Global epidemiology of cirrhosis - aetiology, trends and predictions

Effect of adipose-related parameters on mortality in patients with liver cirrhosis: a meta-analysis

BACKGROUND

Some adipose-related parameters exhibit distinct prognostic value in patients with cirrhosis. However, the magnitude and direction of the association between individual adipose parameter and mortality in patients with cirrhosis are unclear.

AIM

This study aimed to evaluate the association between individual adipose parameter and mortality in patients with cirrhosis using the meta-analysis method.

METHODS

The PubMed, Embase, Web of Science, China Biological Medicine, WanFang, and China National Knowledge Infrastructure databases were searched from inception through December 15, 2023, to identify eligible studies. The impact of each adipose parameter on mortality was assessed by the pooled unadjusted or adjusted hazard ratio (HR) with 95% confidence intervals (CIs) using the random effects model.

RESULTS

A total of 33 studies involving 9626 patients were included in our analysis, with 11 adipose parameters evaluated. The pooled prevalence of sarcopenic obesity (SO) and myosteatosis in patients with cirrhosis was 15.5% and 34.4%, respectively. In adjusted analysis, each unit increase in subcutaneous adipose tissue index (SATI) (HR: 0.99, 95% CI: 0.98-1.00) or muscle attenuation (MA) (HR: 0.94, 95% CI: 0.90-0.98) and each unit decrease in visceral-to-subcutaneous adipose tissue ratio (VSR) (HR: 1.92, 95% CI: 1.45-2.54) showed an independent association with a decreased risk of mortality. However, concurrent myosteatosis (HR: 1.88, 95% CI: 1.48-2.40) or SO (HR: 2.77, 95% CI: 1.95-3.93) significantly increased the risk of mortality in patients with cirrhosis.

CONCLUSION

Decreased SATI or MA, increased VSR, and concurrent myosteatosis or SO were independently associated with a higher risk of mortality in patients with cirrhosis.

Nursing care for patients with liver cirrhosis undergoing surgery for esophageal variceal bleeding in an integrated healthcare system

BACKGROUND

Globally, Liver cirrhosis is the 14th leading cause of death and poses a significant threat to human health.

AIM

To investigate the effects of a multidisciplinary collaboration model on postoperative recovery and psychological stress in patients with liver cirrhosis undergoing esophageal variceal bleeding (EVB) surgery within an integrated healthcare system.

METHODS

Between January 2022 and March 2024, a total of 180 patients with cirrhosis and EVB were admitted and randomly assigned to either a control group (standard care) or an observation group (standard care plus the multidisciplinary collaboration model), with 90 patients in each group. Postoperative recovery indicators (time to symptom improvement, time to start eating, time to bowel sound recovery, time to first flatus, and hospital stay), psychological stress responses [self-rating anxiety scale (SAS); self-rating depression scale (SDS)], subjective well-being, and incidence of complications were compared between the two groups.

RESULTS

Compared to the control group, the observation group showed earlier symptom improvement, earlier return to eating, bowel sound recovery, first flatus, and a shorter hospital stay. Pre-intervention SAS and SDS scores were not significantly different between the groups, but post-intervention scores were significantly lower in the observation group. Similarly, there was no significant difference in the subjective well-being scores before the intervention between the two groups. After the intervention, both groups showed improved scores, with the observation group scoring significantly higher than the control group.

CONCLUSION

The observation group also had a lower incidence of complications. Therefore, for patients with liver cirrhosis undergoing EVB surgery, a multidisciplinary collaboration model within an integrated healthcare system can promote early postoperative recovery, reduces psychological stress, improves subjective well-being, and reduces complications and rebleeding.

Cardiometabolic risk factors and clinical course of liver cirrhosis

BACKGROUND

The global prevalence of Metabolic Dysfunction-Associated Liver Disease is dramatically increasing with the diffusion of cardiometabolic risk factors (CMRFs). The aim of the present study was to assess the natural course of liver cirrhosis, in terms of decompensation, development of hepatocellular carcinoma and mortality, in relation to the presence of CMRFs (type 2 diabetes mellitus, obesity, arterial hypertension, low HDL levels, hypertriglyceridemia).

PATIENTS

667 patients with liver cirrhosis (50 with CMRFs and without non-metabolic aetiological factors, 167 with non-metabolic aetiological factors and without CMRFs, and 450 with both non-metabolic aetiological factors and at least one CMRF) followed at the University and General Hospital of Padua, Italy, from 1998 to 2022, were included.

RESULTS

No difference in the occurrence of cirrhosis decompensating events and development of hepatocellular carcinoma was observed, whereas patients in the metabolic or mixed group had 4-3-fold higher all-cause mortality and significantly lower 3-years survival compared to patients in the non-metabolic group, despite a better liver function at enrolment. Hypertriglyceridemia and low HDL levels were the less prevalent CMRFs, but those associated with the highest risk of cirrhosis decompensation. Hypertriglyceridemia was also associated with an increased risk of mortality. Arterial hypertension was associated with a reduced risk of cirrhosis decompensation, but a higher risk of mortality.

CONCLUSION

Compared to patients without CMRFs, those with CMRFs had similar rates of liver cirrhosis decompensation but higher overall mortality. Hypertriglyceridemia was associated with a high risk of both liver decompensation and death.

Clinical Trial to Assess the Safety and Tolerability of Anti-IL 23 Monoclonal Antibody Guselkumab in Patients With Alcohol-Associated Liver Disease

BACKGROUND

There are no FDA-approved therapies for alcohol-associated liver disease (ALD). Preclinical studies indicate that blocking IL-23/IL-17 signalling may reverse liver injury. Guselkumab, an IL-23-specific antibody approved for psoriasis, may be beneficial for ALD.

AIMS

We aimed to assess the safety and tolerability of guselkumab in patients with ALD.

METHODS

This phase-1 dose-escalation study included patients with ≥ 2 DSM-5 criteria for alcohol use disorder, significant steatosis (MRI-PDFF ≥ 8%) and MRE < 3.63 kPa (to exclude advanced disease). Guselkumab was given subcutaneously on Days 1 and 29 in 30, 70 or 100 mg dose cohorts. Primary endpoints were adverse events (AEs) and dose-limiting toxicity.

RESULTS

We enrolled 13 patients (three 30 mg, three 70 mg, and seven 100 mg). Eleven completed the study and two early discontinued in the 100 mg group. Of them, 77% were men, and the median age was 53 [IQR 49-61] years. The median MRI-PDFF and MRE were 18.4% [IQR 8.4%-34.0%] and 2.5 [2.2-2.6] kPa, respectively. The most frequent AEs were hyperuricemia (13%, mild only) and elevated lipase (11%, mild and moderate). There were no serious adverse events or significant variations in liver enzymes. There was a suppression of peripheral interleukin (IL)-17, IL-23, IL-1b and TNF-α in the 70 and 100 mg groups, and a significant decrease in alcohol consumption over time (AUDIT-C: 6 [3-7] vs. 5 [1-6], p = 0.023).

CONCLUSIONS

Guselkumab is safe in doses up to 100 mg and may reduce inflammation markers in ALD. These findings support further phase 2 studies to evaluate the efficacy of guselkumab in ALD, particularly in patients with severe phenotypes.

Hepatoprotective Effect of Cannabidiol on the Progression of Experimental Hepatic Cirrhosis in Rats

Introduction: Liver cirrhosis is a condition characterized by the gradual replacement of normal liver tissue with scar tissue, ultimately leading to liver failure. This slow and progressive disease begins with a chronic inflammatory process induced by a noxious agent. In its advanced stages, the disease lacks effective therapies. Research has demonstrated the significant involvement of the endocannabinoid system in the pathogenesis of this disease. This study evaluated the hepatoprotective effect of cannabidiol (CBD) in the progression of experimental hepatic cirrhosis induced by thioacetamide (TAA) in rats. Methods: A randomized experimental design was employed using Holtzman rats. Hepatic cirrhosis was induced by intraperitoneal administration of TAA at a dose of 150 mg/kg for 6 weeks, with treatment initiated additionally. The groups were as follows: Group 1: TAA + vehicle; Group 2: TAA + CBD 2 mg/kg; Group 3: TAA + CBD 9 mg/kg; Group 4: TAA + CBD 18 mg/kg; Group 5: TAA + silymarin 50 mg/kg; and Group 6: Healthy control. Serum biochemical analysis (total bilirubin, direct bilirubin, ALT, AST, alkaline phosphatase, and albumin) and hepatic histopathological study were performed. The Knodell histological activity index (HAI) was determined, considering periportal necrosis, intralobular degeneration, portal inflammation, fibrosis, and focal necrosis. Results: All groups receiving TAA exhibited an elevation in AST levels; however, only those treated with CBD at doses of 2 mg/kg and 18 mg/kg did not experience significant changes compared to their baseline values (152.8 and 135.7 IU/L, respectively). Moreover, ALT levels in animals treated with CBD showed no significant variation compared to baseline. The HAI of hepatic tissue was notably lower in animals treated with CBD at doses of 9 and 18 mg/kg, scoring 3.0 and 3.25, respectively, in contrast to the TAA + vehicle group, which recorded a score of 7.00. Animals treated with CBD at 18 mg/kg showed a reduced degree of fibrosis and necrosis compared to those receiving TAA alone (p ≤ 0.05). Conclusion: Our findings demonstrate that cannabidiol exerts a hepatoprotective effect in the development of experimental hepatic cirrhosis induced in rats.

