The value of autoantibody and D-dimer detection in evaluating the prognosis of patients with chronic hepatitis B and hepatitis B cirrhosis

doi:10.16150/j.1671-2870.2024.02.011

Abstract

Abstract:

Objective To detect autoantibodies and D-dimer in patients with chronic hepatitis B (CHB) or with hepatitis B cirrhosis (cirrhosis), and explore the value of detection in evaluating disease progression and prognosis of the patients. Methods A total of 147 consecutive cases meeting the enrollment criteria were collected in out hospital during January 2020 to January 2023, including 82 cases of CHB(CHB group) and 65 cases of cirrhosis(Cirrhosis group). Sixty healthy subjects were selected as the control, and autoantibody detection and D-dimer level were analyzed. In Cirrhosis group,patients died or suffered from digestive bleeding or hepatic encephalopathy were classified into poor prognosis group, and the other into good prognosis group. The autoantibody positivity and D-dimer level were included in binary logistic regression analysis to idetntify the risk factors for poor prognosis in patients with cirrhosis. Results The positive rate of autoantibody in CHB Group （25.61%）and Cirrhosis group （27.69%）were higher than that in control group（8.33%） (P<0.05).The positive rates of antinuclear antibody in CHB and Cirhosis group were 14.63% and 4.62% (P<0.05), and there was no significant difference in positive rates of other antibodies between CHB and Cirrhosis group. The D-dimer levels in CHB and Cirrhosis groups were 0.28 (0.19,0.51) mg/L and 1.19 (0.53,2.49) mg/L(P<0.05), and D-dimer level in Cirrhosis group was higher than that in control group[0.27(0.20,0.32)] (P<0.05). The positive rates of autoantibody in the poor and good prognosis groups of cirrhosis were 47.06% and 20.83%(P<0.05), and D-dimer levels were 1.78 (0.90,6.28) mg/L and 1.06 (0.32,2.07) mg/L(P<0.05). Regression analysis showed that the positive autoantibody [OR=7.447(2.016-27.507), P=0.003] and D-dimer level increase [OR=1.336(1.028-1.736), P=0.030] were risk factors for poor prognosis in patients with cirrhosis. The receiver operating characteristic curve showed that the sensitivity and specificity of positive autoantibody for predicting poor prognosis of cirrhosis were 53.6% and 83.0%, respectively. When the optimal cut-off value of D-dimer was ≥ 0.84 mg/L, the prediction sensitivity for poor prognosis in cirrhosis patients was 88.9%, and specificity was 44.7%. When combination of D-dimer level and autoantibody positivity was performed, the sensitivity and the specificity for predicting poor prognosis was 72.2%, 85.1%, respectively. Conclusions Autoantibody positive rate and D-dimer level are higher in patients with CHB or cirrhosis compared to the healthy subjects. The positive rate of autoantibody is not related to the disease course, while the increase of D-dimer is related to the disease course. The positive rate of antinuclear antibody decreased with the progression of the disease. Combined detection of autoantibody and D-dimer may be used to predict the prognosis of patients with cirrhosis.

Key words: Hepatitis B virus, Chronic hepatitis B, Cirrhosis, Autoantibody, D-dimer

CLC Number:

LIU Yue, WU Hanlin, TONG Wuqing, XU Jing. The value of autoantibody and D-dimer detection in evaluating the prognosis of patients with chronic hepatitis B and hepatitis B cirrhosis[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(02): 173-179.

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References 29

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Group	N(case)	Autoantibody positive [case (%)]	D-dimer (mg/L)
Control	60	5(8.33%)	0.27(0.20,0.32)
Chronic hepatitis B^a	82	21(25.61%)^a	0.28(0.19,0.51)
Cirrhosis^a	65	18(27.69%)^a	1.19(0.53,2.49)^a

Group	N(case)	ANA	RO-52	GP210	ASMA	AMA	LC-1	SLA	LKM-1
Chronic hepatitis B	82	12(14.63)	6(7.32)	2(2.44)	1(1.22)	1(1.22)	5(6.10)	0	0
Cirrhosis	65	3(4.62)	7(10.77)	2(3.08)	0	3(4.62)	4(6.15)	2(3.08)	1(1.54)
P		0.046	0.464	0.813	0.372	0.229	0.989	0.115	0.260

Item	Good prognosis（n=48）	Poor prognosis（n=48）	P
Gender (Male/female)	32/16	12/5	0.766
Age (years)	52.06±12.64	55.50±12.66	0.331
HBV infection years (years)	10(1,20)	10(0.048,22.50)	0.559
D-dimer (mg/L)	1.06(0.32,2.07)	1.78(0.90,6.28)	0.026
Autoantibody positive [case(%)]	10(20.83)	8(47.06)	0.038

Independent variable	B	SE	Wald	P	OR	95%CI
Autoantibody	2.008	0.667	9.071	0.003	7.447	2.016-27.507
D-dimer (mg/L)	0.290	0.134	4.708	0.030	1.336	1.028-1.736

Independent variable	Cutoff	AUC(95%CI)	Sensitivity (%)	Specificity (%)
Autoantibody	0.50	0.693(0.539-0.846)	53.60	83.00
D-dimer (mg/L)	0.84	0.680(0.541-0.818)	88.90	44.70
Combination	0.43	0.824(0.719-0.930)	72.20	85.10