Abstract: Objective This study aimed to explore serum clusterin level changes in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF)and its correlation with short-term prognosis. Methods 48 hospitalized patients with HBV-ACLF and 60 patients with chronic hepatitis B (CHB) were enrolled in our hospital between January 2019 and January 2021, and the patients with HBV-ACLF were classified into early stage with 30% < prothrombin time activity (PTA)<40%, middle stage with 20%<PTA<30% and late stage with PTA<20%. Serum clusterin levels were assayed by ELISA. Results The peripheral white blood cell counts, serum alanine aminotransferase, aspartate aminotransferase, bilirubin levels and model for the end-stage liver diseases (MELD) in patients with HBV-ACLF were(8.0±2.8)×10⁹/L, (418.2±163.5)U/L, (386.1±139.2)U/L, (226.6±74.4)μmol/L and (23.2±5.3), significantly higher than [(6.0±2.3)×10⁹/L, (163.8±75.7)U/L, (118.7±73.3)U/L, (25.6±12.4)μmol/L and (9.6±3.6), respectively, P<0.05], while peripheral platelet counts was (101.8±42.0)×10⁹/L, serum albumin level was (32.6±7.6)g/L, PTA was (35.3±5.3)%, serum clusterin level was (51.0±5.9)μg/mL, all significantly lower than [(128.5±54.4)×10⁹/L, (38.1±8.5)g/L, (77.4±9.3)% and (185.9±13.5)μg/mL, respectively, P<0.05] in patients with CHB; serum clusterin level in 9 patients with HBV-ACLF late stage was (28.5±3.8)μg/mL, significantly lower than [(72.6±7.2)μg/mL, P<0.05] in 20 patients with HBV-ACLF early stage or [(46.0±5.2)μg/mL, P<0.05] in 19 patients with HBV-ACLF middle stage, serum clusterin level in 13 HBV-ACLF patients with bacterial infections was (36.6±4.6)μg/mL, significantly lower than [(56.6±6.1)μg/mL, P<0.05] in 35 HBV-ACLF patients without infections, and serum clusterin level in 15 dead HBV-ACLF patients was (39.8±4.3)μg/mL, significantly lower than [(72.3±7.6)μg/mL, P<0.05] in 33 survivals; the dead patients with HBV-ACLF had even more higher total serum bilirubin levels, elevated MELD scores, more lower PTA, and more the incidence of complications, such as hepatic encephalopathy of 46.7% and hepatorenal syndrome of 40.0%. Conclusion The patients with HBV-ACLF has increased serum clusterin levels, which is a potential biomarker for the evaluation of disease severity and prognosis of patients.

Key words: Acute-on-chronic liver failure, Serum clusterin level, Prognosis