Association Between Plasma Level of Superoxide Dismutase and Survival of Patients with Acute-On-Chronic Liver Failure

Abstract Fewer than 50% patients with acute-on-chronic liver failure (ACLF) recover spontaneously, and ACLF patients have high mortality without liver transplantation. Oxidative stress has been shown to mediate hepatic inflammation during liver failure. The aim of this study is to investigate whether a biomarker of oxidative stress exists in assessing severity and outcomes of patients with ACLF. Between January 2015 and September 2018, a retrospective cohort of 124 ACLF patients, together with healthy individuals, liver cirrhosis and acute liver failure (ALF) patients were analyzed. Plasma Superoxide Dismutase (SOD) level was measured using a commercial ELISA kit, survival analysis was carried out using the Kaplan-Meier method. Results indicated that patients with ACLF had statistically higher plasma SOD levels compared to controls (healthy controls and cirrhosis patients). A level of SOD > 428 U/mL was associated with a statistically increase in risk for mortality or liver transplantation due to ACLF. Combination of plasma SOD level and MELD score had improved performance in assessing severity and outcomes of ACLF. In conclusion, this research revealed that plasma SOD level measured at hospital admission can be used to assign patients with ACLF into high- and low-risk groups. Combination of plasm SOD level and MELD score was more closely associated with patient outcome than either value alone. This system might be used to determine patient prognoses and prioritize patients for liver transplantation.