ArticleFrontiers in medicine2026
Early peripheral monocyte dynamics are associated with 28-day mortality in acute liver failure: an exploratory longitudinal cohort study.
Article in Frontiers in medicine, 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: Acute liver failure (ALF) is a rapidly progressive and life-threatening syndrome with high short-term mortality. The prognostic value of early longitudinal changes in peripheral immune cell counts remains unclear. This study investigated whether early dynamic changes in peripheral monocytes (MONO) are associated with 28-day mortality in ALF. Methods: In this single-center retrospective longitudinal cohort study, 266 patients with International Classification of Diseases-coded ALF between October 2018 and January 2026 were screened. After chart review and application of predefined diagnostic criteria, 46 patients were included. Peripheral blood cell parameters within 7 days after admission were analyzed. MONO-derived indices included delta MONO and slope MONO. Linear mixed-effects models assessed MONO trajectories. Additional analyses included clustering, logistic regression, and model evaluation. Results: Among 46 patients, 23 (50.0%) died within 28 days, while the remaining 23 patients survived. Baseline MONO did not differ between groups. MONO trajectories showed a stable pattern in survivors and a progressive increase in non-survivors, with significant time × group interaction after adjustment for age, gender, and white blood cells. Higher delta MONO and slope MONO were observed in non-survivors. Trajectory-based clustering identified an increasing-MONO phenotype associated with higher mortality. In multivariable analyses, delta MONO showed the most consistent association with 28-day mortality, whereas baseline MONO showed model-dependent associations and slope MONO was less stable after covariate adjustment. Exploratory prognostic analyses suggested that MONO dynamics may provide complementary information beyond conventional variables. A shorter-window analysis further showed that MONO trajectory divergence was already detectable within the first 72 h after admission. Conclusion: Early increases in peripheral MONO are associated with 28-day mortality in ALF, with delta MONO showing the most consistent association across multivariable analyses. Longitudinal MONO monitoring may provide complementary information beyond single baseline measurements, although these findings require validation in larger cohorts.
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