{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T10:45:22Z","timestamp":1781865922760,"version":"3.54.5"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    This study investigates the impact of the indirect bilirubin percentage\u2010to\u2010albumin ratio (iBAR) on the prognosis of patients with acute\u2010on\u2010chronic liver failure (ACLF), as defined by the Chinese Group on the Study of Severe Hepatitis B\u2010ACLF (COSSH ACLF) criteria, who were treated with an artificial liver support system (ALSS). In a retrospective cohort of 258 eligible patients, restricted cubic splines, linear regression, and Cox proportional hazards models were used to analyse the association of iBAR with disease severity and 28\u2010day and 90\u2010day outcomes. The 28\u2010day transplant\u2010free and overall survival rates were 76.4% and 82.2%, respectively, while the 90\u2010day rates were 58.5% and 66.3%. The iBAR was significantly lower in 28\u2010day transplant\u2010free survivors compared to those who underwent transplantation or died (6.47\u2009\u00b1\u20092.95 vs. 8.87\u2009\u00b1\u20092.49,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), with similar findings for 90\u2010day outcomes (6.09\u2009\u00b1\u20092.75 vs. 8.38\u2009\u00b1\u20092.88,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). A positive association was observed between iBAR and COSSH ACLF score (adjusted \u03b2\u2009=\u20090.14, 95% CI: 0.11\u20130.18,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Furthermore, iBAR was independently associated with higher risks of 28\u2010day transplant\u2010free mortality (adjusted HR\u2009=\u20091.21, 95% CI: 1.10\u20131.34,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), 28\u2010day overall mortality (adjusted HR\u2009=\u20091.26, 95% CI: 1.12\u20131.42,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), 90\u2010day transplant\u2010free mortality (adjusted HR\u2009=\u20091.13, 95% CI: 1.06\u20131.22,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and 90\u2010day overall mortality (adjusted HR\u2009=\u20091.14, 95% CI: 1.05\u20131.23,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). Patients with an iBAR &gt;\u20096.13 had significantly poorer 28\u2010day and 90\u2010day prognoses compared to those with iBAR \u2264\u20096.13 (all adjusted HR &gt;\u20091,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). In conclusion, iBAR is positively associated with disease severity and adverse prognosis in COSSH ACLF patients receiving ALSS therapy, suggesting its potential as a prognostic biomarker that warrants validation in future prospective, multicenter studies.\n                  <\/jats:p>","DOI":"10.1111\/jvh.70131","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T09:53:28Z","timestamp":1767952408000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Indirect Bilirubin Percentage to Albumin Ratio and Outcome of Hepatitis B Related Acute on Chronic Liver Failure Treated With Artificial Liver Support System"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7544-4140","authenticated-orcid":false,"given":"Weixi","family":"Tang","sequence":"first","affiliation":[{"name":"Center of Infectious Diseases West China Hospital of Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-6080","authenticated-orcid":false,"given":"Yuanji","family":"Ma","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases West China Hospital of Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingyao","family":"Du","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases West China Hospital of Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5042-4336","authenticated-orcid":false,"given":"Lang","family":"Bai","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases West China Hospital of Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Tang","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases West China Hospital of Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.11.047"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/cm9.0000000000003289"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.11.045"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.41"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn121430\u201020200720\u201000536"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102017\u2010314641"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.08.050"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i7.1262"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1286510"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2024.101017"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.706407"},{"key":"e_1_2_13_14_1","first-page":"1","article-title":"Guideline for the Diagnosis and Treatment of Liver Failure (2024 Edition)","volume":"33","author":"H.F.a.A.L.W.G.T.C.S.o.H: The Chinese Society of Infectious Diseases, Severe Liver Disease and Artificial Liver Working Group","year":"2025","journal-title":"Chinese Journal of Hepatology"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000500408"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1381386"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2020.100176"},{"key":"e_1_2_13_18_1","volume-title":"StatPearls","author":"Reddy D. 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