PYGL as a Novel Biomarker for Disease Progression and Prognosis in HEV-ALF Patients

Hepatitis E virus (HEV) is a significant cause of acute liver failure (ALF). The role of glycogen phosphorylase L (PYGL) in the diagnosis and prognosis of HEV-ALF remains unclear. This study collected clinical data and baseline characteristics from HEV-ALF patients, acute hepatitis E (AHE) patients, and healthy controls (HCs), measuring serum PYGL levels in each group. Methods including Orthogonal partial least squares discriminant analysis (OPLS-DA), receiver operating characteristic (ROC) and decision curve analysis (DCA) were used to evaluate the clinical utility of PYGL. Results showed that PYGL effectively diagnosed HEV-ALF (AUC = 0.911). PYGL levels were significantly higher in HEV-ALF patients than in AHE patients and HCs (p < 0.001). Among HEV-ALF patients, non-survivors exhibited higher PYGL levels than survivors (p < 0.001). PYGL demonstrated good predictive ability for 30-day mortality (AUC = 0.859). OPLS-DA and DCA confirmed its strong decision-making utility. Furthermore, PYGL levels escalated with increasing organ failure and paralleled clinical worsening, being highest in the deterioration group (p < 0.05). PYGL is a potential diagnostic and prognostic biomarker in HEV-ALF patients, where elevated levels indicate poorer outcomes and support early intervention.