ArticleFrontiers in cellular and infection microbiology2026
HBV RNA dynamics and cytokine-driven hyperinflammation: a synergistic prognostic axis in hepatitis B-related acute-on-chronic liver failure.
Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aims: The interplay between hepatitis B virus (HBV) replication and host immunity remains poorly defined in hepatitis B-related acute-on-chronic liver failure (HBV-ACLF). This study aimed to investigate the dynamic antagonism between serum HBV RNA and cytokine-driven hyperinflammation, and to evaluate their combined prognostic value. Methods: In this prospective cohort study (March 2021-December 2022), 133 patients with HBV-ACLF were enrolled. Serum levels of HBV RNA and Th1/Th2 cytokines (IFN-γ, TNF-α, IL-4, IL-6, IL-10) were measured. Logistic regression analysis was used to identify independent predictors of 12-week prognosis, and to construct and internally validate prognostic models. Results: Non-survivors (40.6%, 54/133) exhibited significantly lower HBV RNA levels (2.97 ± 1.22 vs. 4.05 ± 1.30 log Conclusions: HBV RNA and Th1 cytokines form a dynamic prognostic axis in HBV-ACLF. Declining HBV RNA, indicative of viral control, paradoxically heralds a cytokine-driven hyperinflammatory state associated with organ failure. This virus-immunity interplay provides a novel stratification tool to guide early immunomodulatory therapy, challenging the traditional focus on viral load alone.
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