Dynamic interferon-inducible protein-10expressions in the peripheral blood mononuclear cells and its prognostic value in patients with hepatitis B virus related acute-on-chronic liver failure

Objective To investigate the predictive value of dynamic changes of interferon-inducible protein-10(IP-10)expression in the peripheral blood mononuclear cells and the model for end-stage liver disease(MELD)scores for short-term mortality in hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)patients.Methods Eighty patients with HBV-ACLF admitted to the Affiliated Hospital of Hubei College of Arts and Sciences from October 2013 to August 2015 were selected.During 3 months of follow-up,33 patients died and 47 survived.The expression level of IP-10 and MELD score of two groups were measured at admission and 1 week and 2 weeks after treatment.The mean values between the two groups were compared.Accuracy of predicting short-term mortality was performed by area under receiver operating characteristic curve(AUC).Multivariate logistic regression analysis and Kaplan-Meier survival curve were used to analyze the effect of IP-10 expression and MELD score on the mortality of HBV-ACLF patients.Results The expressions of IP-10 at admission and at week 1 and 2 after treatment in the death group were 1.095±0.202,1.071±0.181,and 1.078±0.198,respectively,those in the survival group were 0.894±0.181,0.770±0.153,and 0.732±0.137,respectively,which were significantly different(t=4.66,8.02 and 9.27,respectively,all P<0.01).The MELD scores at admission and at week 1 and 2 after treatment in the death group were 26.70±5.50,27.39±6.24,and 28.64±6.44,respectively,those in the survival group were 23.89±4.41,21.57±4.68,and 18.87±3.92,respectively,which were significantly different(t=2.53,4.77 and 8.42,respectively,all P<0.01).Analysis of variance showed that the MELD score and IP-10 expression in the survival group at admission were significantly higher than those at week 1 and week 2 after treatment(F=13.464 and 15.711,respectively,both P<0.01),while there were no significant differences in the death group(F=0.129 and 0.864,respectively,both P>0.05).The AUC of IP-10 at week 2 after treatment was 0.935,that of MELD score was 0.903(Z=0.788,P=0.045),while there was no significant difference of AUC between week 1 and week 2(0.935 vs 0.909,Z=0.640,P>0.05).In addition,the AUC of IP-10 level at week 1 and MELD score at week 2 after treatment showed no significant difference(0.909 vs 0.903,Z=0.133,P>0.05).Logistic multivariate regression analysis showed that IP-10≥0.902 at week 1,MELD≥22.5 and IP-10≥0.846 at week 2 were independent risk factors for death(OR=11.29,6.60,and 15.27,respectively;95% CI=1.06-119.74,1.27-34.26,and 1.39-167.62,respectively;all P<0.05).Conclusion The dynamic monitor of both IP-10 levels and MELD scores may have greater value in predicting prognosis of patients with HBV-ACLF.