Characteristics of Peripheral Lymphocyte Subsets in Patients With Acute-On-Chronic Liver Failure Associated With Hepatitis B

Background and Aims: Acute-on-chronic liver failure (ACLF) is a rare, but dramatic clinical syndrome. There is substantial evidence suggesting that immunity-mediated inflammation plays an important role in HBV-ACLF. Our aim was to characterize the proportion and cell counts of peripheral blood lymphocyte subsets in acute-on-chronic liver failure patients caused by HBV infection. Methods: One hundred and seventeen patients were enrolled in this study, including those with HBV-related ACLF (HBV-ACLF; n = 70), and HBV related non-ACLF patients (HBV non-ACLF; n = 47). Demographics, clinical and laboratory data at hospital admission were retrospectively analyzed. The percentage and cell count of peripheral lymphocyte subsets were evaluated by flow cytometry. Comparison analysis was performed by t-test or non-parametric Mann-Whitney U-test. Actuarial probabilities of death were calculated by the Kaplan-Meier method. Results: Both circulating lymphocyte count and lymphocyte percentage were significantly reduced in patients with HBV-ACLF (P < 0.001). The CD8(+) T cell, CD4(+) T cell, and CD16(+)CD56(+) NK cell counts were significantly decreased in HBV-ACLF. Consistently, flow cytometric analysis showed that CD8(+) T cell counts were significantly decreased in non-survivors, while no significant differences were found in CD4(+) T cell, CD19(+) B cell, or CD56(+)CD16(+) NK cell counts. Furthermore, the group with the lower CD8(+) T cell count displayed a significantly higher mortality rate compared with the group with the higher CD8(+) T cell count. Conclusions: The abnormal prevalence of lymphocyte subsets may be important in the pathogenesis of HBV-ACLF. The decrease in CD8(+) T cell counts may be related to poor survival in HBV-ACLF patients.