Abstract: Objective The aim of this study was to investigate the changes of serum soluble growth stimulating expression gene 2 (sST2), Toll-like receptor 4 (TLR4), soluble urokinase plasminogen activator receptor (suPAR) and Beclin 1 levels in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods 122 patients with HBV-ACLF were enrolled in our hospital between November 2019 and November 2023, all received conventional liver-supporting therapy and followed-up for 3 months. Serum sST2, TLR4, suPAR and Beclin1 levels were detected by ELISA, and receiver operating characteristic curve (ROC) was drawn to evaluate predicting efficacy of serum indicators in patients with HBV-ACLF. Results 90 d survival rate in our series was 52.5%, as 58 patients didn't survived; total serum bilirubin, INR and score of model for end-stage liver disease at presentation in dead patients were(342.3±97.4)μmol/L, (2.8±0.7) and 23.4(19.3,27.3), all significantly higher than [(223.6±63.7)μmol/L, (1.7±0.5) and 18.6(16.2, 21.8), respectively, P<0.05] in survivals; serum sST2, TLR4, suPAR and Beclin1 levels were (102.6±18.5)ng/mL, (38.7±7.2)pg/mL, (11.4±3.2)ng/mL and (13.4±2.6)mg/L, all significantly higher than [(74.8±13.4)ng/mL, (28.4±5.7)pg/mL, (7.2±1.9)ng/mL and (8.6±2.3)mg/L, respectively, P<0.05] in survivals; ROC analysis showed that the AUC was 0.908, with sensitivity of 70.8% and specificity of 89.1%, suggesting a satisfactory predicting performance, when any three of the four serum parameters reached to cut-off-value in patients with HBV-ACLF. Conclusion Monitoring serum sST2, TLR4, suPAR and Beclin1 levels might be helpful to predict the prognosis of patients with HBV-ACLF.

Key words: Acute-on-chronic liver failure, Soluble growth stimulating expression gene 2, Toll-like receptor 4, Soluble urokinase plasminogen activator receptor, Beclin1, Prognosis