): 1632-1635

Value of high-density lipoprotein cholesterol in evaluating the severity and prognosis of hepatitis B virus-associated acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2021.07.030

  • Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China

Research funding:

National Ministry of Science and Technology, the 13th Five-Year Major Project (2017ZX10203201002-002)

  • Received Date: 2020-11-28
  • Accepted Date: 2021-01-21
  • Published Date: 2021-07-20
    Abstract
  •   Objective  To investigate the association of high-density lipoprotein cholesterol (HDL-C) with the prognosis of hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) and its predictive value.  Methods  The patients with liver disease who were admitted to Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, from January 2015 to January 2019 were enrolled, and according to the stage of disease progression, they were divided into HBV-ACLF group with 42 patients, liver cirrhosis group with 30 patients, and chronic hepatitis group with 25 patients. A total of 24 healthy individuals were enrolled as healthy control group. General clinical data were collected, including sex, age, prothrombin time (PT), albumin (Alb), total bilirubin (TBil), serum creatinine, blood urea nitrogen (BUN), total cholesterol (TC), triglyceride (TG), HDL-C, low-density lipoprotein cholesterol (LDL-C), and Model for End-Stage Liver Disease (MELD) score. The HBV-ACLF group was further divided into improvement group with 17 patients and non-improvement group with 25 patients, and the patients were followed up for 3 months. The Mann-Whitney U test was used for comparison of non-normally distributed continuous variables between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Wilcoxon rank-sum test was used for comparison within each group. A binary logistic regression analysis was used to investigate independent risk factors for prognosis, and the receiver operating characteristic (ROC) curve was used to evaluate the accuracy of the variables in prediction.  Results  There were significant differences in PT, Alb, BUN, TBil, TC, TG, HDL-C, LDL-C, and MELD scores between the liver cirrhosis group, the HBV-ACLF group, the chronic hepatitis group, and the healthy control group (χ2=75.134, 44.638, 10.253, 80.357, 55.067, 19.858, 68.174, 52.492, and 64.359, all P < 0.05). Further comparison between two groups showed that the HBV-ACLF group had a significantly lower level of HDL-C than the liver cirrhosis group [0.12 (0.08-0.30) mmol/L vs 0.79 (0.60-1.01) mmol/L, Z=3.821, P < 0.001], the chronic hepatitis group [0.12 (0.08-0.30) mmol/L vs 1.06(0.88-1.44) mmol/L, Z=5.921, P < 0.001], and the healthy control group [0.12 (0.08-0.30) mmol/L vs 2.03 (1.36-2.98) mmol/L, Z=7.228, P < 0.001]. The improvement group had a significantly higher level of HDL-C than the non-improvement group [0.20 (0.11-0.49) mmol/L vs 0.10 (0.07-0.15) mmol/L, Z=-1.628, P=0.014]. The binary logistic regression analysis showed that HDL-C (odds ratio [OR]=0.003, 95% confidence interval [CI]: 0-0.548, P=0.029) and MELD score (OR=1.588, 95%CI: 1.032-2.443, P=0.035) were independent influencing factors for the prognosis of HBV-ACLF. HDL-C had an area under the ROC curve (AUC) of 0.807 in predicting the prognosis of HBV-ACLF, with a sensitivity of 0.706, a specificity 0.800, and a 95% CI of 0.677-0.937 at the optimal cut-off value of 0.175 mmol/L; MELD score had an AUC of 0.822, with a sensitivity of 0.760, a specificity of 0.765, and a 95% CI of 0.696-0.928 at the optimal cut-off value of 26.500.  Conclusion  HDL-C is an independent risk factor for the prognosis of patients with HBV-ACLF and has a good value in predicting the prognosis of HBV-ACLF.

     

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