A cohort study of HBV DNA load,liver stiffness and serum inflammatory factors combined to predict HBV-DC progression and prognosis

Cao Haiyang; Yu Min; Jiang Hai; Wang Chaojie; Chen Jie

doi:10.3969/j.issn.1007-8134.2025.06.006

Abstract：Objective To investigate the combined predictive value of hepatitis B virus DNA(HBV DNA)load,liver stiffness measurement(LSM),and serum inflammatory markers for the progression and prognosis of decompensated hepatitis B-related cirrhosis(HBV-DC).Methods A prospective cohort study was conducted involving 168 patients with HBV-DC admitted between May 2023 and April 2024.A standardized follow-up protocol was established:dynamic monitoring was performed at months 1,3,6,9,and 12 post-enrollment,with the 12-month endpoint following treatment initiation.Patients were categorized into the improvement group(n=96)and the progression group(n=72).Baseline characteristics,HBV DNA levels,liver stiffness,and serum inflammatory markers[procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP)]were compared between groups.Logistic regression models analyzed factors influencing HBV-DC progression and prognosis.ROC curves assessed the predictive value of combined HBV DNA levels,liver stiffness,and serum inflammatory factors for HBV-DC progression and prognosis.Finally,validation cohort data were incorporated into the constructed combined prediction model to evaluate the efficacy of the inflammatory combination prediction.Results Significant differences were observed between the improvement group and the progression group in terms of age,concomitant diabetes,type of first decompensated event,ALT,AST,and Child-Pugh score(P<0.05).At all time points,the improvement group exhibited lower levels of HBV DNA,LSM,PCT,and hs-CRP compared to the progression group.Notably,LSM and HBV DNA levels in the progression group increased significantly over time,whereas the improvement group showed a decreasing trend.These indicators demonstrated divergent temporal trends between groups(P<0.05).Logistic regression analysis revealed that age,Child-Pugh score,elevated HBV DNA,LSM,PCT,and hs-CRP were independent predictors of HBV-DC progression and prognosis(P<0.05).ROC curve analysis indicated optimal predictive thresholds for HBV-DC progression and prognosis:HBV DNA≥4.85 log10 IU/mL,≥9.14 kPa,≥0.78 ng/mL,and≥9.63 mg/L,respectively.The combined predictive sensitivity and specificity for HBV-DC progression and prognosis were 76.73%and 86.72%,demonstrating superior predictive efficacy.Hosmer-Lemeshow goodness-of-fit testing confirmed high calibration accuracy for the combined predictive model.Conclusions HBV DNA load,liver stiffness,and serum inflammatory markers(PCT,hs-CRP)serve as independent predictors of HBV-DC progression and prognosis,with their combined predictive value being even higher.