Revealing curcumin therapeutic targets on SRC, PPARG, MAPK8 and HSP90 as liver cirrhosis therapy based on comprehensive bioinformatic study

Cirrhosis naturally progresses through three stages: compensated, decompensated, and late decompensated, which carry an elevated risk of death. Although curcumin's anti-cirrhosis effects have been studied, underlying mechanism in preventing cirrhosis progression and the correlation between curcumin's action with upregulated genes remains insufficiently explored. In this study, we employed network pharmacology approach to construct a drug-target-disease network through bioinformatics and validate the findings with molecular docking and dynamic simulation. The curcumin-targeted liver cirrhosis network encompassed 54 nodes with 282 edges in protein-protein interactions (PPI) network. By utilizing network centrality analysis, we identified eight crucial genes. KEGG enrichment pathway revealed that these crucial genes are involved in pathway of cancer, endocrine resistance, estrogen signaling, chemical carcinogenesis-receptor activation, lipid metabolism, and atherosclerosis. Notably, these eight genes predominantly participate in cancer-related pathways. Further investigation revealed upregulation of four genes and downregulation of four others in hepatocellular carcinoma patients. These upregulated genes-MAPK8, SRC, PPARG, and HSP90AA1-strongly correlated with reduced survival probability in liver hepatocellular carcinoma patients with survival times approximately under 4000 days (∼11 years). Molecular docking and molecular dynamic results exhibited curcumin's superior binding affinities and stability compared to native ligands of MAPK8, SRC, PPARG, and HSP90AA1 within 50 ns simulations. Moreover, MM-GBSA analysis showed stronger binding energy of curcumin to MAPK8, SRC, and HSP90AA1 than native ligand. In conclusion, this study provides valuable insights into curcumin's potential mechanisms in preventing liver cirrhosis progression, specifically in HCC. These findings offer a theoretical basis for further pharmacological research into anti-HCC effect of curcumin.

Global perspectives on transplant disparities

PURPOSE OF REVIEW

Our goal was to review and summarize the current state of global disease burden from organ failure and the efforts to improve outcomes with organ transplantation. We also reviewed intra- and inter-country disparities in organ failure and organ transplantation along with potential mechanisms to improve access to organ transplantation globally.

RECENT FINDINGS

Many disparities and inequities observed globally can be characterized by the country's income category. Low- and lower-middle income countries (LLMICs) have higher rates of communicable disease-attributed organ failure, while upper-income countries (UICs) have high overall prevalence due to global growth in noncommunicable etiologies of organ failure. Many downstream disparities in access to organ transplantation and outcomes are associated with country income designation. Improvements in data collection and surveillance of populations with organ failure and organ transplantation are urgently needed.

SUMMARY

Improving outcomes for patients with end-organ disease globally will require countries to improve organ transplantation access and care. For LLMICs, collaboration with international transplant systems and engagement with neighboring countries may establish important foundations for organ transplant systems. For UICs, increasing organ donor availability through technological advances and increasing public engagement will help meet the growing needs for organ transplantation as an important treatment modality.

Quantifying the economic impact of premature mortality from cirrhosis in Spain

OBJECTIVES

Excessive alcohol consumption is a major contributor to illness and mortality on a global scale. Per-capita alcohol consumption rose from 5.5 litres in 2005 to 6.4 litres in 2016 and is projected to reach 7.6 litres by 2030. In 2019, alcohol was associated with roughly a quarter of all cirrhosis-related deaths worldwide. The aim of this study is to assess the economic impact of premature mortality due to cirrhosis in Spain.

METHODS

To estimate the economic impact of premature mortality due to cirrhosis, we utilized the human capital method. This method involved collecting data on mortality rates, average salaries, and unemployment rates. Our objective was to quantify the financial implications of cirrhosis-related deaths, offering valuable insights for policymakers and healthcare professionals.

RESULTS

In 2022, 45% of cirrhosis deaths occurred among individuals of working age. This resulted in the loss of 20,190 years of potential life lost (YPLL), contributing to productivity losses totalling €20.4 billion over a decade. These statistics highlight the significant economic and societal burdens associated with cirrhosis mortality.

CONCLUSIONS

Over the past two decades, there has been a global increase in alcohol consumption, a trend expected to persist and possibly escalate through 2030. As a direct consequence, projections indicate a corresponding increase in cirrhosis-related deaths over the coming decade. This anticipated rise underscores the ongoing public health challenge posed by alcohol-related liver diseases worldwide.

Epidemiological characteristics and treatment challenges of chronic hepatitis C in the kashi region of xinjiang china: A retrospective investigation from 2018 to 2022

Due to the emergence of direct-acting antiviral (DAA), more attention has been devoted to the prevalence and antiviral treatment of chronic hepatitis C in the Kashi region of Xinjiang, China, over the past decade. This study aimed to investigate the epidemiology, genotype (GT) distribution, diagnosis, and antiviral treatment of chronic hepatitis C virus (HCV) infection in this region from 2018 to 2022 and to highlight the challenges in achieving effective management. This retrospective study included individuals with HCV antibody (HCV-Ab) positivity at the First People's Hospital of Kashi from January 1, 2018, to August 31, 2022. Clinical data, including HCV RNA data, GT distribution, and DAA treatment history, were collected. Patients were followed up via telephone to assess treatment adherence and reasons for refusal. The HCV-Ab positivity rate increased from 1.7% in 2018 to 2.9% in 2022. Among the 4,928 HCV-Ab-positive individuals, 2174 (44%) underwent HCV RNA testing, with 1,088 (22%) confirmed positive. Of these patients, 707 were genotyped, with GT1b (70.7%) being the most prevalent GT. Due to limited access to DAA, only 327 (30%) RNA-positive patients received antiviral treatment, 243 (74%) of whom completed the course. Barriers to receiving DAA included high costs, low disease awareness, and limited healthcare access. These findings underscore the severity of the chronic HCV epidemic in Kashi, where healthcare access is inadequate, including limited HCV RNA testing and DAA treatment coverage. Tailored public health interventions and improvements in healthcare infrastructure are essential for better managing chronic HCV infection in this high-burden region.

Global transplantation: Lessons from organ transplantation organizations worldwide

Although national transplant organizations share common visions and goals, the creation of a unified global organization remains impractical. Differences in ethnicity, culture, religion, and education shape local practices and infrastructure, making the establishment of a single global entity unfeasible. Even with these social disparities aside, logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges. While technological advancements have extended organ preservation times, they have yet to support the demands of transcontinental transplantations effectively. This review presents a comparative analysis of the structures, operational frameworks, policies, and legislation governing various transplant organizations around the world. Key differences pertain to the administration of these organizations, trends in organ donation, and organ allocation policies, which reflect the financial, cultural, and religious diversity across different regions. While a global transplant organization may be out of reach, agreeing on best practices for the benefit of patients is essential.

Incidence of luminal gastrointestinal cancers in patients with cirrhosis: A systematic review and meta-analysis

BACKGROUND

The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing. It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer. Such an association would have significant clinical implications, particularly for cancer screening prior to liver transplantation.

AIM

To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.

METHODS

An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis. Study-specific standardized incidence ratios (SIR) along with corresponding 95%CI for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model. Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.

RESULTS

We identified 5054 articles; 4 studies were selected for data extraction. The overall incidence of all cancers was significantly higher in patients with cirrhosis, with an SIR of 2.79 (95%CI: 2.18–3.57). When stratified by cirrhosis etiology, the incidence of luminal cancers remained significantly elevated for alcohol (SIR = 3.13, 95%CI: 2.24–4.39), Primary Biliary Cholangitis (SIR = 1.40, 95%CI: 1.10–1.79), and unspecified cirrhosis (SIR = 3.52, 95%CI: 1.87–6.65).

CONCLUSION

The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis. Oral cavity, pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer. Therefore, increased screening of luminal cancers, and in particular these upper luminal tract subtypes, should be considered in this population.

