Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is characterized by immune dysregulation and systemic inflammation, which lead to high mortality. Although immunosuppressive CD45+ erythroid progenitor cells (EPCs) percentages are elevated in chronic hepatitis B (CHB) and are associated with disease progression, their role in HBV-ACLF remains unclear. This study aims to evaluate the impact of CD45+ EPCs on disease progression in patients with HBV-ACLF.

In this retrospective study, we analyzed the data of 102 patients with CHB and 65 patients with HBV-ACLF receiving standard drugs treatment from the Third Affiliated Hospital of Sun Yat-sen University between January 2021 and December 2023. HBV-ACLF diagnosis followed the Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure criteria, with strict exclusion of comorbidities. Peripheral blood mononuclear cells (PBMCs) were isolated via density gradient centrifugation, and CD45+ EPCs (CD45+ CD71+ CD235a+) were quantified using flow cytometry. Liver tissue EPCs were assessed by immunofluorescence in biopsy/transplant specimens. Receiver operating characteristic (ROC) and multivariable logistic regression analyses identified prognostic factors associated with disease progression.

Our findings revealed that patients with HBV-ACLF had significantly elevated percentages of CD45+ EPCs compared with those with CHB. We also observed strong correlations between CD45+ EPC percentages and creatinine concentration, leukocyte count, and neutrophil-to-lymphocyte ratio (NLR). The area under the ROC curve for CD45+ EPCs was 0.718, indicating a significant predictive value [95% confidence interval (CI): 0.586-0.851, p = 0.004]. High CD45+ EPC percentage was associated with a greater incidence of hepatic encephalopathy (30.8% vs. 10.3%, p = 0.037) and higher rates of disease progression (73.1% vs. 35.9%, p = 0.003). Multivariate logistic regression analysis identified international normalized ratio (INR) and NLR as independent predictors of poor 28-day outcomes (INR odds ratio [OR] = 6.098, p < 0.001; NLR OR = 1.354, p = 0.005).

The percentage of CD45+ EPCs in PBMCs may be a potential biomarker for predicting 28-day disease progression in patients with HBV-ACLF. These findings highlight their possible clinical utility for risk stratification.

Hepatitis B virus (HBV) infection is a global health concern, and it can potentially affect mental health like depression. Resolved HBV infection, often perceived as a milder form of HBV infection, are often overlooked, and the association between it and depression remains unclear. This study aims to investigate the association between resolved HBV infection and depression. A cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, including 20,655 adult Americans. Resolved HBV infection was defined as HBV surface antigen (HBsAg) negative and HBV core antibody (HBcAb) positive. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) score. Propensity score matching (PSM) was performed to balance baseline characteristics. Algorithms such as inverse probability of treatment weighting (IPTW) were also applied. Among the participants, 1,551 (7.5%) were reported to have resolved HBV infection. Depression was reported by 1,796 participants (8.7%), with a higher prevalence among those with resolved HBV infection (10.6%) compared to those without HBV infection(8.5%). PSM and IPTW revealed a significantly positive association between resolved HBV infection and depression (PSM: OR = 1.40, 95%CI 1.09-1.79, p = 0.008; IPTW: OR = 1.48, 95%CI 1.26-1.74, p < 0.001). Subgroup and sensitivity analyses supported the robustness of the findings. The results suggest a complex relationship between resolved chronic viral infections and mental health. Based on this finding, it is advisable to conduct psychological monitoring and offer support to individuals who have achieved a functional cure for HBV. Further prospective studies are still needed to reveal the potential mechanism.

A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features. The combined radiomic-clinical model demonstrated strong predictive capabilities, achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort. The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk, aiding in timely clinical decision-making. Additionally, manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it. The study adjusted for clinical covariates, while some potential confounders, such as socioeconomic status, alcohol use, and liver function scores, were not included. Additionally, an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation. Expanding the validation cohort and incorporating multi-center external validation would improve generalizability. Future studies should focus on incorporating long-term patient outcomes, exploring additional imaging modalities, and integrating automated segmentation techniques to refine the predictive model.

