#100 - High-Density Lipoprotein Cholesterol as a Predictor of in-Hospital Mortality in Patients With Acute-on-Chronic Liver Failure at a Tertiary Care Center

Introduction and Objectives High-density lipoprotein (HDL) cholesterol plays immunomodulatory and anti-inflammatory roles, and low HDL levels may reflect impaired hepatic synthetic function and systemic inflammation. Therefore, HDL could represent an accessible prognostic biomarker in Acute-on-chronic liver failure (ACLF). To evaluate the prognostic performance of HDL cholesterol for predicting in-hospital mortality in patients with ACLF and compare it with established prognostic scores. Materials and Methods We conducted a retrospective observational cohort study including 70 patients diagnosed with ACLF according to EASL-CLIF criteria at a tertiary care center between January 2020 and April 2026. The primary outcome was in-hospital mortality. Discriminatory performance of admission HDL levels was assessed using receiver operating characteristic (ROC) curves and compared with MELD, MELD-Na, and CLIF-C ACLF scores. Survival was analyzed using Kaplan-Meier curves. Univariate and multivariate logistic regression analyses were performed. Results In-hospital mortality was 37.1%. Non-survivors had significantly lower median HDL levels than survivors (4.5 vs 19 mg/dL, p<0.001). HDL demonstrated an AUC of 0.848 (95%CI 0.75–0.94), comparable to CLIF-C ACLF (AUC 0.841). An HDL cutoff 11 mg/dL showed 88.5% sensitivity and 72.7% specificity for predicting mortality. In univariate analysis, HDL 11 mg/dL was associated with increased mortality (OR 11.20; 95%CI 3.44–36.43; p<0.001). In multivariate analysis adjusted for CLIF-C ACLF, HDL 11 mg/dL(adjusted OR 12.12; 95%CI 2.82–51.82; p=0.001). Conclusions Low HDL cholesterol levels were strongly associated with in-hospital mortality in ACLF. HDL demonstrated prognostic performance comparable to CLIF-C ACLF and may represent a simple and accessible biomarker for risk stratification in ACLF.