Background. Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute deterioration of liver function and high short-term mortality. Clusterin, with biological functions similar to small heat shock proteins, can protect cells from apoptosis induced by various stressors. The aim of this study was to detect the level of serum clusterin in hepatitis B virus- (HBV-) related ACLF and to assess the predictive value of clusterin for the short-term prognosis of HBV-ACLF. Methods. We detected serum clusterin by ELISA in 108 HBV-ACLF patients, 63 HBV-non-ACLF patients, and 44 normal controls. Results. Serum clusterin was markedly lower in HBV-ACLF patients (median, 51.09 μg/mL) than in HBV-non-ACLF patients (median, 188.56 μg/mL) and normal controls (median, 213.45 μg/mL; all ). Nonsurviving HBV-ACLF patients who died within 90 days had much lower clusterin levels than did surviving patients, especially those who died within 28 days (nonsurvival group vs. survival group: vs. , ; survival vs. survival : median 28.39 vs. 43.22, ). The results showed that for identifying HBV-ACLF, the sensitivity of clusterin (93.7%) was similar to the sensitivities of the international normalized ratio (INR; 94.4%) and total bilirubin (TBIL; 94.8%), but its specificity (90.7%) was higher than that of prothrombin activity (PTA; 65.8%) and TBIL (69.8%) and was similar to INR (88.9%). As the concentration of clusterin increased, the mortality of HBV-ACLF patients decreased significantly from 59.3% to 7.0%. Clusterin had better ability for predicting the prognosis of HBV-ACLF patients than did the model for end-stage liver disease (MELD) score and the chronic liver failure consortium (CLIF-C) ACLF score (MELD vs. clusterin: ; CLIF-C ACLF vs. clusterin: ). Conclusion. Serum clusterin is a potential biomarker for HBV-ACLF which can be used to assess clinical severity and the short-term prognosis of patients with this disease and may help clinicians identify HBV-ACLF with greater specificity and improved prognostic accuracy than existing prognostic markers.

中文翻译：

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血清凝聚素：评估乙型肝炎病毒相关慢性急性肝衰竭临床严重性和短期预后的潜在标志物

背景。慢加急性肝衰竭（ACLF）是一种以肝功能急性恶化和短期死亡率高为特征的临床综合征。Clusterin 具有类似于小热休克蛋白的生物学功能，可以保护细胞免受各种应激源诱导的细胞凋亡。本研究的目的是检测乙型肝炎病毒（HBV-）相关 ACLF 中血清凝聚素的水平，并评估凝聚素对 HBV-ACLF 短期预后的预测价值。方法。我们通过 ELISA 检测了 108 名 HBV-ACLF 患者、63 名 HBV-非 ACLF 患者和 44 名正常对照的血清凝聚素。结果。HBV-ACLF 患者的血清凝聚素（中位数，51.09  μ g/mL）明显低于 HBV-非 ACLF 患者（中位数，188.56 μ g/mL）和正常对照（中位数，213.45  μ g/mL；所有）。在 90 天内死亡的非存活 HBV-ACLF 患者的凝聚素水平远低于存活患者，尤其是在 28 天内死亡的患者（非存活组与存活组：对比, ; 生存与生存：中位数 28.39 对 43.22，）。结果表明，对于鉴定HBV-ACLF，clusterin的敏感性（93.7%）与国际标准化比率（INR；94.4%）和总胆红素（TBIL；94.8%）的敏感性相似，但其特异性（90.7%） ) 高于凝血酶原活性 (PTA; 65.8%) 和 TBIL (69.8%) 并且与 INR (88.9%) 相似。随着凝聚素浓度的增加，HBV-ACLF 患者的死亡率从 59.3% 显着下降到 7.0%。与终末期肝病 (MELD) 评分模型和慢性肝功能衰竭联盟 (CLIF-C) ACLF 评分模型相比，Clusterin 对 HBV-ACLF 患者预后的预测能力更好（MELD vs. clusterin：; CLIF-C ACLF 与 clusterin：）。 结论。血清凝集素是 HBV-ACLF 的潜在生物标志物，可用于评估该病患者的临床严重程度和短期预后，与现有预后标志物相比，可帮助临床医生以更高的特异性和更高的预后准确性识别 HBV-ACLF。