Value of serum tryptophan in stratified management of 90-day mortality risk in patients with hepatitis B virus-related acute-on-chronic liver failure: a multicenter retrospective study

Nan Fang Yi Ke Da Xue Xue Bao. 2025 Jan 20;45(1):59-64. doi: 10.12122/j.issn.1673-4254.2025.01.08.
[Article in English, Chinese]

Abstract

Objectives: To explore the correlation of serum tryptophan level with 90-day mortality risk in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).

Methods: This retrospective study was conducted among 108 patients with HBV-ACLF, whose survival outcomes within 90 days after diagnosis were recorded. The correlation of baseline serum tryptophan levels measured by high-performance liquid chromatography with 90-day mortality of the patients was analyzed, and the predictive value of serum tryptophan for 90-day mortality was explored.

Results: Within 90 days after diagnosis, 53 (29.4%) of the patients died and 127 (70.6%) survived. The deceased patients had significantly lower baseline serum tryptophan levels than the survivors (7.31±3.73 pg/mL vs 13.32±7.15 pg/mL, P<0.001). Multivariate analysis suggested that serum tryptophan level was an independent factor correlated with mortality of HBV-ACLF after adjustment for confounding variables. The patients with serum tryptophan levels below the median level (10.14 pg/mL) at admission had significantly higher 90-day mortality risks than those with higher tryptophan levels (43.3% vs 15.6%, HR: 3.157, 95% CI: 1.713-5.817), and the complication by kidney dysfunction further increased the risk to 73.3% as compared with patients with higher serum tryptophan levels with normal kidney function (15.0%; HR: 7.558, 95% CI: 3.369-16.960). Serum tryptophan levels had an area under the receiver operating characteristic curve of 0.771 (95% CI: 0.699-0.844) for predicting 90-day mortality.

Conclusions: Serum tryptophan level is closely correlated with the survival outcomes of patients with HBV-ACLF, and a decreased tryptophan level indicates a high 90-day mortality risk, which can be further increased by the complication by kidney dysfunction.

目的: 探索血清色氨酸与乙肝相关慢加急性肝衰竭(HBV-ACLF)死亡风险之间的相关性。方法: 回顾性纳入180例HBV-ACLF患者,根据确诊后90 d结局为患者分为存活组和死亡组;采用高效液相色谱法测定两组患者外周血中的血清色氨酸含量;比较两组患者基线血清色氨酸水平的差异;通过单因素及多因素回归分析基线血清色氨酸水平对于HBV-ACLF患者确诊后90 d病死率的影响;通过受试者曲线下面积探讨血清色氨酸对HBV-ACLF 90 d死亡风险的潜在预测价值。结果: 90 d随访期内,53例(29.4%)HBV-ACLF患者因疾病死亡,127例(70.6%)存活。死亡患者的基线色氨酸水平低于存活患者(P<0.001);经多因素回归分析校正混杂因素显示,色氨酸水平是HBV-ACLF死亡风险的独立预测因素。HBV-ACLF患者入组时低水平色氨酸(<10.14 pg/mL)与高水平色氨酸(≥10.14 pg/mL)相比具有更高的90 d死亡风险(43.3% vs 15.6%,HR:3.157,95% CI:1.713-5.817);同时合并肾功能不全和低水平色氨酸的90 d死亡风险更高(73.3% vs 15.0%,HR:7.558,95% CI:3.369-16.960);血清色氨酸水平用于预测HBV-ACLF患者的90 d死亡风险具有一定潜在价值(ROC=0.771,95% CI:0.699-0.844)。结论: 血清色氨酸与 HBV-ACLF预后密切相关;低水平的血清色氨酸预示90 d高死亡风险;尤其是同时合并肾功能不全的患者90 d死亡风险更高。.

Keywords: hepatitis B virus; kidney dysfunction; liver failure; prognosis; tryptophan.

Publication types

  • Multicenter Study

MeSH terms

  • Acute-On-Chronic Liver Failure* / blood
  • Acute-On-Chronic Liver Failure* / mortality
  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Tryptophan* / blood

Substances

  • Tryptophan