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

Figures & data

Table 1 Clinical Characteristic of the Subjects

	HC (n =25)	CHB (n =26)	HBV-LC (n =28)	HBV-DCC (n = 27)	HBV‐ACLF
					Total (n=185)	Deriving Cohort (n=120)	Validation Cohort (n=65)	P*
Age (y)	45.40±11.95	38.15±10.76	47.75±12.46	54.85±10.75	48.39±12.69^bd	48.68±13.61	47.86±10.86	NS
Gender (female/male)	8/17	7/19	7/21	9/18	27/158^ad	16/104	11/54	NS
WBC (×10^9/L)	6.63±1.48	5.51±1.68	4.13±1.86	2.86±1.52	7.11±4.56^bcd	7.11±4.08	6.56±3.25	NS
Neutrophil (×10^9/L)	3.64±1.08	2.86±1.09	2.19±1.04	2.53±4.67	4.95±3.38^abcd	5.11±3.66	4.64±2.81	NS
Platelet (×10^9/L)	207.00(190.00 −253.00)	178.00(156.50–211.00)	88.50(61.50–125.25)	50.00(31.00–84.00)	87.00(60.00–120.50)^abd	86.50(63.25–125.00)	92.00 (56.00–115.00)	NS
Albumin (g/L)	46.20±2.67	41.17±3.22	35.24± 5.66	28.40±5.87	29.74±4.84^abc	29.62±4.77	29.97±5.00	NS
ALT (U/L)	19.00(15.50–35.50)	29.00(19.50–77.25)	51.50(27.25–169.50)	26.00(18.00–43.00)	401.00(119.50–751.50)^abcd	403.50(130.25–768.25)	355.00(112.00–715.00)	NS
AST (U/L)	24.00(22.50–29.50)	26.00(19.00–47.25)	52.50(32.50–100.50)	46.00(33.90–66.10)	262.00(145.50–599.00)^abcd	263.50(157.00–611.50)	228.00 (116.00–584.00)	NS
Serum bilirubin (mg/dL)	0.83±0.21	0.94±0.76	1.57± 1.24	2.15±1.51	19.42±8.21^abcd	19.52±8.23	19.23±8.22	NS
BUN (mmol/L)	4.88(4.73–5.68)	4.59(3.84–5.62)	4.36(3.40–5.60)	4.92(3.56–7.26)	4.33(3.07–5.96)	4.26(3.05–5.65)	4.44 (3.32–6.16)	NS
Creatinine (mg/dL)	0.78(0.62–0.94)	0.76(0.64–0.88)	0.67(0.51–0.76)	0.86(0.53–1.02)	0.84(0.70–1.02)	0.84(0.70–1.02)	0.83 (0.70–0.95)	NS
INR	0.91(0.87–0.95)	1.00(0.92–1.06)	1.18(1.04–1.36)	1.45(1.35–1.53)	2.08(1.72–2.63)^abcd	2.17(1.78–2.64)	2.01 (1.65–2.60)	NS
MELD	ND	ND	5.01±3.70	10.61±5.05	24.90±6.80^abcd	25.49±6.87	24.51±6.49	NS

Notes: P* values correspond to the comparison of the deriving and validation groups of HBV-ACLF patients. ND not determined, ^aP < 0.05 HBV-ACLF vs HCs, ^bP < 0.05 HBV-ACLF vs CHB, ^cP < 0.05 HBV-ACLF vs LC, ^dP < 0.05 HBV-ACLF vs DCC.

Abbreviations: WBC, White blood cell count; ALT, Alanine transaminase; AST, Aspartate transaminase; BUN, blood urea nitrogen; INR, International normalized ratio; MELD, Model for end-stage liver disease.

Figure 1 The comparison of PAB levels in HBV-ACLF, HBV-DCC, HBV-LC, CHB, and HCs patients. Values are presented as mean± SD. The level of PAB in patients with HBV-ACLF was significantly lower than that in patients with HBV-DCC, HBV-LC, CHB, and HCs.

Figure 2 The serum PAB levels in non-survivor (n = 57) and survivor (n = 128) patients with HBV-ACLF.

Figure 3 Correlations between serum PAB levels and liver injury parameters in patients with HBV-related liver diseases. Correlations between PAB and ALT (a), AST (b), TBIL (c), INR (d), PLT (e), MELD (f).

