Low Testosterone Levels Predict Increasing Severity and Worse Outcomes of Hepatitis B Virus-related Acute-on-chronic Liver Failure in Males

BackgroundHepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is more prevalent among males than females and has a high rate of short-term mortality, and low serum testosterone has been prevalent in critical illness such as acute respiratory failure and cirrhosis, we investigated the association between testosterone level and severity of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) in males remains unknown.MethodsThis single-center observational study involved patients with HBV-ACLF planned to undergo treatment with an artificial liver support system. Morning blood samples were collected and androgen levels analyzed by chemi-bioluminescent immunoassay. Time to death or liver transplantation within 90 days comprised the primary composite outcome. We assessed the relationships between androgen levels, stage (early, middle, or late, categorized according to clinical manifestation), severity scores, and clinical outcomes of HBV-ACLF.ResultsAmong 160 male subjects, 32 had early stage HBV-ACLF, 61 middle stage, and 67 end stage. Serum levels of total testosterone (TT), free testosterone index (FTI), dehydroepiandrosterone sulfate and cortisol were significantly lower among subjects than chronic hepatitis B patients and healthy controls, while androstenedione was higher. Low TT, SHBG, FTI and high androstenedione were associated with increased stage (of HBV-ACLF, ascites, and hepatic encephalopathy) and severity scores (Model for End-stage Liver Disease and Chinese Group on the Study of Severe Hepatitis B-ACLF scores). Low TT (