Prognostic value of serum adenosylhomocysteinase in patients with hepatitis E related acute liver failure
Objective To investigate the prognostic value of serum adenosylhomocysteinase(AHCY)in patients with hepatitis E virus acute liver failure(HEV-ALF).Methods From 1 January 2017 to 31 December 2022,100 patients each with HEV-ALF and acute hepatitis E(AHE)from the First Affiliated Hospital of Medical School of Zhejiang University and Affiliated Suzhou Hospital of Nanjing Medical University were included in this case-control study.The HEV-ALF group was 58.56±11.16 years old,including 71 men.The AHE group was 56.04±14.30 years old,including 61 men.All serum samples were obtained before the patient had an acute onset and were obtained without treatment.Firstly,the serum AHCY levels in patients with HEV-ALF and AHE were analyzed by ELISA.Secondly,the serum AHCY levels in HEV-ALF patients with different organ failure and disease condition were compared.According to the number of organ failure,100 HEV-ALF patients were divided into organ failure number=2 group(n=58),number=3 group(n=24)and number＞3 groups(n=18).According to the disease condition,100 patients were divided into improvement group(n=49),disease fluctuation group(n=37),and deterioration group(n=14).Thirdly,the survival times between the high serum AHCY level group(n=50)and the low serum AHCY level group(n=50)were compared.Finally,the independent risk factors to predict mortality using the multivariate Logistic regression analysis,and evaluated the predictive and decision-making abilities of serum AHCY levels were explored using the receiver operating characteristic(ROC)curve and decision curve analysis(DCA).Results Serum AHCY levels in HEV-ALF patients were significantly higher than those in AHE patients[326.92(295.37-385.84)pg/ml vs.222.88(188.04-246.78)pg/ml,Z=-12.217,P＜0.001].Serum AHCY levels in group 2 were significantly lower than those in group 3[303.44(284.40-330.15)pg/ml vs.335.36(306.30-385.84)pg/ml,Z=-3.353,P=0.001].Serum AHCY level in group 3 were significantly lowerthan those in group＞3[335.36(306.30-385.84)pg/ml vs.549.89(423.35-660.22)pg/ml,P＜0.001].The serum AHCY levels in the fluctuation group were lower than those in the deterioration group[322.17(283.92-423.74)pg/ml vs.458.26(374.66,593.89)pg/ml,Z=-4.016,P=0.009].The survival time of high serum AHCY level group was significantly lower than that of low serum AHCY level group[23.11(20.25-25.96)days vs.29.49(28.79-30.20)days,Z=-2.596,P＜0.001].The multivariate Logistic regression analysis showed that the levels of serum AHCY and total bilirubin were independent risk factors to predict mortality in HEV-ALF patients[AHCY,OR(95％CI):1.008(1.002-1.015),P=0.008;total bilirubin,OR(95％CI):1.011(1.005-1.018),P=0.001].Serum AHCY level predicting the area under the curve(AUC)of 30-day mortality in HEV-ALF patients was 0.912,with a sensitivity of 90.00％and a specificity of 93.75％.DCA results demonstrated that serum AHCY level had good decision-making power for predicting 30-day mortality in HEV-ALF patients.Conclusion Serum AHCY has an important prognostic value for HEV-ALF patients.Higher serum AHCY levels indicate the worse prognosis of HEV-ALF patients.
万方数据
维普