Liver Cirrhosis: ancient disease, new challenge

Liver cirrhosis is a common cause of morbidity and mortality worldwide. Excessive alcohol consumption and metabolic associated steatotic liver disease are the most common etiological factors of cirrhosis in our region. Cirrhosis occurs in two well-differentiated phases, compensated and decompensated, depending on the absence or presence of complications, respectively. Current therapeutic strategies are aimed at controlling these complications (such as ascites, hepatic encephalopathy, bacterial infections, or digestive hemorrhage, among others) or performing a liver transplant if there are no contraindications. However, it is important to eliminate the etiological factor responsible for the disease, as this can lead to the disappearance of complications, a state known as recompensation. This article proposes an updated review of the epidemiology of cirrhosis and its main causes, and offers an overview of the clinical features and treatment of the disease's complications, in addition to outlining future lines of research in this field.

Role of Intestinal Barrier Disruption to Acute-on-Chronic Liver Failure

Acute-on-chronic liver failure (ACLF) is a severe condition in patients with decompensated liver cirrhosis, marked by high short-term mortality. Recent experimental and clinical evidence has linked intestinal dysfunction to both the initiation of ACLF as well as disease outcome. This review discusses the significant role of the gut-liver axis in ACLF pathogenesis, highlighting recent advances. Gut mucosal barrier disruption, gut dysbiosis, and bacterial translocation emerge as key factors contributing to systemic inflammation in ACLF. Different approaches of therapeutically targeting the gut-liver axis via farnesoid X receptor agonists, nonselective beta receptor blockers, antibiotics, and probiotics are discussed as potential strategies mitigating ACLF progression. The importance of understanding the distinct pathophysiology of ACLF compared with other stages of liver cirrhosis is highlighted. In conclusion, research findings suggest that disruption of intestinal integrity may be an integral component of ACLF pathogenesis, paving the way for novel diagnostic and therapeutic approaches to manage this syndrome more effectively.

Gut microbiota analysis in cirrhosis and non-cirrhotic portal hypertension suggests that portal hypertension can be main factor of cirrhosis-specific dysbiosis

Gut dysbiosis plays an important role in cirrhosis, but the mechanism of its development was not established. The aim of the study was to test the hypothesis that portal hypertension can be the main factor in the development of gut dysbiosis in cirrhosis. This cross-sectional study included 25 patients with chronic non-cirrhotic portal hypertension due to extrahepatic portal vein obstruction after portal vein thrombosis (PVT) (NCPVT group), 29 cirrhotic patients without PVT (CirNoPVT), 15 cirrhotic patients with chronic PVT (CPVT), and 22 healthy controls. The fecal microbiota was assessed using 16S rRNA gene sequencing. The CirNoPVT and CPVT groups had largely similar differences in gut microbiota composition from the control group. Patients with NCPVT, as well as patients with cirrhosis, had a higher abundance of Streptococcus, Escherichia, Enterococcus, Enterobacteriaceae, Enterococcaceae, Streptococcaceae, Bacilli, Gammaproteobacteria, Proteobacteria, and a lower abundance of Roseburia, Faecalibacterium, Methanobrevibacter, Ruminococcaceae, Methanobacteriaceae, Clostridia, Methanobacteria, and Euryarchaeota as they were compared with healthy individuals. Patients with NCPVT had a higher abundance of Bifidobacterium, Bifidobacteriaceae, Actinobacteria, and a lower abundance of Gemmiger and Catenibacterium compared to healthy individuals, which was not observed in the cirrhosis groups. The abundance of Porphyromonadaceae with the genus Parabacteroides was reduced in both groups with PVT, but not in CirNoPVT. There were no significant differences in gut microbiota beta-diversity among the CirNoPVT, CPVT and NCPVT groups. All these groups had significant differences in beta-diversity from the control group. Portal hypertension seems be the main factor in the development of gut dysbiosis in cirrhosis.

Selection for somatic escape variants in SERPINA1 in the liver of patients with alpha-1 antitrypsin deficiency

Somatic variants accumulate in non-malignant tissues with age. Functional variants, leading to clonal advantage of hepatocytes, accumulate in the liver of patients with acquired chronic liver disease (CLD). Whether somatic variants are common to CLD from differing etiologies is unknown. We analyzed liver somatic variants in patients with genetic CLD from alpha-1 antitrypsin (A1AT) deficiency or hemochromatosis. We show that somatic variants in SERPINA1, the gene encoding A1AT, are strongly selected for in A1AT deficiency, with evidence of convergent evolution. Acquired SERPINA1 variants are clustered at the carboxyl terminus of A1AT, leading to truncation. In vitro and in vivo, C-terminal truncation variants reduce disease-associated Z-A1AT polymer accumulation and disruption of the endoplasmic reticulum, supporting the C-terminal domain swap mechanism. Therefore, somatic escape variants from a deleterious germline variant are selected for in A1AT deficiency, suggesting that functional somatic variants are disease-specific in CLD and point to disease-associated mechanisms.

Toward near real-time precise supervision of radiofrequency ablation for liver fibrosis using hyperspectral imaging

BACKGROUND AND AIMS

Chronic liver diseases pose a significant global health concern, ranking as the 11th leading cause of death worldwide. It often progresses to organ fibrosis and severe complications such as portal hypertension and cirrhosis. Liver transplantation is the most effective treatment for such diseases, however, the persistent shortage of donors highlights the need for alternatives. Radiofrequency ablation (RFA) is a promising alternative since it is a minimally invasive procedure. RFA uses heat to destroy abnormal tissues. Its benefits include reduced recovery time compared to surgery, precise targeting of affected areas, and long-lasting symptom relief in many cases. However, RFA has challenges, such as potential risks of nerve damage, infection, or incomplete ablation, requiring repeat treatments. Although significant progress in RFA techniques, effective monitoring remains challenging due to the limited ability to accurately characterize the dynamic thermal diffusion and complex tissue responses.

METHODS

To address this challenge, hyperspectral imaging (HSI) shows promise in monitoring tissue necrosis post-ablation. Our study evaluated HSI's efficacy in monitoring RFA on ex vivo human fibrotic liver tissue samples.

RESULTS

Statistical analysis revealed correlations between spectral patterns and tissue conditions, which helped identify the optimal spectral bands of 543 nm and 579 nm for accurately distinguishing different tissue states. Analyzing the hemoglobin absorption profile indicated significant reductions in absorption of the green light band, showing approximately 40 % reduction in fibrotic tissue and around 20 % reduction in ablated tissue when compared to normal liver tissue. Additionally, a threshold was established for predicting the ablated area of liver samples, ensuring a condition of 90 % specificity.

CONCLUSIONS

Consequently, HSI proved to be a valuable tool for monitoring ablation and a step for improving treatment outcomes for liver fibrosis.

Metabolic dysfunction-associated steatotic liver disease in adults

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the umbrella term that comprises metabolic dysfunction-associated steatotic liver, or isolated hepatic steatosis, through to metabolic dysfunction-associated steatohepatitis, the progressive necroinflammatory disease form that can progress to fibrosis, cirrhosis and hepatocellular carcinoma. MASLD is estimated to affect more than one-third of adults worldwide. MASLD is closely associated with insulin resistance, obesity, gut microbial dysbiosis and genetic risk factors. The obesity epidemic and the growing prevalence of type 2 diabetes mellitus greatly contribute to the increasing burden of MASLD. The treatment and prevention of major metabolic comorbidities such as type 2 diabetes mellitus and obesity will probably slow the growth of MASLD. In 2023, the field decided on a new nomenclature and agreed on a set of research and action priorities, and in 2024, the US FDA approved the first drug, resmetirom, for the treatment of non-cirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced fibrosis. Reliable, validated biomarkers that can replace histology for patient selection and primary end points in MASH trials will greatly accelerate the drug development process. Additionally, noninvasive tests that can reliably determine treatment response or predict response to therapy are warranted. Sustained efforts are required to combat the burden of MASLD by tackling metabolic risk factors, improving risk stratification and linkage to care, and increasing access to therapeutic agents and non-pharmaceutical interventions.

Development and evaluation of a predictive model of upper gastrointestinal bleeding in liver cirrhosis

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a prevalent and severe complication of cirrhosis, often resulting from esophagogastric variceal bleeding (EVB). This condition poses significant life-threatening risks. Once bleeding occurs, the risk of recurrent episodes substantially increases, further compromising liver function and worsening patient outcomes. This study aims to identify risk factors for UGIB in cirrhotic patients using clinical examination data and to develop a non-invasive predictive model to improve diagnostic precision and efficiency.

