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The mortality rate of HBV-ACLF has decreased in recent years due to advances in treatment therapies; however, it is still above 50%. Many cases of HBV-ACLF are caused by HBV reactivation due to discontinuation of nucleoside analog treatment. The present study focused on plasma levels of superoxide dismutase (SOD) in HBV-ACLF patients and investigated whether the plasma level of SOD is a useful biomarker in assessing disease severity and predicting outcomes of HBV-ACLF patients, including patients treated with Entecavir (ETV) and patients who were withdrawn from ETV treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Plasma samples and clinical data from 200 HBV-ACLF patients and from age- and sex-matched cirrhotic and healthy controls were collected and analyzed. Plasma levels of SOD were measured using an ELISA commercial kit.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among the HBV-ACLF patients, in the ETV withdrawal group, the mortality rate was higher than in the ETV group (69.95% vs 46.71%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Moreover, HBV-DNA and SOD plasma levels were higher in the ETV withdrawal group than in the ETV group (<jats:italic>Log<\/jats:italic><jats:sub><jats:italic>10<\/jats:italic><\/jats:sub><jats:italic>(HBV-DNA)<\/jats:italic>: 6.49\u2009\u00b1\u20090.24 vs 4.79\u2009\u00b1\u20090.14, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01; SOD: 463.1\u2009\u00b1\u200927.61 U\/mL vs 397.2\u2009\u00b1\u200910.97 U\/mL, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). The mortality and liver transplantation rates were significantly higher in HBV-ACLF patients with plasma levels of SOD\u2009&gt;\u2009428 U\/mL than in patients with plasma SOD levels\u2009\u2264\u2009428 U\/mL.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Reactivation of HBV and elevated oxidative stress caused by discontinuation of ETV treatment are crucial factors in the pathogenesis of HBV-ACLF. Plasma level of SOD may serve as a useful biomarker in estimating disease severity and predicting outcomes of HBV-ACLF patients who stop ETV treatment.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-022-02371-1","type":"journal-article","created":{"date-parts":[[2022,6,25]],"date-time":"2022-06-25T15:03:06Z","timestamp":1656169386000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prognostic value of plasma level of superoxide dismutase in HBV-related acute-on-chronic liver failure"],"prefix":"10.1186","volume":"22","author":[{"given":"Naijuan","family":"Yao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajuan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,6,25]]},"reference":[{"issue":"42","key":"2371_CR1","doi-asserted-by":"publisher","first-page":"12125","DOI":"10.3748\/wjg.v21.i42.12125","volume":"21","author":"S Blasco-Algora","year":"2015","unstructured":"Blasco-Algora S, Masegosa-Ataz J, Guti\u00e9rrez-Garc\u00eda ML, Alonso-L\u00f3pez S, Fern\u00e1ndez-Rodr\u00edguez CM. 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