Abstract: Objective To investigate the value of total bilirubin rebound rate (TBRR) and total bilirubin clearance rate (TBCR) in evaluating the prognosis of artificial liver therapy in patients with hepatitis B associated acute-on-chronic liver failure (HBV-ACLF). Methods An analysis was conducted on the clinical data of HBV-ACLF patients who had undergone artificial liver treatment at our hospital between January 2020 and December 2022. Patients were divided into an improvement group and a death group based on their clinical outcomes. Various parameters, including blood cells counts, liver biochemical indicators, coagulation indicators, MELD scores, as well as differences in TBRR and TBCR after artificial liver treatment, were compared between the two groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the area under the curve (AUC) for these values and identify optimal cutoff points. Results A total of 98 HBV-ACLF patients with complete clinical data were included in the study. In the improvement group (65 cases), the levels of PLT、INR、MELD scores and TBRR were 122.2±50.5、1.7±0.5、18.8±5.2、22.59±39.29, respectively. In the death group (33 cases), the levels of PLT、INR、MELD scores and TBRR were 91.7±38.1、2.0±0.5、21.9±4.8、67.69±65.50, respectively. Statistically significant differences were observed between the two groups (t=2.186, P=0.03; t=0.013,P=0.050; t=2.048, P=0.046; t=2.067, P=0.016). The AUC for TBRR in predicting clinical outcomes in HBV-ACLF patients was 0.709, with a 95% CI of 0.549 to 0.870. The optimal cutoff value for TBRR was 71.13%, with a sensitivity of 50% and specificity of 85.5% at a Jordan index of 0.408. Conclusion Higher TBRR value after artificial liver treatment is associated with increased mortality in patients with HBV-ACLF. A TBRR value exceeding 71.13% may indicate a greater risk of death in this patient population.

Key words: TBRR, TBCR, artificial liver treatment, HBV related acute-on-chronic liver failure, prognosis, evaluation value