METHODS

Based on the inclusion and exclusion criteria, the study included 140 cirrhotic patients hospitalized at the First Affiliated Hospital of Nanjing Medical University between June 2022 and May 2023, who experienced UGIB within six months after discharge. These patients were compared with 151 cirrhotic patients hospitalized at the same hospital during the same period, who were discharged within six months without experiencing UGIB. General characteristics of the patients during hospitalisation, laboratory parameters on admission, and liver and spleen stiffness were retrospectively collected, and a retrospective case-control study was conducted. All patients were randomly assigned to the training and validation sets in a ratio of 7:3. Independent factors associated with UGIB were identified by univariate analysis, multivariate logistic regression analysis, and stepwise regression analysis, on the basis of which a predictive model was developed. The model's performance was assessed via receiver operating characteristic (ROC) curve and decision curve analysis (DCA) and was compared with established prognostic models, including the Child-Pugh and MELD scores.

RESULTS

The study analyzed 291 patients with cirrhosis, of whom 208 were allocated to the training set and 83 to the validation set. Independent predictors were identified, and predictive models were constructed using multivariate logistic regression analysis, and stepwise regression analysis in the training set, followed by validation in the validation set. The stepwise regression analysis identified ascites, spleen stiffness, albumin, fibrinogen, total cholesterol, and total bilirubin as independent predictors of UGIB (P < 0.05). These variables were incorporated into the predictive model. The area under the curve (AUC) for UGIB prediction was 0.956 in the training set and 0.909 in the validation set, demonstrating strong predictive performance. Furthermore, comparative analysis using ROC and DCA demonstrated that the developed model outperformed established scoring systems, such as the Child-Pugh score and the MELD score.

CONCLUSION

Ascites, spleen stiffness, albumin, fibrinogen, total cholesterol and total bilirubin as independent predictors of UGIB in cirrhotic patients.

The trend in incidence of non-alcoholic fatty liver disease and its impact on cirrhosis and liver cancer: An analysis from Global Burden of Disease 2021

OBJECTIVES

We aimed to recognize the burden of NAFLD and support public health policy development for its prevention and management.

STUDY DESIGN

A cross-sectional analysis of GBD 2021 results was conducted.

METHODS

We collected incidence data on NAFLD from 1990 to 2021 using Global Burden of Disease Study in 2021. Estimated annual percentage changes (EAPCs) in NAFLD age standardized incidence rate (ASR) were calculated to quantify the temporal trends in NAFLD ASR. Bayesian age-period-cohort models were constructed to project NAFLD incidence rates and cases up to 2050. Additionally, we assessed the percentage of cirrhosis and liver cancer attributable to NAFLD.

RESULTS

Globally, the newly-occurred cases of NAFLD increased by 94.49 % from 24, 856, 159 in 1990 to 48, 353, 272 in 2021. The case number will further increase to 78,602,984 in 2050, and ASR will increase from 5.93 per 1000 in 2021 to 7.26 per 1000 in 2050. The most pronounced increases were observed in young people and men. In 2021, NAFLD accounted for 82.7 % of cirrhosis and other chronic liver diseases and 8.0 % of liver cancer cases.

CONCLUSIONS

From 1990 to 2021, the incidence of NAFLD has been continuously increasing and is expected to continue rising until 2050. The increases in young people and men highlight their priority in future schedules. The rising proportions of cirrhosis and liver cancer caused by NAFLD further underscore the serious health risks.

Global Epidemiology of Cirrhosis in Women

Recent epidemiological evidence indicates a significant rise in cirrhosis burden over the past 2 decades in all parts of the world, with cirrhosis incidence rates and related deaths escalating quickly. Women face unique risk factors and susceptibility to chronic liver diseases compared with men, underscoring the need for a sex-specific approach in early identification, reversal of causative factors, and complication prevention. This review aims to explore epidemiological trends and sex-specific factors contributing to the global epidemiology of cirrhosis among female patients today. While cirrhosis prevalence remains higher in male patients globally, the incidence rate from 2010 to 2019 grew faster among female patients. The female-to-male incidence ratio of metabolic dysfunction-associated steatotic liver disease-related cirrhosis globally in 2019 was 1.3, indicating a shifting trend toward new diagnoses among women now surpassing that of men. Alcohol-associated cirrhosis epidemiology is also changing, with trends toward an equal incidence of alcohol-associated cirrhosis between both sexes, particularly in industrialized nations with increased alcohol accessibility. Cirrhosis from viral hepatitis remains the main etiology among female patients in endemic regions. Sex differences in epidemiology are likely multifactorial, influenced by varying risk factors, susceptibility, and behaviors between sexes. Further research is necessary to better understand these disparities and to tailor sex-specific interventions toward improved management and treatment strategies, ultimately enhancing outcomes for women with cirrhosis and providing better patient-centered care.

Emerging biotechnologies for engineering liver organoids

The engineering construction of the liver has attracted enormous attention. Organoids, as emerging miniature three-dimensional cultivation units, hold significant potential in the biomimetic simulation of liver structure and function. Despite notable successes, organoids still face limitations such as high variability and low maturity. To overcome these challenges, engineering strategies have been established to maintain organoid stability and enhance their efficacy, laying the groundwork for the development of advanced liver organoids. The present review comprehensively summarizes the construction of engineered liver organoids and their prospective applications in biomedicine. Initially, we briefly present the latest research progress on matrix materials that maintain the three-dimensional morphology of organoids. Next, we discuss the manipulative role of engineering technologies in organoid assembly. Additionally, we outline the impact of gene-level regulation on organoid growth and development. Further, we introduce the applications of liver organoids in disease modeling, drug screening and regenerative medicine. Lastly, we overview the current obstacles and forward-looking perspectives on the future of engineered liver organoids. We anticipate that ongoing innovations in engineered liver organoids will lead to significant advancements in medical applications.

Autologous macrophage therapy for liver cirrhosis: a phase 2 open-label randomized controlled trial

Cirrhosis is a major cause of morbidity and mortality; however, there are no approved therapies except orthotopic liver transplantation. Preclinical studies showed that bone-marrow-derived macrophage injections reduce inflammation, resolve fibrosis and stimulate liver regeneration. In a multicenter, open-label, parallel-group, phase 2 randomized controlled trial ( ISRCTN10368050 ) in n = 51 adult patients with compensated cirrhosis and Model for End-Stage Liver Disease (MELD) score ≥10 and ≤17, we evaluated the efficacy of autologous monocyte-derived macrophage therapy (n = 27) compared to standard medical care (n = 24). The primary endpoint was the difference in baseline to day 90 change in MELD score (ΔMELD) between treatment and control groups (ΔΔMELD). Secondary endpoints included adverse clinical outcomes, non-invasive fibrosis biomarkers and health-related quality of life (HRQoL) at 90 d, 180 d and 360 d. The ΔΔMELD between day 0 and day 90 in the treatment group compared to controls was -0.87 (95% confidence interval: -1.79, 0.0; P = 0.06); therefore, the primary endpoint was not met. During 360-d follow-up, five of 24 participants in the control group developed a total of 10 severe adverse events, four of which were liver related, and three deaths (two liver related), whereas no liver-related severe adverse events or deaths occurred in the treatment group. Although no differences were observed in biomarkers or HRQoL, exploratory analysis showed anti-inflammatory serum cytokine profiles after macrophage infusion. This study reinforces the safety and potential efficacy of macrophage therapy in cirrhosis, supporting further investigation.

The Global Burden of Cirrhosis and Other Chronic Liver Diseases in 2021

BACKGROUND AND AIM

The burden of cirrhosis and other chronic liver diseases has changed in recent years due to shifts in the contributing aetiologies. We estimated the burden of cirrhosis and other chronic liver diseases, including etiological and regional differences, across 204 countries and territories from 2010 to 2021.

APPROACH AND RESULTS

We analysed temporal trends in the burden of cirrhosis and other chronic liver diseases utilising data from the Global Burden of Disease Study 2021. We estimated annual frequencies and age-standardised rates (ASRs) of incident cases, deaths and disability-adjusted life-years (DALYs) by sex, country, World Health Organisation region and its contributing aetiologies. In 2021, there were an estimated 58 417 006 incident cases, 1 425 142 deaths and 46 417 777 DALYs related to cirrhosis and other chronic liver diseases. From 2010 to 2021, there was a rise in age-standardised incidence rates (ASIRs) (APC: +0.35%) but age-standardised death rates (ASDRs) (APC: -1.74%) and age-standardised disability-adjusted life-years (ASDALYs) (APC: -1.85%) declined. Cirrhosis related to metabolic dysfunction-associated steatohepatitis (MASH) contributed to 48 310 981 incident cases in 2021 and was largely responsible for the overall increase in ASIRs from 2010 to 2021. Cirrhosis and other chronic liver diseases related to MASH were the only aetiology with a rise in ASIR (APC: +0.86%). Age-standardised deaths related to all aetiologies of cirrhosis and other chronic liver diseases declined during the study period. Age-standardised deaths and DALYs related to MASH increased in the Americas, unlike all other world regions where they declined or remained stable.

