Cao Z, et al. - In patients with hepatitis B virus (HBV)-related acute decompensation (AD) of cirrhosis with and without acute-on-chronic liver failure (ACLF), researchers examined the prognostic ability of serum cell death markers. They assessed two cohorts, with the first made up of 201 outpatients with stable chronic hepatitis B (49 cirrhosis), and the second of 232 inpatients with hepatitis B virus (HBV)-related cirrhosis admitted for acute decompensation (AD). To appraise cell death, they determined serum keratin-18 (K18) for total death and serum caspase-cleaved-K18 (cK18) for apoptosis. K18 and cK18 increase were chiefly ascribed to HBV flare and were linked with liver and coagulation failure. During follow-up, a higher likelihood of developing acute-on-chronic liver failure (ACLF) was observed for HBV-related AD patients without ACLF who were admitted with upper tertile of K18 or cK18. Irrespective of leucocytes, HBV DNA, bacterial infection, encephalopathy and severity scores, transplant-free 90-day survival was observed in significant correlation to baseline serum K18 or cK18. Significant improvement in the prognostic ability of the currently established prognostic scores was observed with the combination of cell death biomarkers. Increased short-term survival was evident in correlation with the reduction of cell death level following standard treatment. Overall, ACLF prediction and risk stratification of short-term outcome could be done via measuring serum K18 or cK18 in HBV decompensated cirrhosis.