AUTHOR=Sun Shuning , Xu Baoyan , Tan Wenting , Xiang Xiaomei , Zhou Yi , Dan Yunjie , Guo Yanzhi , Tan Zhaoxia , Deng Guohong 

TITLE=Testosterone and Estradiol as Novel Prognostic Indicators for HBV-Related Acute-on-Chronic Liver Failure

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.729030

DOI=10.3389/fmed.2021.729030

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> HBV-related acute-on-chronic liver failure (HBV-ACLF) has a high short-term mortality and urgently needs an early warning system with simplicity and high accuracy. Previous studies show that sex hormones play potential roles in the progression of HBV-related liver diseases.</p><p><bold>Aims:</bold> To explore the effect of testosterone and estradiol on the occurrence and prognosis of HBV-ACLF.</p><p><bold>Methods:</bold> A prospective cohort of 300 chronic hepatitis B (CHB) patients was enrolled among which 108 were diagnosed with HBV-ACLF at admission and 20 developed to HBV-ACLF during hospitalization. We compared the level of serum testosterone and estradiol of patients with varied ACLF background, disease severity and cirrhosis conditions and analyzed the predictive ability of short-term prognosis. A novel prognostic model involving testosterone was developed and further validated in the HBV-ACLF group.</p><p><bold>Results:</bold> The baseline estradiol level of HBV-ACLF group was significantly higher while testosterone was lower than that of non-ACLF group. The estradiol level increased while the testosterone level decreased as the number of organ failures increased. Testosterone had high accuracy in predicting the short-term mortality in HBV-ACLF (AUROC = 0.726) and estradiol did better in predicting the occurrence of ACLF during hospitalization (AUROC = 0.695). The novel prognostic model involving testosterone (TATIM model) was proved to have considerable prediction efficiency in HBV-ACLF cohort with or without cirrhosis.</p><p><bold>Conclusion:</bold> Testosterone could be utilized as short-term prognostic indicator for HBV-related ACLF and estradiol can help to predict its occurrence. TATIM model is a novel prognostic model for HBV-related ACLF with simplicity and good performance irrespectively of liver cirrhosis.</p><p><bold>Clinical Trial Registration Number:</bold> This study was based on a sub-cohort from the prospective multicenter cohort (NCT02457637).</p>