CONCLUSIONS

Age-adjusted deaths related to cirrhosis and other chronic liver diseases are declining. However, the age-adjusted incidence of cirrhosis and other chronic liver diseases is increasing, driven by increases in the incidence of MASH.

Expanding Indications in Transplant Oncology

Liver transplantation is aptly described as the only curative treatment for cirrhosis and cirrhosis with co-morbid hepatocellular carcinoma (HCC). Its utility in the management of various other primary and secondary liver cancers is gaining traction rapidly, with more thorough assessments on broader populations continuing to emerge. Most prominently, this includes colorectal cancer liver metastasis (CRLM), cholangiocarcinoma (CCA), neuroendocrine tumors (NETs), and more. Furthermore, despite being a well described treatment for HCC for many years, growing evidence supports a change in oncological strategy for HCC, with broadened selection criteria and more advanced systemic and locoregional therapies available. Our review aims to describe the evidence supporting the expansion of indications and selection criteria for liver transplantation in various oncologic indications of primary and secondary liver tumors.

Endoscopic ultrasound guided liver biopsy and portal pressure gradient: when, why and how? Can it become the standard of care in endo-hepatology?

INTRODUCTION

The armamentarium of 'Endo-hepatology' is proliferating with the advancements in techniques and availability of new devices in the field of endoscopic ultrasound (EUS). This has resulted in the merger of multitude of diagnostic and therapeutic interventions, such as EUS-liver biopsy (LB), EUS-angioembolization of gastric varices, EUS-portal pressure gradient (PPG) measurement, and others into a 'one-stop-shop' for efficient patient management. Lack of standardization of these techniques forms a major hinderance in their widespread adoption.

AREAS COVERED

A comprehensive literature search was undertaken across various databases on EUS-LB and EUS-PPG till November 2024 for reviews, observational studies, and randomized trials on EUS-LB and EUS-PPG, describing its indications, technique, and data of safety and efficacy, detailing its role in day-to-day clinical practice.

EXPERT OPINION

EUS-LB and EUS-PPG have shown promise in the ever-growing field of endo-hepatology. EUS-LB has exhibited excellent safety profile and comparable tissue yield compared to its percutaneous counterpart. On the other hand, EUS-PPG seems to be a viable alternative although it needs to be standardized further. From a patient and hospital perspective, they might prove to be convenient and cost-effective. Nevertheless, more evidence is warranted before they can be labeled as the new standard of care.

The prognostic nutritional index is an effective prognostic and nutritional status indicator for cirrhosis

BACKGROUND AND AIM

Malnutrition is an important clinical feature of cirrhotic patients and is closely associated with prognosis. The prognostic nutritional index (PNI) is a measure of nutritional status. This study was conducted to clarify whether the PNI is related to the severity and prognosis of cirrhosis.

METHODS

In this study, we retrospectively analysed the clinical data of patients who were hospitalized with a primary diagnosis of liver cirrhosis from January 2020 to December 2023 at Tianmen Hospital affiliated with Wuhan University of Science and Technology. Cox regression was used to analyse the independent risk factors for prognosis in patients with decompensated cirrhosis, and the predictive value of the PNI for assessing cirrhosis severity and prognosis was analysed via receiver operating characteristic (ROC) curves.

RESULTS

A total of 513 patients with cirrhosis were included in the study. The patients were divided according to disease severity into compensated (28) and decompensated (485) groups, where the decompensated group consisted of the ascites-only group (63), the complications group (381), and the death group (41). The PNI [hazard ratio (HR) = 0.925, 95% confidence interval (CI): 0.858-0.997, P = 0.041] and platelet count (HR = 1.006, 95% CI: 1.002-1.01, P = 0.002) were found to be independent factors influencing poor prognosis in patients with decompensated cirrhosis. The PNI has predictive value for mortality in decompensated cirrhosis patients. Moreover, a significant disparity was observed in the PNI between the compensated and decompensated groups, and the PNI in the compensated group [47.03(42.85,51.50)] was markedly greater than that in the decompensated group [34.15(30.05,37.93)]. As the severity of the disease increased, the PNI progressively decreased in the ascites-only group [36.40 (32.15, 40.80)], the complication group [34.05 (30.08, 37.80)], and the death group [30.15 (27.05, 35.58)].The ROC curves revealed that the PNI had a high predictive value for decompensated cirrhosis [area under the curve (AUC) = 0.897] and the highest predictive value for mortality outcome (AUC = 0.943). This research also demonstrated that the PNI is strongly correlated with the occurrence and number of complications.

CONCLUSION

The prognostic nutritional index is a good indicator of the severity and prognosis of cirrhotic disease and warrants clinical promotion.

Validation of an albumin-indocyanine green-based China liver cancer staging system to evaluating resectable hepatocellular carcinoma patients and comparison with the Child-Pugh-based China liver cancer staging system

Aim

Here, the utility of an albumin-indocyanine green-based China liver cancer (CNLC) staging system (ALICE-CNLC) as a tool for the prognostic assessment of hepatocellular carcinoma (HCC) patients was evaluated, comparing this system to the Child-Pugh score-based CNLC staging system.

Methods

The cohort for this study included 331 patients with HCC who had undergone hepatectomy at Jinhua Municipal Central Hospital Medical Group in China from April 2012-June 2021 and had postoperative pathology-confirmed HCC. Kaplan-Meier survival curves were generated, with log-rank tests used to examine prognostic factors. Univariate and multivariate analyses were used for identification of outcome predictors using Cox proportional hazards regression.

Results

The prediction of overall survival (OS) by the ALICE-CNLC system for patients with stage Ia disease was markedly better than that for patients with stage Ib and IIa disease (P=0.010, P=0.026), while the latter groups did not differ significantly (P=0.796). The ALICE-CNLC system predicted the 3-year recurrence-free survival (RFS) rates for patients with stage Ia, Ib, and IIa disease to be 50.4%, 47.7%, and 25%, respectively, with significant differences among the groups (P=0.033, P<0.001, and P=0.043). These results were similar to those of the CNLC staging system.The OS and RFS did not differ significantly between the same grades of patients evaluated with the ALICE-CNLC and CNLC staging systems.

Conclusion

The ALICE-CNLC and CNLC staging systems did not show significant differences in predicting the prognosis of patients with HCC who have undergone hepatectomy.

Revolutionizing MASLD: How Artificial Intelligence Is Shaping the Future of Liver Care

Metabolic dysfunction-associated steatotic liver disease (MASLD) is emerging as a leading cause of chronic liver disease. In recent years, artificial intelligence (AI) has attracted significant attention in healthcare, particularly in diagnostics, patient management, and drug development, demonstrating immense potential for application and implementation. In the field of MASLD, substantial research has explored the application of AI in various areas, including patient counseling, improved patient stratification, enhanced diagnostic accuracy, drug development, and prognosis prediction. However, the integration of AI in hepatology is not without challenges. Key issues include data management and privacy, algorithmic bias, and the risk of AI-generated inaccuracies, commonly referred to as "hallucinations". This review aims to provide a comprehensive overview of the applications of AI in hepatology, with a focus on MASLD, highlighting both its transformative potential and its inherent limitations.

Risk of hepatic decompensation or HCC is similar in patients with ALD- and MASLD-cirrhosis: A population-based cohort study

BACKGROUND

It is unclear if the risk of hepatic decompensation or hepatocellular carcinoma (HCC) differs between patients with compensated alcohol-related liver disease (ALD)- and metabolic dysfunction-associated steatotic liver disease (MASLD)-cirrhosis. We investigated the risk to develop hepatic decompensation or HCC based on ALD or MASLD as the underlying etiology of cirrhosis.

METHODS

All patients with a new diagnosis in hospital-based outpatient care of ALD- or MASLD-cirrhosis in Sweden between 2002 and 2020 were identified using national registers. Hepatic decompensation was analyzed as a composite outcome with HCC. Cox regression was employed to compare rates of hepatic decompensation or HCC, and subsequent death.

