Stratified alpha-fetoprotein pattern accurately predicts mortality in patients with acute-on-chronic hepatitis B liver failure

Expert Rev Gastroenterol Hepatol. 2018 Mar;12(3):295-302. doi: 10.1080/17474124.2018.1424540. Epub 2018 Jan 12.


Background: Alpha-fetoprotein (AFP) has been shown to predict the prognosis of liver disease in several studies. This study aimed to evaluate the prognostic value of stratified AFP in patients with acute-on-chronic hepatitis B liver failure (ACHBLF).

Methods: A total of 192 patients were included and AFP were categorized into quartiles. The prognostic value was determined for overall survival (OS) and assessed by Kaplan-Meier analysis. Univariate and multivariate Cox proportional hazard regression analyses studied the association of all independent parameters with disease prognosis.

Results: The optimal cut-off points of AFP were: (Q1) 252.3-4800.0 ng/ml, (Q2) 76.0-252.2 ng/ml, (Q3) 18.6-75.9 ng/ml, and (Q4) 0.7-18.5 ng/ml. Based on the Kaplan-Meier analysis of the OS, each AFP quartile revealed a progressively worse OS and apparent separation (log-rank P = 0.006). The second-highest quartiles of AFP (Q2) always demonstrated an extremely favorable short-term survival. Combining the lowest AFP quartiles with a serum sodium < 131mmol/L or an INR ≥ 3.3 showed a poor outcome (90-days survival of 25.0% and 11.9% respectively).

Conclusions: Stratified AFP could strengthen the predictive power for short-term survival of patients with ACHBLF. Combining AFP quartiles with low serum sodium and high INR may better predict poor outcome in ACHBLF patients.

Keywords: Alpha-fetoprotein; hepatitis B virus; hepatitis B virus-related-acute-on-chronic liver failure; liver disease; overall survival; risk factor.

MeSH terms

  • Acute-On-Chronic Liver Failure / blood*
  • Acute-On-Chronic Liver Failure / virology*
  • Adult
  • Female
  • Hepatitis B, Chronic / complications*
  • Humans
  • International Normalized Ratio
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Sodium / blood
  • Survival Rate
  • alpha-Fetoproteins / metabolism*


  • alpha-Fetoproteins
  • Sodium