Table 2 Baseline Characteristics of the Deriving Cohort Enrolled in This Study on Admission

Variables	Total Population (n=120)	Nonsurvivor (n = 38)	Survivor (n =82)	Univariate Logistic Regression		Multivariate Logistic Regression
				OR (95% CI)	P	0R (95% CI)	P
Clinical characteristics
Age (y)	48.68±13.61	54.34±12.78	46.05±13.25	1.049(1.017–1.082)	0.003	1.068(1.021–1.118)	0.005
Gender (female/male)	16/104	5/33	11/71	0.978(0.314–3.042)	0.969
SBP	38(31.67%)	14 (36.8%)	24 (29.3%)	1.410(0.625–3.178)	0.408
HE (mild/serve)	5/12	4/10	1/2	15.361(4.071–57.965)	<0.001	12.025(1.719–84.105)	0.009
Laboratory parameters
WBC (×10^9/L)	7.11±4.08	7.86±4.03	6.77±4.08	1.065(0.970–1.169)	0.186	–	–
Neutrophil (×10^9/L)	5.11±3.66	6.05±3.59	4.69±3.63	1.102(0.992–1.226)	0.071
Platelet (×10^9/L)	86.50(63.25–125.00)	79.00(50.75–103.00)	95.00(67.25–139.50)	0.991(0.983–0.999)	0.033	0.985(0.971–0.999)	0.039
Total protein (g/L)	57.82±8.07	55.91±7.88	58.71±8.04	0.957(0.910–1.005)	0.081	–	–
Albumin (g/L)	29.62±4.77	29.40±3.99	29.72±5.11	0.986(0.909–1.069)	0.729
Globulin (g/L)	28.20±7.81	26.51±7.01	28.99±8.07	0.958(0.909–1.009)	0.108
A/G	1.04(0.84–1.40)	1.05(0.92–1.43)	1.01(0.81–1.40)	1.330(0.619–2.854)	0.465	–	–
ALT (U/L)	403.50(130.25–768.25)	574.00(281.50–940.25)	349.50(99.50–654.50)	1.001(1.000–1.002)	0.027	–	–
AST (U/L)	263.50(157.00–611.50)	491.50(239.00–859.50)	214.00(121.75–424.75)	1.001(1.000–1.002)	0.046	–	–
Serum bilirubin (mg/dL)	19.52±8.23	20.47±6.81	19.08±8.82	1.021(0.974–1.069)	0.389
BUN (mmol/L)	4.26(3.05–5.65)	4.35(3.08–6.94)	4.19(3.02–5.33)	1.048(0.957–1.147)	0.311
Creatinine (mg/dL)	0.84(0.70–1.02)	0.86(0.71–1.15)	0.81(0.70–1.00)	2.314(0.888–6.030)	0.086	–
INR	2.17(1.78–2.64)	2.59(2.06–4.13)	2.04(1.66–2.39)	3.117(1.772–5.483)	<0.001	2.197(1.005–4.805)	0.049
Lg (DNA)	4.93±1.75	5.12±1.54	4.83±1.84	1.120(0.897–1.397)	0.317	–
Prealbumin	34.00(20.00–61.00)	20.00(12.00–34.50)	36.00(26.00–67.25)	0.959(0.937–0.982)	0.001	0.963(0.934–0.994)	0.018
HIAPP score	−1.63±2.74	0.97±0.41	−2.80±0.21	<0.001
MELD	25.49±6.78	29.78±7.73	23.50±5.25	<0.001

Note: Data presented as means ± SD or medians (P25‐P75).

Abbreviations: SBP, spontaneous bacterial peritonitis; HE, Hepatic encephalopathy; A/G, albumin/globulin.

Table 3 Mortality According to PAB Levels

	Mortality	P value	Odds Ratio	95% CI
				Lower	Upper
With low levels of PAB (n = 59)	28 (47.5%)	–	–	–	–
With high levels of PAB (n = 61)	10(16.4%)	<0.001	0.217	0.093	0.507

Note: P values indicate statistical significance.

Abbreviation: PAB, Prealbumin.

Figure 4 Using PAB on admission for predicting the prognosis of HBV‐ACLF. (a) the concentrations of PAB in Non-survivor (n = 38) and Survivor (n =82) patients in the deriving cohort. (b) ROC analysis shows the performance of PAB in distinguishing Non-survivor patients from Survivor patients in the deriving cohort.

Figure 5 The correlations between HIAPP and other scores on admission in the deriving cohorts (a) HIAPP score distribution of non-survivor and survivor HBV-ACLF patients in the deriving cohorts (b) The correlations between HIAPP and MELD (c) ROC analysis shows the performance of the HIAPP, COSSH-ACLF II, CLIF-C ACLF, and MELD scores.

Figure 6 The performance of PAB, HIAPP, COSSH-ACLF II, CLIF-C ACLF and MELD for predicting the 30‐day mortality in the validation cohort (a) PAB level of non-survivor and survivor of HBV‐ACLF patients in the validation cohort. (b) HIAPP score of non-survivors and survivors in the validation cohort. (c) ROC analysis shows the performance of PAB, HIAPP, COSSH-ACLF II, CLIF-C ACLF, and MELD scores in the validation cohort.