RESULTS

1660 patients with ALD-cirrhosis and 943 patients with MASLD-cirrhosis were identified. The median ages were 64 years (IQR 57-70) and 69 years (IQR 62-75) in patients with ALD- and MASLD-cirrhosis, respectively. Patients with ALD-cirrhosis consisted of 69.4 % males, compared to 47.6 % males in the MASLD-cirrhosis group. 581 (35 %) patients with ALD-cirrhosis and 284 (30 %) patients with MASLD-cirrhosis developed hepatic decompensation or HCC (median follow-up time: 25 months), resulting in an adjusted hazard ratio of 1.12 (ALD- vs. MASLD-cirrhosis, 95 %-confidence interval=0.88-1.41). The adjusted risk of mortality afterwards was lower in patients with ALD-cirrhosis compared to patients with MASLD-cirrhosis (adjusted hazard ratio 0.62, 95 %-confidence interval=0.39-0.97).

CONCLUSIONS

The risk of hepatic decompensation or HCC is comparable in patients with ALD- and MASLD-cirrhosis, but the risk of mortality after a decompensation event or HCC tends to be higher in patients with MASLD-cirrhosis.

JTCD attenuates HF by inhibiting activation of HSCs through PPARα-TFEB axis-mediated lipophagy

BACKGROUND

Hepatic fibrosis (HF) is an intermediate stage in the progression of chronic liver disease to cirrhosis and has been shown to be a reversible pathological process. Known evidence suggests that activation of hepatic stellate cells (HSCs) and degradation of their lipid droplets (LDs) play an indispensable role in the process of HF. Jiawei Taohe Chengqi Decoction (JTCD) can inhibit the activation of HSCs in the process of HF, but the exact mechanism remains to be elucidated.

PURPOSE

The aim of this study is to determine whether JTCD inhibits lipophagy and to explore the possible mechanisms of its HF effect in HSCs by regulating the PPARα/TFEB axis.

METHODS

Network pharmacology and molecular docking were firstly applied to predict the potential mechanism of JTCD for the treatment of HF. In vivo, a mouse model of HF was constructed using carbon tetrachloride (CCl4) solution, and the efficacy of JTCD was assessed by staining of pathological sections, oil red O staining, immunofluorescence (IF), immunohistochemistry (IHC) staining, Western blotting and qRT-PCR. The intervention of JTCD was verified in vitro by induction of activated LX-2 cells with TGF-β solution and intervention using agonists and antagonists of PPARα. Finally, transient transfection of cells using TFEB siRNA was performed for validation studies.

RESULTS

JTCD effectively alleviated CCl4-induced HF in mice and reduced the levels of HF markers α-smooth muscle actin (α-SMA) and collagen I (COL1A1), and inhibited PPARα expression and lipophagy process. In vitro, JTCD delayed the degradation of LDs and reduced lipophagy in LX-2 cells, suggesting a mechanism involving PPARα/TFEB axis signaling regulation.

Cirrhosis and Faecal microbiota Transplantation (ChiFT) protocol: a Danish multicentre, randomised, placebo-controlled trial in patients with decompensated liver cirrhosis

INTRODUCTION

Liver cirrhosis is a progressive disease with high mortality. Gut microbiota derangement, increased gut permeability, bacterial translocation and chronic inflammation all drive disease progression. This trial aims to investigate whether faecal microbiota transplantation (FMT) may improve the disease course in patients with acute decompensation of liver cirrhosis.

METHODS AND ANALYSIS

In this Danish, multicentre, randomised, double-blinded, placebo-controlled trial, 220 patients with acute decompensation of liver cirrhosis and a Child-Pugh score≤12 will be randomised (1:1) to oral, encapsulated FMT or placebo in addition to standard of care. Before the intervention, the patients will be examined and biological samples obtained, and this is repeated at 1 and 4 weeks and 3, 6 and 12 months after the intervention. The primary outcome is the time from randomisation to new decompensation or death. Secondary endpoints include mortality, number of decompensation events during follow-up and changes in disease severity and liver function.

ETHICS AND DISSEMINATION

The Central Denmark Region Research Ethics Committee approved the trial protocol (no. 1-10-72-302-20). The results will be published in an international peer-reviewed journal, and all patients will receive a summary of the results.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov study identifier NCT04932577.

Liver Transplantation for Hepatocellular Carcinoma: An Expanding Cornerstone of Care in the Era of Immunotherapy

Liver transplantation (LT) has been accepted as a cornerstone of care in hepatocellular carcinoma (HCC) for almost three decades. In recent years, its role has been evolving to include patients with disease burden beyond the widely used Milan criteria. The integration of dynamic biomarkers such as alpha-fetoprotein together with downstaging approaches and tumor evolution after enlistment has allowed the selection of patients most likely to benefit, resulting in 5-year survival rates greater that 70%. With the increasing use of immune checkpoint inhibitors (ICIs) across all stages of disease, alone or in combination with locoregional therapies, there is now the potential to further expand the patient population with HCC who may benefit from LT. This brings challenges, given the global shortage of organs and the need to better understand the optimal use of ICIs before transplantation. Furthermore, the field of transplant oncology awaits additional biomarkers that can predict those likely to benefit from ICIs. More than ever, a multidisciplinary approach for liver cancer management is critical to ensure all patients are considered for LT where appropriate, and do not miss the opportunity for long-term survival.

The mediating role of social support in self-management and quality of life in patients with liver cirrhosis

Patients with liver cirrhosis often experience factors such as malnutrition and lack of exercise, leading to reduced quality of life. Insufficient social support is related to self-management in patients with chronic diseases. Therefore, this study explores the mediating role of social support in the relationship between self-management and quality of life, analyzing the impact of exercise frequency and malnutrition risk assessment on social support, self-management, and quality of life. Using a convenience sampling method, cross-sectional data were collected from 257 patients with liver cirrhosis at the infectious disease department of a tertiary hospital in Zunyi, China, from 2021 to 2022. The patients were evaluated using a demographic questionnaire, the Self-Management Behavior Scale for Liver Cirrhosis Patients, the Social Support Rating Scale (SSRS), the Chronic Liver Disease Questionnaire (CLDQ), and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT). Data were analyzed using SPSS and PROCESS software. (1) Patients in the decompensated stage of liver cirrhosis and those classified in Child-Pugh class B/C had lower scores in self-management, quality of life, and social support compared to patients in the compensated stage of liver cirrhosis and those classified in Child-Pugh Class A. (2) Quality of life was positively correlated with both social support and self-management (r = 0.668, r = 0.665, both P < 0.001). (3) Mediation analysis showed that self-management had a direct predictive effect on quality of life. Social support had a mediating effect between self-management and quality of life, with an indirect effect of 0.489 (95% CI: 0.362, 0.629), accounting for 40.58% of the total effect. (4) Exercise frequency and malnutrition risk assessment were independent influencing factors for social support, self-management, and quality of life. (5) In the regression model, after excluding confounding factors, Model I explained 14% of the variance in quality of life due to control variables, Model II explained 49.5%, and when social support was added, Model III explained 56.9% of the variance in quality of life. Under the mediating role of social support, self-management can improve quality of life. Exercise frequency and malnutrition risk assessment, as independent influencing factors, also modulate social support and self-management. These findings underscore the importance of strengthening social support and developing self-management programs targeting exercise and nutrition to enhance the quality of life in patients with liver cirrhosis.

Advanced glycation end products and risk of mortality in patients with cirrhosis: a prospective cohort study

The role of diet in reducing the burden of liver disease and mortality attributed to cirrhosis is very imperative. The present study scrutinized the relationship between dietary advanced glycation end products (AGEs) and mortality in patients with cirrhosis. This research was a prospective cohort study on 166 ambulatory cirrhotic patients who had been diagnosed with cirrhosis for a maximum of six months. Follow-up of patients continued for 5 years until May 2024. To determine the incidence of mortality in the quartiles of dietary AGEs, cox regression models were used with the adjustment of potential confounding variables. Although the first model of the analysis by adjusting the results for age and sex failed to show a significant increase in the risk of mortality in patients (HRQ4 vs. Q1 = 2.64; 95% CI = 0.9-7.5, P trend = 0.075), after adjusting the results for further confounders in the second (HRQ4 vs. Q1 = 3.56; 95% CI = 1.1-11.6, P trend = 0.040) and third (HRQ4 vs. Q1 = 3.3; 95% CI = 1.79-13.7, P trend = 0.048) models, the P trend for the risk of mortality during the quartiles of AGEs became significant. In addition, along with increasing trend of dietary AGEs, the number of deaths increased significantly (P = 0.024). Higher mortality risk was generally attributed to higher dietary AGEs in patients with cirrhosis.

Machine learning-based plasma metabolomics for improved cirrhosis risk stratification

BACKGROUND

Cirrhosis is a leading cause of mortality in patients with chronic liver disease (CLD). The rapid development of metabolomic technologies has enabled the capture of metabolic changes related to the progression of cirrhosis.

