Serum Homocysteine as a Prognostic Biomarker for Short-Term Mortality in HBV-Related Acute-on-Chronic Liver Failure Patients

Background: The liver plays a central role in the synthesis and metabolism of homocysteine (Hcy). The present study aimed to determine the prognostic role of serum Hcy levels in patients with HBV-related acute-on-chronic liver failure (AoCLF). Methods: Fifty-two AoCLF and 52 chronic hepatitis B (CHB) patients were recruited. The virological parameters and biochemical examination of blood were obtained after 12 hours of fasting. In the AoCLF group, the relationships between the prognosis and the Hcy level were analyzed. The primary end-point was 3-month in-hospital mortality. Results: A significantly higher Hcy level was detected in AoCLF patients than in the healthy controls (HCs) and CHB groups (both p < 0.01). The Hcy level was positively correlated with the model of end-stage liver disease (MELD) score and the creatinine levels and was inversely correlated with the estimated glomerular filtration rate. Moreover, Hcy levels at presentation were higher among non-survivors than survivors in AoCLF patients. Multivariate analysis suggested that both Hcy level and MELD score were independent predictors of 3-month mortality in patients with AoCLF (p < 0.001). Conclusions: Serum Hcy level measured at admission may serve as a biomarker for 3-month mortality rate in patients with HBV-AoCLF.