The prognosis of hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is critical in clinical management. We aimed to assess the prognostic e cacy of superoxide dismutase 2 (SOD2) for 90-day mortality in HBV-ACLF patients. The expression patterns of SOD2 in peripheral blood mononuclear cells (PBMCs) were examined in a derivation set (n = 82) by quantitative real-time polymerase chain reaction (RT-qPCR). The results were further validated in a validation set (n = 35). The expression levels of SOD2 were signi cantly decreased in the derivation set compared to those with chronic hepatitis B (CHB) or the healthy controls (HCs) (P < 0.001). In HBV-ACLF patients, SOD2 levels were negatively correlated with serum total bilirubin (TBIL) (rs = -0.43, P < 0.001) and model for end-stage liver disease (MELD) scores (rs = -0.22, P = 0.047), but positively correlated with alkaline phosphatase (AKP) (rs = 0.23, P = 0.034). SOD2 was identi ed as an independent risk factor for 90-day mortality in HBV-ACLF patients (hazard ratio: 0.124, 95% con dence interval: 0.059-0.261, P < 0.001). SOD2 yielded a larger area under the receiver operating characteristic curve (AUROC) than the MELD score in predicting 90-day mortality (0.914 versus 0.712, P < 0.001). Kaplan-Meier analysis revealed a favorable overall survival (OS) for the SOD2 high expression group compared with the SOD2 low expression group in both the derivation and validation sets (P < 0.001). SOD2 has promising potential as a predictor of 90-day mortality in patients with HBV-ACLF. synthesis kit (Fermentas, Vilnius, Lithuania). qRT-PCR was performed using SYBR® Premix ExTaqTM (TaKaRa), with β-actin serving as the internal control. The reaction was performed in a total volume of 10 µL, which included 4.1 µL of RNase-free ddH2O, 0.2 µL of speci c forward and reverse primers, 5 µL of SYBR Green, and 0.5 µL of cDNA, under the following conditions: initial denaturation at 95℃ for 10 minutes, then 40 cycles of denaturation at 95 °C for 5 seconds, annealing at 58 °C for 30 seconds and extension at 72 °C for 30 seconds. The primers used have been described in a previous study [17]: SOD2 forward, 5′-GAGAAGTACCAGGAGGCGTTG-3′; SOD2 reverse, 5′-GAGCCTTGGACACCAACAGAT-3′; β-actin forward, 5′-AGAGCTACGAGCTGCCTGAC-3′; β-actin reverse, 5′-AGCACTGTGTTGGCGTACAG-3′. The relative expression of SOD2 was calculated using the 2 − ΔΔCT method. All ampli cation reactions were performed in triplicate.
Statistical AnalysisStatistical analyses were performed using IBM SPSS Statistics (version 26.0; IBM Statistics, Armonk, NY) and R software (version 4.0.2 for Windows; the R foundation for statistical computing, Vienna, Austria). The demographic characteristics are presented as medians (interquartile range) or percentages. The Mann-Whitney U test was used to quantitative variables, while the chi-square test was used to categorical variables. Spearman rank correlation analysis was used to assess the associations between SOD2 levels and clinical variables. Using Cox proportional hazard regr...