Aims. Soluble urokinase plasminogen activator receptor (suPAR) reflects the immune activation in circumstances of inflammation\nand infection. It has been considered as a risk biomarker associated with poor outcome in various low-grade inflammation and\ninfectious diseases. The study is aimed at investigating whether suPAR has a predictive value with short-term survival in\npatients with hepatitis B-related acute-on-chronic liver failure (HB-ACLF). Methods. Serum suPAR expression was compared\namong patients with different states of chronic hepatitis B virus infection. Sixty HB-ACLF patients were recruited as the training\ncohort and followed up for 90 days. Serum suPAR level and the clinical relevance with short-term outcome were investigated.\nThe temporal dynamics of suPAR were evaluated in 50 HB-ACLF patients with available serum sequentially at baseline, week 2\nand week 4. Another 167 HB-ACLF patients were enrolled to validate the predictive value of suPAR with respect to the\nprognosis. Results. Serum suPAR level was significantly increased in HB-ACLF patients compared to non-ACLF patients. In the\ntraining set of HB-ACLF, we observed higher suPAR level, INR, MELD score, and more complications in nonsurvivors than\nsurvivors. Longitudinal analysis revealed an increased trend of suPAR level in nonsurvivors during week 0 to week 4 and the\nmodest decline in survivors. It showed that the synchronous suPAR level was higher in nonsurvivors at all indicated time\npoints. Elevated suPAR level at baseline was identified as a strong predictor of a 90-day mortality of HB-ACLF patients. It was\nconfirmed suPAR > 16 26 ng/ml had a positive predictive value of 72.22% and a negative predictive value of 77.88% for poor\noutcome in the validation cohort. Conclusions. Serum suPAR level increases significantly in HB-ACLF patients and associated\nwith a 90-day mortality. It suggests that suPAR might be a potential biomarker to predict the prognosis of HB-ACLF patients.
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