LAUSR

Early diagnosis and prognosis evaluation are of great significance to hepatitis E virus (HEV)‐related acute liver failure (HEV‐ALF) patients. We collected serum samples from 200 health controls (HCs), 200 patients with acute hepatitis E (AHE), and 200 HEV‐ALF patients to evaluate serum exosome‐derived carbamoyl phosphate synthase 1 (CPS1) levels and determine its diagnostic and prognostic value. The exosome‐derived CPS1 levels in the HEV‐ALF group were significantly higher than those in the AHE and HCs groups. The AUC of exosome‐derived CPS1 to predict the occurrence of HEV‐ALF was 0.850 (0.811−0.883). Both logistical regression and orthogonal partial least squares discriminant analysis (OPLS‐DA) showed that exosome‐derived CPS1 is an independent risk factor for HEV‐ALF. The exosome‐derived CPS1 levels were positively correlated with organ failure and the outcomes in HEV‐ALF patients. The exosome‐derived CPS1 levels in the worsening group were significantly higher than those in the fluctuating and the improving groups. The AUC of serum exosome‐derived CPS1 to predict 30‐day mortality was 0.829 (0.770−0.879), which was significantly greater than that of the Child‐Pugh, KCH, and MELD models. The level of serum exosome‐derived CPS1 might serve as a promising diagnostic and prognostic biomarker for HEV‐ALF patients, which may provide better guidance for the diagnosis, prognosis, and treatment of HEV‐ALF patients.