Abstract: Objective To investigate the prognostic value of combined serum cystatin C (CysC) and total bilirubin (TBil) for patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods In the retrospective analysis, 162 patients with HBV-ACLF admitted in our hospital from January 2012 to January 2016 were enrolled. Baseline clinical information, laboratory examination results, Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score were collected within 24 h after admission. All patients were followed up for 90 days and divided into survival and death groups according to prognoses. Multivariate logistic regression analysis was applied to identify independent risk factors. Results Seventy-eight (48.2%) patients died during the 90-day follow-up. Serum CysC and TBil were independent predictors for mortality (P<0.01). Additionally, serum CysC was positively correlated with serum creatinine (Cr) (r=0.400, P<0.001) and MELD score (r=0.416, P<0.001), respectively. In the combination prognostic model (PM) of serum CysC and TBil, area under the receiver operating characteristic curve was 0.833, suggesting that PM had a higher predictive value than CTP and MELD score for 90-day mortality in HBV-ACLF patients. The survival rate in high risk group (PM ≥ 3.07) was 23.8%, which was markedly lower than that in low risk group (PM<3.07) (79.3%, P<0.001). Conclusion The combination prognostic model of CysC and TBil is superior to the only CTP score or MELD score in predicting 90-day mortality for HBV-ACLF patients.

Key words: Hepatitis B, Acute-on-chronic liver failure, Cystatin C, Total bilirubin, Prognosis