Elevated FDP levels independently predict poor outcomes in HBV-ACLF patients treated with artificial liver support...

Acute-on-chronic liver failure (ACLF) is an extremely severe clinical syndrome, often associated with systemic inflammation, coagulation dysfunction, and fibrinolysis abnormalities. Fibrin degradation product (FDP), as a byproduct of fibrinolysis, is a crucial indicator reflecting the state of fibrinolysis. The objective of this study is to investigate the relationship between FDP levels and the 28-day mortality rate in patients with ACLF. We retrospectively enrolled 520 patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) who underwent artificial liver support system therapy and collected relevant clinical data at admission. Cox regression analysis was employed to investigate the relationship between FDP levels and the 28-day mortality rate, and the predictive value of FDP was evaluated using receiver operating characteristic (ROC) curves. Among the 520 eligible patients, the 28-day mortality rate was 20.2%. The FDP levels of surviving patients were significantly lower than those of deceased patients [6.15 (3.23-10.97) vs. 16.98 (9.58-28.93), P < 0.001]. Through multivariate Cox proportional hazards analysis, after adjusting for confounding factors, It was observed that for every 10 µg/mL increase in FDP levels, the risk increased by 12.8% [HR = 1.128 (95% CI: 1.044-1.219), P < 0.001]. Compared to patients with low FDP levels (< 11.1 µg/mL), patients with high FDP levels (≥ 11.1 µg/mL) demonstrated a markedly higher mortality risk [HR = 3.222 (95% CI: 1.999-5.192), P < 0.001]. Among various prognostic scores, the COSSH-ACLF score exhibited the largest area under the receiver operating characteristic curve (AUROC), comparable to that of FDP (P = 0.891), and its predictive performance was superior to that of FIB and D-dimer. Additionally, for patients who received three or more sessions of artificial liver support system therapy, those with high FDP levels had a significantly reduced 28-day mortality risk. Elevated FDP levels are associated with the 28-day prognosis in patients with HBV-ACLF. Moreover, undergoing multiple sessions of artificial liver treatment is associated with favorable survival outcomes for patients with high FDP levels (≥ 11.1 µg/mL).