Abstract: Objective The aim of this study was to explore the changes of Golgi protein 73 (GP73), soluble urokinase plasminogen activator receptor (suPAR) and antithrombin-III (AT-III) levels in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods 81 patients with HBV-ACLF, including 29 cases at early stage, 28 cases at middle stage and 24 cases at advanced stage, and 65 patients with chronic hepatitis B (CHB), matched by gender and age, were enrolled in our hospital between November 2019 and October 2022. Serum GP73, suPAR and AT-III levels were detected by ELISA. The patients with HBV-ACLF were carefully managed and followed-up for 3 months. The predicting performance was evaluated by the area under the receiver operating characteristic (ROC) curves. Results Serum GP73 and suPAR levels in patients with HBV-ACLF were(227.4±48.4)ng/mL and (8.3±2.3)ng/mL, much higher than [(126.6±31.6)ng/mL and (5.1±1.6)ng/mL, respectively, P＜0.05], while serum AT-Ⅲ level was (48.2±12.9)%, much lower than [(76.6±18.7)%, P＜0.05] in patients with CHB; serum GP73 and suPAR levels in patients with advanced HBV-ACLF were (265.6±27.1)ng/mL and (9.4±1.2)ng/mL, significantly higher than [(231.7±29.5)ng/mL and (8.4±1.4)ng/mL, P＜0.05] in patients at middle stage or [(191.6±33.5)ng/mL and (7.3±1.6)ng/mL, P＜0.05] in patients at early stage, while serum AT-Ⅲ level was (36.8±9.1)%, significantly lower than [(47.1±10.9)%, P＜0.05] in patients at middle stage or [58.7±11.3)%, P＜0.05] in patients at early stage; at the end of three month treatment, 59 patients(72.8%) survived and 22 patients (27.2%) died in our series; serum GP73 and suPAR levels in dead patients at admission were (270.4±38.3)ng/mL and (9.9±6.2)ng/mL, significantly higher than [(210.9±41.5)ng/mL and (8.0±1.5)ng/mL, P＜0.05], while serum AT-Ⅲ level was (35.4±9.1)%, significantly lower than [(51.1±10.6)%, P＜0.05] in survivals; the AUC was 0.846 by the three combination in predicting the prognosis, much superior to the three parameters alone (the AUCs were 0.703, 0.710 and 0.744, P＜0.05), with the sensitivity of 81.8%, the specificity of 81.4%, and the accuracy of 81.5%. Conclusion The surveillance of serum GP73, suPAR and AT-III levels might help predict the prognosis of patients with HBV-ACLF, and warrants further clinical investigation.

Key words: Acute-on-chronic liver failure, Golgi protein 73, Soluble urokinase plasminogen activator receptor, Antithrombin-III, Prognosis