The introduction of pegaspargase has greatly advanced the treatment of acute lymphoblastic leukemia (ALL). In the literature, only one case of pegaspargase-induced multiple organ failure has been reported, and the patient died due to multiple organ failure.

Herein, we present a rare case of a 40-year-old man with ALL who developed multiple organ failure after treatment with pegaspargase. The patient had two rare phenomena reflecting poor prognosis, including the discrepancy between clinical manifestations and liver function and persistently low alpha-fetoprotein (AFP) levels from subacute liver failure. However, the patient was successfully treated using a multidisciplinary team approach.

This is the first case report of successful treatment of pegaspargase-induced multiple organ failure. The findings emphasize the importance of a multidisciplinary team approach in treating pegaspargase-induced multiple organ failure.

ObjectiveTo investigate the clinical significance of alpha-fetoprotein and carbohydrate antigen 19-9 as potential predictors of outcomes in patients with acute liver failure.MethodsWe conducted a retrospective analysis of 208 patients with acute liver failure admitted to the intensive care unit between 2009 and 2023. Serum alpha-fetoprotein and carbohydrate antigen 19-9 levels were measured on Days 1 and 3, and their prognostic value was evaluated using logistic regression and receiver operating characteristic curve analyses. Patients were stratified by etiologies to assess biomarker performance across different causes of acute liver failure.ResultsNonsurvivors had significantly lower alpha-fetoprotein levels and higher carbohydrate antigen 19-9 levels than survivors on Days 1 and 3 (all p < 0.05). Alpha-fetoprotein levels increased over time in both groups, whereas carbohydrate antigen 19-9 levels increased in nonsurvivors and decreased in survivors. The combination of carbohydrate antigen 19-9 with the Model for End-Stage Liver Disease score significantly improved prognostic accuracy, with an area under the curve value of 0.828, compared with 0.784 for alpha-fetoprotein combined with Model for End-Stage Liver Disease score. Etiology-specific analysis revealed that carbohydrate antigen 19-9 showed the best predictive performance in acetaminophen-induced acute liver failure (area under the curve value = 0.885), whereas alpha-fetoprotein showed better predictive performance in viral hepatitis-associated acute liver failure (area under the curve value = 0.880).ConclusionsAlpha-fetoprotein is a protective prognostic factor, whereas carbohydrate antigen 19-9 enhances outcome prediction, particularly when combined with Model for End-Stage Liver Disease score. Etiology-specific biomarker performance supports tailored prognostic approaches in the management of acute liver failure.

Biofloc technology offers a viable choice for the rearing of fish seed by offering a safe and protected habitat for young fish. Nevertheless, it is crucial to establish a standardised stocking density and implement effective ameliorative steps in order to successfully utilise this technology. In this study, a 90-day investigation was conducted to assess the effect of stocking density and dietary vitamin C (Vit C) levels on the growth and immunity of Labeo gonius fry (1.03 ± 0.01 g) reared in a biofloc system. Three stocking density groups (5, 10 and 15 fish per 50 L) were established, and each experimental group was supplemented with three levels of Vit C (0, 500 and 1000 mg kg-1). The highest survival rate was observed in the lowest density group (five fish per 50 L) fed with 1000 mg kg-1 Vit C. A better feed conversion ratio and significantly higher protein efficiency ratio were found in the moderate stocking density group (10 fish per 50 L) fed with 500 mg kg-1 Vit C. Total leukocyte count (TLC), haemoglobin, and packed cell volume improved in Vit C-fed groups. The total erythrocyte count (TEC) increased in groups fed Vit C and stocked at lower densities (5 and 10 fish per 50 L). Total serum protein (TPP) content increased when Vit C was added at a rate of 500 mg kg-1. Serum glucose and cortisol levels were significantly reduced in Vit C-supplemented groups. Supplementation of Vit C at 500 mg kg-1 resulted in a significantly lower value of malondialdehyde (MDA). Thus, the findings confirm that the incorporation of Vit C in the basal diet promotes the growth and health status of L. gonius fry reared in the biofloc system at high-density rearing.

The global burden of invasive fungal infections (IFIs) is emerging in immunologic deficiency status from various disease. Patients with acute-on-chronic hepatitis B liver failure (ACHBLF) are prone to IFI and their conditions are commonly exacerbated by IFI. However, little is known about the characteristics and risk factors for IFI in hospitalized ACHBLF patients.

A total of 243 hospitalized ACHBLF patients were retrospectively enrolled from January 2010 to July 2023. We performed restricted cubic spline analysis to determine the non-linear associations between independent variables and IFI. The risk factors for IFI were identified using logistic regression and the extreme gradient boosting (XGBoost) algorithm. The effect values of the risk factors were determined by the SHapley Additive exPlanations (SHAP) method.

There were 24 ACHBLF patients (9.84%) who developed IFI on average 17.5 (13.50, 23.00) days after admission. The serum creatinine level showed a non-linear association with the possibility of IFI. Multiple logistic regression revealed that length of hospitalization (OR = 1.05, 95% CI: 1.02-1.08, P = 0.002) and neutrophilic granulocyte percentage (OR = 1.04, 95% CI: 1.00-1.09, P = 0.042) were independent risk factors for IFI. The XGBoost algorithm showed that the use of antibiotics (SHAP value = 0.446), length of hospitalization (SHAP value = 0.406) and log (qHBV DNA) (SHAP value = 0.206) were the top three independent risk factors for IFI. Furthermore, interaction analysis revealed no multiplicative effects between the use of antibiotics and the use of glucocorticoids (P = 0.990).

IFI is a rare complication that leads to high mortality in hospitalized ACHBLF patients, and a high neutrophilic granulocyte percentage and length of hospitalization are independent risk factors for the occurrence of IFI.

Background: Conventional prognostic models do not fully reflect the severity of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). This study aimed to establish an effective and convenient nomogram for patients with HBV-related ACLF. Methods: A nomogram was developed based on a retrospective cohort of 1,353 patients treated at the Third Affiliated Hospital of Sun Yat-sen University from January 2010 to June 2016. The predictive accuracy and discriminatory ability of the nomogram were determined by a concordance index (C-index) and calibration curve, and were compared with current scoring systems. The results were validated using an independent retrospective cohort of 669 patients consecutively treated at the same institution from July 2016 to March 2018. This study is registered at ClinicalTrials.gov (NCT03992898). Results: Multivariable analysis of the derivation cohort found that independent predictors of 90-day survival were age, white blood cell (WBC) count, hemoglobin (Hb), aspartate aminotransferase (AST), total bilirubin (TBil), international normalized ratio, serum creatinine (Cr), alpha fetoprotein (AFP), serum sodium (Na), hepatic encephalopathy (HE), pre-existing chronic liver disease(PreLD), and HBV DNA load. All factors were included in the nomogram. The nomogram calibration curve for the probability of 90-day survival indicated that nomogram-based predictions were in good agreement with actual observations. The C-index of the nomogram was 0.790, which was statistically significantly greater than those for the current scoring systems in the derivation cohort (P < 0.001). The results were confirmed in the validation cohort. Conclusions: The proposed nomogram is more accurate in predicting the 90-day survival of patients with HBV-related ACLF than current commonly used methods.