Serum Exosomal Long Noncoding Rna Nuclear-Enriched Abundant Transcript 1 Predicts 90-Day Mortality In Acute-On-Chronic Hepatitis B Liver Failure

Objectives: Acute-on-chronic hepatitis B liver failure (ACHBLF) is characterized by high short-term mortality, calling for accurate prognostic biomarkers. This study aims to evaluate the predictive value of serum exosomal long noncoding RNA nuclear-enriched abundant transcript 1 (lncRNA NEAT1) for 90-day mortality of ACHBLF. Methods: This prospective study consisted of 113 ACHBLF patients from June 2013 to June 2017 as a training cohort and 72 ACHBLF patients from July 2017 to June 2020 as a validating cohort. LncRNA NEAT1 was detected using quantitative real-time polymerase chain reaction from serum exosomes. Results: LncRNA NEAT1 levels were higher in non-survivors than survivors (P< 0.01). In the training cohort, lncRNA NEAT1 (HR 1.049, 95%CI 1.023-1.075, P< 0.001) was an independent predictor for 90-day mortality of ACHBLF. Meanwhile, lncRNA NEAT1 showed significantly higher area under the curve of receiver operating characteristic (AUC) than MELD score in the training and validation cohort (P< 0.05, respectively). However, no significant difference was found in AUC between lncRNA NEAT1 and NEAT1 plus MELD score (P> 0.05). ACHBLF patients with lncRNA NEAT1 levels above 1.92 showed poorer survival condition than those below (P< 0.01). Conclusions: The serum exosomal lncRNA NEAT1 might be a better prognostic biomarker than MELD score for 90-day mortality of ACHBLF.