APOC3 as a potential prognostic factor for hepatitis B virus-related acute-on-chronic liver failure

Acute-on-chronic liver failure (ACLF) is the major cause of mortality in patients infected with the hepatitis B virus (HBV); however, early determination of the prognosis of patients with HBV-ACLF is insensitive or limited. This study aimed to analyze differentially expressed proteins in the plasma of patients with HBV-ACLF using data-independent acquisition mass spectrometry to provide a reference for short-term prognosis. Fifty HBV-ACLF patients and 15 healthy controls were enrolled in this study. Of these, 10 patients with HBV-ACLF and 5 healthy volunteers participated in data-independent acquisition-based proteomics and the potential core proteins were screened out via bioinformatics. Apolipoprotein C3 (APOC3) was selected and quantified by enzyme linked immunosorbent assays in all patients. And the area under the curve (AUC) was calculated to evaluate the value of APOC3 in the diagnosis and prognosis of patients with HBV-ACLF. A total of 247 differentially expressed proteins were identified in the serum of patients in the HBV-ACLF and normal control groups. A total of 148 proteins were upregulated and 99 proteins were downregulated in the HBV-ACLF group compared with those in the normal group. The expression level of APOC3 was 1.65 ± 0.44 mg/mL in patients with HBV-ACLF, which was obviously lower than the normal controls (2.04 ± 0.22 mg/mL) (P < .001) (AUC was 0.766, with a sensitivity of 62%, and specificity of 93.3%). The expression level of APOC3 was 1.38 ± 0.44 mg/mL in the non-survival group, which was obviously lower than the survival group (1.83 ± 0.35 mg/mL) (P < .0001) (AUC was 0.780, with a sensitivity of 50%, and specificity of 96.7%). APOC3 is associated with short-term prognosis of patients with HBV-ACLF and can be used as a potential prognostic biomarker in patients with HBV-ACLF.