METHODS

This study used proton nuclear magnetic resonance (1 H-NMR) serum metabolomics data from the UK Biobank (UKB) and employed elastic net-regularized Cox proportional hazards models to explore the role of metabolomics in cirrhosis risk stratification in patients with CLD. Metabolomic data were integrated with aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 score (FIB-4) to construct predictive models for cirrhosis risk. The model performance was assessed in both the derivation and validation cohorts.

RESULTS

A total of 2,738 eligible patients were included in the analysis. Several metabolites showed an independent association with cirrhosis events (68 out of 168 metabolites after adjustment for age and sex, and 21 out of 168 metabolites after full adjustment). The integration of metabolomics with FIB-4 improved the predictive performance compared to FIB-4 alone (Harrell's C: 0.717 vs. 0.696, ΔC = 0.021, 95% confidence interval [CI] 0.014-0.028, Net Reclassification Improvement [NRI]: 0.504 [0.488-0.520]). Similarly, the combination of metabolomics with APRI also improved predictive performance compared to APRI alone (Harrell's C: 0.747 vs. 0.718, ΔC = 0.029, 95% CI 0.022-0.035, NRI: 0.378 [0.366-0.389]). Key metabolites, including branched-chain amino acids (BCAAs), lipids, and markers of oxidative stress, were identified as significant predictors. Pathway enrichment analysis revealed that disruptions in lipid and amino acid metabolism play a central role in the progression of cirrhosis.

CONCLUSION

1 H-NMR serum metabolomics significantly improves the prediction of cirrhosis risk in patients with CLD. The APRI + Metabolomics model demonstrated strong discriminatory power, with key metabolites involved in fatty acid and amino acid metabolism, providing a promising tool for the early screening of cirrhosis risk.

Update on the Complications and Management of Liver Cirrhosis

Liver cirrhosis represents the advanced pathological stage of chronic liver disease, characterized by the progressive destruction and regeneration of the hepatic parenchyma over years, culminating in fibrosis and disruption of the vascular architecture. As a leading global cause of morbidity and mortality, it continues to affect millions worldwide, imposing a substantial burden on healthcare systems. Alcoholic/nonalcoholic fatty liver disease and chronic viral hepatitis infection, hepatitis C (HCV) in particular, remain leading causes of cirrhosis. Despite significant advances in understanding the pathogenesis of cirrhosis, its management is still complex due to the multifaceted complications, including ascites, hepatic encephalopathy, variceal bleeding, and hepatocellular carcinoma, all of which severely compromise the patient outcomes and quality of life. This review aims at filling a critical gap by providing a comprehensive summary of the latest evidence on the complications and management of liver cirrhosis. Evidence-based therapies targeting both the etiologies and complications of cirrhosis are essential for improving outcomes. While liver transplantation is considered a definitive cure, advancements in pharmacological therapies offer promising avenues for halting and potentially reversing disease progression. This review summarizes the latest management strategies for cirrhosis and its associated complications, emphasizing the importance of early intervention and novel therapeutic options for improving outcomes and quality of life in affected individuals.

Role of noninvasive tests in the prognostication of metabolic dysfunction-associated steatotic liver disease

In managing metabolic dysfunction-associated steatotic liver disease, which affects over 30% of the general population, effective noninvasive biomarkers for assessing disease severity, monitoring disease progression, predicting the development of liver-related complications, and assessing treatment response are crucial. The advantage of simple fibrosis scores lies in their widespread accessibility through routinely performed blood tests and extensive validation in different clinical settings. They have shown reasonable accuracy in diagnosing advanced fibrosis and good performance in excluding the majority of patients with a low risk of liver-related complications. Among patients with elevated serum fibrosis scores, a more specific fibrosis and imaging biomarker has proved useful to accurately identify patients at risk of liver-related complications. Among specific fibrosis blood biomarkers, enhanced liver fibrosis is the most widely utilized and has been approved in the United States as a prognostic biomarker. For imaging biomarkers, the availability of vibration-controlled transient elastography has been largely improved over the past years, enabling the use of liver stiffness measurement (LSM) for accurate assessment of significant and advanced fibrosis, and cirrhosis. Combining LSM with other routinely available blood tests enhances the ability to diagnose at-risk metabolic dysfunction-associated steatohepatitis and predict liver-related complications, some reaching an accuracy comparable to that of liver biopsy. Magnetic resonance imaging-based modalities provide the most accurate quantification of liver fibrosis, though the current utilization is limited to research settings. Expanding their future use in clinical practice depends on factors such as cost and facility availability.

Recompensation in MASLD-related cirrhosis via metabolic bariatric surgery

The prognosis of patients with decompensated cirrhosis is poor, with significantly increased liver-related mortality rates. With the rising tide of decompensated cirrhosis associated with metabolic dysfunction-associated steatotic liver disease (MASLD), the role of metabolic bariatric surgery (MBS) in achieving hepatic recompensation is garnering increasing attention. However, the complexity of preoperative assessment, the risk of postoperative disease recurrence, and the potential for patients to experience surgical complications of the MBS present challenges. In this opinion article we analyze the potential of MBS to induce recompensation in MASLD-related cirrhosis, discuss the mechanisms by which MBS may affect recompensation, and compare the characteristics of different MBS procedures; we highlight the therapeutic potential of MBS in MASLD-related cirrhosis recompensation and advocate for research in this complex area.

Prognostic Implications of Cardiac Geometry in Cirrhosis: Findings From a Large Cohort

BACKGROUND AND AIMS

Cirrhosis is characterised by hyperdynamic circulation, which contributes to cirrhotic cardiomyopathy (CCM). However, the expert consensus on CCM did not initially include cardiac structure because of scant evidence. Therefore, this study investigated the associations of cardiac chamber geometry with mortality and CCM.

METHODS

We retrospectively included 2514 cirrhotic patients from 2011 to 2023. In accordance with the guidelines for echocardiography, left ventricular (LV) hypertrophy (LVH) and LV, left atrial (LA), right ventricular (RV), and right atrial (RA) enlargement were evaluated. Cox and logistic regression analyses were performed to examine the relationships among cardiac chamber, all-cause mortality, and CCM.

RESULTS

The prevalence rates of LV hypertrophy and LV, LA, RV, and RA enlargement were 21.9%, 21.3%, 30.4%, 5.9%, and 10.9%, respectively. Concentric LVH (HR: 1.305, 95% confidence interval (CI): 1.153-1.466), eccentric LVH (HR: 1.272, 95% CI: 1.139-1.426), LV enlargement (HR: 1.305, 95% CI: 1.153-1.466), and LA enlargement (HR: 1.254, 95% CI: 1.130-1.379) were significantly associated with mortality during the median follow-up of 2.1 years. In a subcohort of 1898 individuals, CCM, with a prevalence of 29.0%, was independently associated with concentric LVH (OR: 1.834, 95% CI: 1.214-2.707), eccentric LVH (OR: 3.063, 95% CI: 2.379-3.903), LV enlargement (OR: 2.519, 95% CI: 2.150-2.977), LA enlargement (OR: 3.559, 95% CI: 2.770-4.321), and RA enlargement (OR: 1.416, 95% CI: 1.025-1.915). LV abnormalities showed 90% specificity and 35% sensitivity for CCM diagnosis.

CONCLUSIONS

Geometric pattern changes in the LV and LA are prevalent and independently associated with all-cause mortality and CCM. These indicators have potential for hazard stratification and CCM redefinition.

The impact of integrated care on clinical outcomes in patients with alcohol-associated liver disease: Early outcomes from a multidisciplinary clinic

BACKGROUND

We analyzed early outcomes regarding the impact of our integrated alcohol-associated liver disease (ALD) clinic on patients with ALD and alcohol use.

METHODS

We conducted a retrospective study of patients with ALD who were evaluated in our integrated clinic from May 1, 2022, to December 31, 2023. Primary outcomes included differences in baseline clinical/demographic data between patients who accepted versus declined an appointment and changes in the severity of ALD, alcohol consumption, functional status, hospital utilization, and remission in alcohol use disorder for evaluated patients.

