Prognostic value of anti‐HBc quantification in hepatitis B virus related acute‐on‐chronic liver failure

Abstract

Background and Aim It has been reported that serum quantification of anti‐HBc (qAnti‐HBc) could predict antiviral response in chronic hepatitis B (CHB) patients, while its role in hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) remains unclear. Its implication in HBV‐ACLF was evaluated in this study. Methods Baseline serum qAnti‐HBc levels were retrospectively detected in HBV‐ACLF and CHB patients using recently developed double‐sandwich immunoassay. The association of qAnti‐HBc level with clinical outcomes was evaluated by multiple logistic regression. Nomogram was adopted to formulate an algorithm incorporating qAnti‐HBc for the prediction of survival in HBV‐ACLF. The post‐hospitalization of HBV‐ACLF patients were followed‐up for 1 year. Results Eighty‐eight HBV‐ACLF as training set, 80 HBV‐ACLF as validation set and 216 CHB cases were included. Serum qAnti‐HBc level was significantly higher in HBV‐ACLF (4.95 ± 0.54 log10 IU/mL) than CHB patients (4.47 ± 0.84 log10 IU/mL) (P < 0.01). Among HBV‐ACLF cases, both in training and validation set, patients with poor outcomes had lower qAnti‐HBc level. Area under receiver operating characteristic curve of the novel qAnti‐HBc inclusive model was 0.82, superior to 0.73 from model for end‐stage liver disease scores (P = 0.018), which was confirmed in validation set. During follow‐up, the qAnti‐HBc level declined at month 3 and month 6, then plateaued at 3.84 log10 IU/mL. Conclusions Serum qAnti‐HBc level was associated with disease severity and might be served as a novel biomarker in the prediction of HBV‐ACLF clinical outcomes. The underlying immunological mechanism warrants further investigation.

Protective Role of Rheumatic Diseases Against Hepatitis B Virus Infection and Human Leukocyte Antigen B27 Highlighted

“…We previously demonstrated the role of core coding protein in immunopathogenesis (3). We also found that severe cases of HBV infection had higher HBcAb levels, while in the terminal stage, lower HBcAb level was correlated with poor outcomes (12). Based on these considerations, the immunogenicity of core-related proteins during HBV infection might be complex, yet important.…”

“…We previously found that overactivated HBV immunity in patients could be HBV core coding proteins related (11). We also discovered that the HBcAb level possessed a prognostic value in severe cases (12), albeit in a biphasic manner.…”

Clinical Utility of Quantitative HBV Core Antibodies for Solving Diagnostic Dilemmas

“…Since the host’s hyper-inflammatory status seems responsible for multisystem organ failure and high mortality, an immune-related marker is expected to be a good choice for clinical prognosis. The first study that investigated the performance of qAnti-HBc level in patients with ACLF demonstrated that qAnti-HBc level was significantly higher in patients with ACLF than in patients with CHB regardless of the HBeAg status [ 36 ]. On the other hand, the qAnti-HBc level was notably lower in patients with the fatal outcome than in patients who survived ACLF.…”

“…[ 35 ] (differentiation between acute infection and acute CHB exacerbation), ref. [ 36 ] (diagnosis of acute-on-chronic liver failure), refs. [ 20 , 27 , 28 , 37 , 38 ] (diagnosis of OBI), refs.…”

Hepatitis B Core Antibody Level: A Surrogate Marker for Host Antiviral Immunity in Chronic Hepatitis B Virus Infections

“…This study found the HBV-ACLF patients had a significantly higher level of anti-HBc than CHB patients (4.95 ± 0.54 vs. 4.47 ± 0.84 log10 IU/mL), and the qAnti-HBc showed a comparable and complementary prognostic accuracy to MELD (model for end-stage liver disease) score in predicting clinical outcome (survival or death). A high level of qAnti-HBc was associated with less mortality in HBV-ACLF patients [ 72 ]. In another study conducted in HBV-infected patients who received orthotopic liver transplantation (OLT), Lou et al also suggested a high level of pre-transplantation qAnti-HBc was associated with a low risk of post-transplantation HBV recurrence [ 73 ].…”