Abstract: Objective The aim of this study was to explore implications of serum human beta-defensin 1 (HBD-1), Golgi protein 73 (GP73) and interleukin-33 (IL-33) levels in patients with hepatitis B viral infection-related acute-on-chronic liver failure (HBV-ACLF), with emphasis on 28-day and 90-day prognosis. Methods 156 patients with HBV-ACLF, 60 patients with HBV-related liver cirrhosis (LC) and 60 healthy individuals were encountered in our hospital between April 2020 and March 2023. Serum HBD-1, GP73 and IL-33 levels were assayed by ELISA, and univariate and multivariate Logistic regression analysis were applied to reveal risk factors for poor prognosis, and receiver operating characteristic curve (ROC) was drawn for evaluation of diagnostic performance. Results By admission, serum HBD-1 level in patients with ACLF was (314.9±47.3)ng/mL, much higher than [(256.5±42.6)ng/mL, P＜0.05] in patients with LC or [(43.1±11.3)ng/mL, P＜0.05] in healthy persons, serum GP73 level was (285.4±68.4)ng/mL, much higher than [(142.4±51.6)ng/mL, P＜0.05] in LC group or [(44.6±12.0)ng/mL, P＜0.05] in healthy group, and serum IL-33 level was (1.7±0.4)pg/mL, significantly higher than [(1.3±0.2)pg/mL, P＜0.05] in LC or [(0.5±0.1)pg/mL, P＜0.05] in control group; 28 day- and 90 day-survival rates in our series were 76.3% and 43.6%; serum HBD-1, GP73 and IL-33 levels in 28 d survivals were significantly lower than in dead patients (P＜0.05), and serum HBD-1 and IL-33 levels in 90 d survivals were much lower than in dead (P＜0.05); multivariate Logistic regression analysis showed that total serum bilirubin (TSB), INR, HBD-1, GP73 and IL-33 levels were risk factors for 28 d survivals (P＜0.05), and serum TSB, INR, HBD-1 and IL-33 levels were risk factors for 90 d survivals (P＜0.05); ROC analysis showed the AUC as 0.902(95%CI:0.846-0.961), with sensitivity (Se) of 85.7% and specificity (Sp) of 80.9%, when HBD-1, GP73 and IL-33 levels (265.6 ng/mL, 266.3 ng/mL and 1.4 pg/mL were set as cut-off-value) were combined to predict 28 day survival, and the AUC was 0.879(95%CI:0.805-0.979), with Se of 83.6% and Sp of 78.4%, when serum HBD-1 and IL-33 levels (277.7 ng/mL and 1.4 pg/mL were set as cu-off-value) were combined to predict 90 day prognosis. Conclusion Besides TSB and INR, detection of serum HBD-1, IL-33 and/or GP73 levels could predict prognosis of patients with HBV-ACLF, which might help clinicians make appropriate measure for management of patients with ACLF in this setting.

Key words: Acute-on-chronic liver failure, Human beta-defensin-1, Golgi protein 73, Interleukin-33, Prognosis