Effect of CD163 Modification on Glucocorticoid-Related Mortality in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

作者全名："Zhang, Yu; Cai, Yali; Tu, Beijia; Yang, Xiaoli; Hu, Jiahua; Zhang, Huiyan"

作者地址："[Zhang, Yu; Cai, Yali; Tu, Beijia; Yang, Xiaoli; Hu, Jiahua; Zhang, Huiyan] Chongqing Med Univ, Dept Infect Dis, Affiliated Hosp 3, Chongqing, Peoples R China"

通信作者："Zhang, HY (通讯作者)，Chongqing Med Univ, Dept Infect Dis, Affiliated Hosp 3, Chongqing, Peoples R China."

来源：ALTERNATIVE THERAPIES IN HEALTH AND MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001137669200142

JCR分区：Q4

影响因子：1.5

年份：2023

卷号：29

期号：8

开始页：850

结束页：855

文献类型：Article

关键词：　

摘要："Objective center dot This study aimed to assess the relationship between glucocorticoid treatment and mortality among patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods center dot We conducted a retrospective, hospital-based cohort study from 2019 to 2022, including 394 consecutively enrolled HBV-ACLF patients at the Third Affiliated Hospital of Chongqing Medical University. We recorded patient demographics, liver function, CD163 concentration, Model for End-Stage Liver Disease (MELD) score, and complications. The primary endpoint was 30-day mortality. Results center dot No significant differences were observed between the glucocorticoid-treated and non-glucocorticoid groups regarding sex, age, liver function, complications, or plasma CD163 concentration. After treatment, the median levels of total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), international normalized ratio (INR), and HBV DNA were 322.9 (IQR 258.6-383.3) mu mol/L, 354.4 (IQR 253.1-444.6) U/L, 258.4 (IQR 186.4-322.4) U/L, 2.3 (IQR 2.1-2.5), and 5.0 (IQR 4.0-6.0) log IU/mL, respectively. Changes in ALT, AST, sCD163, TBil, INR, and MELD score before and after treatment showed no statistical differences between the glucocorticoid and non-glucocorticoid groups (P >.05). However, the mortality rate was significantly lower in the glucocorticoid group compared to the non-glucocorticoid group (11.2% vs. 29.9%, respectively; P <.001). Multivariable analysis revealed that, after adjusting for confounders, non-glucocorticoid treatment was associated with a higher adjusted hazard ratio (HR) for mortality (HR = 3.7, 95% CI 2.2-6.2) compared to glucocorticoid treatment. Additionally, an interaction test indicated that the association between non-glucocorticoid treatment and mortality was more robust in the sCD163 >= 18.2 mg/L group (HR = 7.6, 95% CI 2.9-19.9) but weaker in the sCD163 < 18.2 mg/L group (HR = 2.2, 95% CI 1.2-4.3) (P for interaction <.05). Conclusions center dot These findings suggest that glucocorticoids are an effective treatment for reducing mortality in HBVACLF patients, with particular effectiveness observed in patients with high sCD163 concentrations."

基金机构：Natural Science Foundation of Chongqing [cstc2019jcyj-msxmX0356]

基金资助正文："This work was supported by the Natural Science Foundation of Chongqing cstc2019jcyj-msxmX0356, The role and mechanism of glucocorticoid receptor gene polymorphism in the pathogenesis of HBV-associated chronic and acute liver failure)."