Early determination of prognosis in patients with acute-on-chronic liver failure (ACLF) is crucial for optimizing treatment options and liver allocation. This study aimed to identify risk factors associated with ACLF and to develop new prognostic models that accurately predict patient outcomes.

We retrospectively selected 1,952 hospitalized patients diagnosed with ACLF between January 2010 and June 2018. This cohort was used to develop new prognostic scores, which were subsequently validated in external groups.

The study included 1,386 ACLF patients and identified six independent predictors of 28-day mortality through multivariate analysis (all p < 0.05). The new score, based on a multivariate regression model, demonstrated superior predictive accuracy for both 28-day and 90-day mortalities, with Areas under the ROC curves of 0.863 and 0.853, respectively (all p < 0.05). This score can be used to stratify the risk of mortality among ACLF patients with ACLF, showing a significant difference in survival between patients categorized by the cut-off value (log-rank (Mantel-Cox) χ2 = 487.574 and 606.441, p = 0.000). Additionally, the new model exhibited good robustness in two external cohorts.

This study presents a refined prognostic model, the Model for end-stage liver disease-complication score, which accurately predicts short-term mortality in ACLF patients. This model offers a new perspective and tool for improved clinical decision-making and short-term prognostic assessment in ACLF patients.

Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) has been confirmed as a prevalent form of end-stage liver disease in people subjected to chronic HBV infection. However, there has been rare in-depth research on the risk factors for the mortality of HBV-ACLF. This study aimed at determining the risk factors for the mortality of HBV-ACLF.

The relevant research was selected from four electronic databases that have been published as of August 2023. The existing research was reviewed in accordance with the inclusion and exclusion criteria. The level of quality of previous research was evaluated using the Newcastle-Ottawa scale. Moreover, a pooled estimate of the odds ratios (ORs) with their associated 95% confidence intervals (CIs) was provided through a meta-analysis. The data were combined, and the risk variables that at least two studies had considered were analyzed. The publication bias was examined through Egger's test and Begg's test.

Twenty two studies that conformed to the inclusion criteria were selected from 560 trials. Eight risk variables in terms of HBV-ACLF mortality were determined, which covered INR (OR = 1.923, 95% CI = 1.664-2.221, P < 0.001), Monocytes (OR = 1.201, 95% CI = 1.113-1.296, P < 0.001), Cirrhosis (OR = 1.432, 95% CI = 1.210-1.696, P < 0.001), HE (OR = 2.553, 95% CI = 1.968-3.312, P < 0.001), HE grade (OR = 2.059, 95% CI = 1.561-2.717, P < 0.001), SBP (OR = 1.383, 95% CI = 1.080-1.769, P = 0.010), Hyponatremia (OR = 1.941, 95% CI = 1.614-2.334, P < 0.001), as well as HRS (OR = 2.610, 95% CI = 1.669-4.080, P < 0.001).

The most significant risk factors for HBV-ACLF mortality comprise HRS, HE, and HE grade, followed by INR and hyponatremia. The Monocytes, cirrhosis, and SBP have been confirmed as the additional key risk factors for HBV-ACLF mortality.

Variceal bleeding is a consequence of severe portal hypertension in patients with liver cirrhosis. Although the rate of bleeding has decreased over time, variceal bleeding in the presence of acute-on-chronic liver failure (ACLF) carries a high risk of treatment failure and short-term mortality. Treatment and/or removal of precipitating events (mainly bacterial infection and alcoholic hepatitis) and decrease of portal pressure may improve outcome of patients with acute decompensation or ACLF. Transjugular intrahepatic portosystemic shunts (TIPSs), especially in the preemptive situation, have been found to efficiently control bleeding, prevent rebleeding, and reduce short-term mortality. Therefore, TIPS placement should be considered as an option in the management of ACLF patients with variceal bleeding.