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Abstract: Objective To investigate the expression of Beclin1, mucin domain 3 (TIM-3) and
interleukin-34 (IL-34) in patients with acute liver failure and their predictive value for disease
outcomes. Methods Total of 80 patients with acute liver failure who received medical treatment in
General Hospital of the Central Theater Command from January 2020 to January 2022 were selected
as acute liver failure group, and 80 healthy individuals who underwent physical examinations in our
hospital during the same period were selected as healthy group. The expression levels of Beclin1
and IL-34 were measured by enzyme-linked immunosorbent assay, and TIM-3 was measured by
flow cytometry. All patients with acute liver failure were treated with liver protection, artificial liver
or liver transplantation. They were divided into survival group (56 cases) and death group (24 cases)
according to the outcome of the disease after treatment. The expression levels of Beclin1, TIM-
3 and IL-34 of patients in two groups were compared. Pearson correlation coefficient was used to
analyze the correlation between Beclin1, TIM-3, IL-34 and liver function indicators. Multivariate
Logistic regression was used to analyze the risk factors affecting the prognosis of acute liver failure
patients. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of
Beclin1, TIM-3, IL-34 on the prognosis of patients with acute liver failure. Results Compared with
those of healthy group, Beclin1 [(13.42 ± 2.11) μg/L vs. (8.10 ± 1.12) μg/L], TIM-3 [(44.53 ± 3.29)%
vs. (20.19 ± 2.31)%] and IL-34 [(15.53 ± 2.05) ng/L vs. (9.73 ± 1.13) ng/L] expression levels of
patients in acute liver failure group increased significantly (all P ＜ 0.05). Pearson correlation
analysis showed that the levels of Beclin1, TIM-3 and IL-34 in peripheral blood of patients with
acute liver failure were positively correlated with liver function indicators [total bilirubin (TBil),
alanine aminotransferase (ALT), aspartate aminotransferase (AST)] (all P ＜ 0.05). Compared with
those of survival group, Beclin1 [(15.64 ± 2.13) μg/L vs. (10.02 ± 1.54) μg/L], TIM-3 [(51.32 ±
6.75)% vs. (35.64 ± 3.41)%] and IL-34 [(19.08 ± 2.43) ng/L vs. (11.12 ± 1.32) ng/L] expression
levels of patients in death group increased significantly (all P ＜ 0.05). Multivariate Logistic
regression analysis showed that elevated Beclin1 (OR = 4.536, 95%CI: 3.442～8.904, P ＜ 0.001), TIM-3
(OR = 2.342, 95%CI: 1.023～6.757, P ＜ 0.001) and IL-34 (OR = 5.642, 95%CI: 3.452～9.089,
P ＜ 0.001) were independent risk factors affecting the outcome of patients with acute liver failure.
ROC curve showed that the areas under the curve of Beclin1, TIM-3 and IL-34 were 0.897, 0.839
and 0.800, respectively. The area under the curve of Beclin1 + TIM-3 + IL-34 was 0.934, which was
significantly higher than those of the individual indicators (Z = 2.272, P = 0.011; Z = 2.246, P = 0.014;
Z = 3.980, P ＜ 0.001). Conclusions Beclin1, TIM-3 and IL-34 were highly expressed in patients
with acute liver failure and were associated with the outcomes. The increase of Beclin1, TIM-3 and
IL-34 in peripheral blood of patients in death group was exacerbated. Clinically, the disease outcome
could be predicted early according to the expression level of the three indicators in the peripheral
blood of patients to improve the outcome.
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