# The gamma-glutamyl transpeptidase to platelet ratio: a good noninvasive biomarker for predicting for the occurrence and prognosis of patients with hepatitis E virus-related acute liver failure

## TL;DR

This study shows that the gamma-glutamyl transpeptidase to platelet ratio (GPR) is a useful noninvasive biomarker for predicting the occurrence and prognosis of hepatitis E virus-related acute liver failure.

## Contribution

The study introduces GPR as a novel noninvasive biomarker for diagnosing and predicting outcomes in HEV-related acute liver failure.

## Key findings

- GPR levels were significantly higher in HEV-ALF patients compared to AHE patients.
- GPR was identified as a key factor in predicting 30-day mortality in HEV-ALF patients.
- GPR demonstrated strong diagnostic performance with an AUC of 0.701 for HEV-ALF occurrence.

## Abstract

The relationship between GPR and hepatitis E has not been reported. This study evaluates the GPR levels in AHE patients and HEV-ALF patients and explores the role of GPR levels in the prognosis of HEV-ALF patients, offering new strategies and methods for the diagnosis and prognosis of HEV-ALF patients.

Serum samples were collected from 206 AHE patients and 217 HEV-ALF patients admitted to the First Affiliated Hospital of Zhejiang University School of Medicine, Suzhou Yongding Hospital, and Nanjing Medical University Affiliated Suzhou Hospital between January 1, 2017, and November 30, 2024.

The GPR level in the HEV-ALF group was significantly higher than in the AHE group (p < 0.001). OPLS-DA analysis revealed that INR, TBIL, PLT, GPR, TCH, ALT, AFP, TP, ALB, and AST were the major influential factors for the occurrence of HEV-ALF. GPR showed good diagnostic performance with an AUC of 0.701. DCA further supported the utility of GPR across a range of threshold probabilities. Regarding the prediction of 30-day mortality, GPR levels were significantly higher in the non-survival group compared to the survival group (p < 0.001). OPLS-DA analysis highlighted GPR as the most influential factor for predicting 30-day mortality. GPR demonstrated an AUC of 0.703. DCA results also indicated GPR’s strong decision-making ability for predicting 30-day mortality in HEV-ALF patients.

GPR is highly expressed in HEV-ALF patients and is closely related to their prognosis.