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Background  Several studies have suggested a relationship between hepatitis B virus (HBV) basal core promoter/pre-core mutations and HBV-induced acute-on-chronic liver failure (ACLF). Therefore, we evaluated this potential relationship using a meta-analysis.    Methods  Chinese or English studies from 1966 to January 31, 2014 were included in the analysis. A random or fixed-effects model was used to merge the odds ratios (ORs).    Results  We identified 31 case–control studies containing a total population of 1995 ACLF and 3822 chronic hepatitis B (CHB) patients. Several mutations were significantly correlated with ACLF: T1753V (1.889, 95 % confidence interval (CI) [1.357–2.631]), A1762T (2.696 [2.265–3.207]), G1764A (3.005 [2.077–4.347]), A1762T/G1764A (2.379 [1.519–3.727]), C1766T (1.849 [1.403–2.437]), T1768A (2.440 [1.405–3.494]), A1846T (3.163 [2.157–4.639]), G1896A (2.181 [1.800–2.642]), G1899A (3.569 [2.906–4.385]) and G1896A/A1762T/G1764A (1.575 [1.172–2.116]). Additionally, HBeAg-negative status was also statistically significant for the progression to ACLF (OR = 2.813, 95 % CI = 2.240–3.533,  p  < 0.001). However, there was no association between ACLF development and HBV genotype.    Conclusions  The HBV basal core promoter/pre-core mutations T1753V, A1762T, G1764A, C1766T, T1768A, A1846T, G1896A and G1899A, and an HBeAg-negative status correlate with an increased risk of HBV-ACLF.    Electronic supplementary material  The online version of this article (doi:10.1186/s12985-015-0313-5) contains supplementary material, which is available to authorized users.

Associations between hepatitis B virus basal core promoter/pre-core region mutations and the risk of acute-on-chronic liver failure: a meta-analysis