RESULTS

Patients who declined appointments (n=66) had higher median no-show rates (15.0 [8.0,30.0] vs. 8.5 [3.25,15.0], p<0.001), social vulnerability index (0.53 [0.26,0.79] vs. 0.38 [0.17,0.63], p=0.033), and proportions of cirrhosis (78.8% vs. 59.8%, p=0.017) versus evaluated patients. Comparison of baseline to first follow-up visit for evaluated patients (n=102) demonstrated significant reductions in median AST (59.5 [41.75, 89] vs. 44.5 [33.5, 56.25], p<0.001), alanine-aminotransferase (33.5 [20,45.25] vs. 26.5 [18.75,33.0], p=0.017), total bilirubin (1.6 [0.7,3.3] vs. 1 [0.5,1.9], p=0.001), phosphatidylethanol (263 [35, 784] vs. 0 [0, 163], p<0.001), MELD-3.0 and Sodium scores for patients with alcohol-associated hepatitis and cirrhosis (16 [11, 18.75] vs. 12 [9, 14], p<0.001), 14 [9.25, 17.75] vs. 11 [8.5, 14], p<0.001), and Child-Turcotte-Pugh scores for patients with cirrhosis (9 [6, 10.5] vs. 7 [6, 9], p<0.001). The proportion of patients with active-severe alcohol use disorder significantly decreased (85.2% vs. 51.9%, p<0.001). Additionally, patients had significant reductions in emergency department utilization (incidence rate ratio of 0.64 emergency department visits/month (p=0.002) and 0.71 hospital admissions/month (p=0.025). However, after considering the false discovery rate, the reduction in hospitalization admissions/month was not statistically significant (False Discovery Rate adjusted p=0.056).

CONCLUSIONS

Our integrated approach led to reductions in liver injury, degree of liver decompensation, alcohol use, and ED utilization, and remission in AUD in a population of both non-transplant ALD and post-transplant patients.

Preclinical liver toxicity models: Advantages, limitations and recommendations

Experimental animal models are crucial for elucidating the pathophysiology of liver injuries and for assessing new hepatoprotective agents. Drugs and chemicals such as acetaminophen, isoniazid, valproic acid, ethanol, carbon tetrachloride (CCl4), dimethylnitrosamine (DMN), and thioacetamide (TAA) are metabolized by the CYP2E1 enzyme, producing hepatotoxic metabolites that lead to both acute and chronic liver injuries. In experimental settings, acetaminophen (centrilobular necrosis), carbamazepine (centrilobular necrosis and inflammation), sodium valproate (necrosis, hydropic degeneration and mild inflammation), methotrexate (sinusoidal congestion and inflammation), and TAA (centrilobular necrosis and inflammation) are commonly used to induce various types of acute liver injuries. Repeated and intermittent low-dose administration of CCl4, TAA, and DMN activates quiescent hepatic stellate cells, transdifferentiating them into myofibroblasts, which results in abnormal extracellular matrix production and fibrosis induction, more rapidly with DMN and CCL4 than TAA (DMN > CCl4 > TAA). Regarding toxicity and mortality, CCl4 is more toxic than DMN and TAA (CCl4 > DMN > TAA). Models used to induce metabolic dysfunction-associated liver disease (MAFLD) vary, but MAFLD's multifactorial nature driven by factors like obesity, fatty liver, dyslipidaemia, type II diabetes, hypertension, and cardiovascular disease makes it challenging to replicate human metabolic dysfunction-associated steatohepatitis accurately. From an experimental point of view, the degree and pattern of liver injury are influenced by various factors, including the type of hepatotoxic agent, exposure duration, route of exposure, dosage, frequency of administration, and the animal model utilized. Therefore, there is a pressing need for standardized protocols and regulatory guidelines to streamline the selection of animal models in preclinical studies.

Efficacy and safety of anticoagulation in asymptomatic cirrhotic patients with portal vein thrombosis: a systematic review and meta-analysis

BACKGROUND

The role of anticoagulation in asymptomatic cirrhotic patients with portal vein thrombosis (PVT) remains unclear. This study aims to evaluate the efficacy and safety of anticoagulation in this patient population.

METHODS

We systematically searched PubMed, Web of Science, Cochrane Library, and Embase up to August 2024. The primary outcomes analyzed were PVT recanalization, progression of PVT, bleeding events, and mortality. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for dichotomous variables.

RESULTS

Seventeen studies, including randomized controlled trials (RCTs) and observational studies, were included in the analysis. Compared to no intervention, anticoagulation significantly increased the PVT recanalization rate (OR = 3.89, p < .001) and decreased the PVT progression rate (OR = 0.28, p < .001) as well as overall mortality (OR = 0.66, p = .008). Importantly, anticoagulation did not significantly increase the bleeding rate (OR = 1.21, p = .41). Subgroup analysis revealed a greater benefit in PVT recanalization within the short-term treatment subgroup (≤ 6 months) compared to long-term treatment subgroup (> 6 months), and in the Asian subgroup compared to the European or United States of America (USA) subgroup. In the Warfarin subgroup, while the total bleeding rate increased significantly, there was no significant rise in major bleeding events. Additionally, a downward trend in variceal bleeding was observed in the Asian subgroup (OR = 0.44; 95% CI: 0.19-1.04; p = .06).

CONCLUSION

Anticoagulation is both safe and effective for asymptomatic cirrhotic patients with PVT. It not only treats PVT and reduces all-cause mortality, but also does so without significantly increasing the risk of bleeding events.

Resistance-Associated Substitution Testing Trends and Impact on HCV Treatment Outcomes in Canada: A CanHepC-CANUHC Analysis

Resistance-associated substitutions (RASs) are mutations within the hepatitis C (HCV) genome that may influence the likelihood of achieving a sustained virological response (SVR) with direct acting antiviral (DAA) treatment. Clinicians conduct RAS testing to adapt treatment regimens with the intent of improving the likelihood of cure. The Canadian Network Undertaking against Hepatitis C (CANUHC) prospective cohort consists of chronic HCV patients enrolled between 2015 and 2023 across 17 Canadian sites. Utilisation of RAS testing was assessed across demographics, clinical characteristics and years. SVR was described for the overall cohort and compared across populations of patients with historically negative predictors of SVR. The detection of key RASs and how this information influenced DAA selection were assessed. 2434 patients were identified with information on RAS testing. 98.3% achieved SVR. Out of the 227 patients tested for RAS, 147 (64.8%) had any detected RAS, and 84 (37.0%) had an NS5A RAS. The proportion of patients with SVR did not differ between RAS-tested (98.3%) and non-tested patients (98.3%; p = 0.99). SVR in those with an NS5a RAS was similar (98.6%) to the overall SVR proportion. Proportions with SVR did not differ between those with and without RAS testing in key subgroups (genotype 1a, genotype 3, prior treatment, cirrhosis). The specific DAA regimen and the addition of ribavirin were not associated with SVR outcome. RAS testing has a minimal influence on antiviral treatment selection. Going forward, there is a reduced role for RAS testing in most clinical scenarios.

Production and characterization of monoclonal antibodies against hepatitis B e-antigen and their potential application for development of HBeAg detection ELISA

Despite global vaccination efforts, hepatitis B virus (HBV) infection remains a major health threat, causing over a million deaths annually. Hepatitis B e-antigen (HBeAg) is an indicator of HBV replication and high infectivity. HBeAg is an essential serological marker for monitoring response to treatment and/or determining the stage of chronic HBV infection. Here, we produced a panel of mouse hybridomas secreting monoclonal antibodies (MAbs) to HBeAg by fusing a mouse myeloma cell line with splenocytes from mice immunized with recombinant HBeAg. Anti-HBe MAbs were then characterized by competition ELISA and Western blotting. We designed and optimized an in-house sandwich ELISA using HBeAg-specific rabbit polyclonal and mouse monoclonal antibodies. The diagnostic performance of the assay was then compared to a commercial HBeAg detection ELISA kit using 176 HBeAg[-] and 44 HBeAg[+] serum samples, showing a significant positive correlation (r = 0.8250; P < 0.0001). The in-house ELISA showed reasonable sensitivity (97.56 %) and specificity (99.40 %), with a cut-off value and area under the curve of 0.193 and 0.9884, respectively. Additionally, the assay showed high repeatability, with intra- and inter-assay coefficients of variation of 2.46 % and 11.38 %, respectively. Our designed HBeAg-detecting sandwich ELISA has the potential for use in clinical diagnosis.

Correlation between gallstones and fasting blood glucose to serum high-density lipoprotein cholesterol ratio among American adults

Background

Research indicates that the ratio of fasting blood glucose (FBG) to serum high-density lipoprotein cholesterol (HDL-C) (GHR) can accurately predict many diseases. Nevertheless, the relationship between GHR and the risk of gallbladder stones remains unclear. This study investigates the possible relationship between GHR and the incidence of gallbladder stones.

Methods

This research used information gathered from the National Health and Nutrition Examination Survey (NHANES) between March 2017 and March 2020. A calculation was made to determine the GHR by dividing the fasting blood glucose level by the HDL-C level. Several statistical methods, including analysis of threshold effects, smoothed curve fitting, multiple logistic regression modeling, and subgroup analysis, were utilized to investigate the connection between GHR and gallstones.

Results

In 3898 U.S. adults, GHR was significantly positively associated with the prevalence of gallbladder stones. In a fully adjusted model, the incidence of gallbladder stones increased by 7% with each 1-unit increase in GHR (OR [95% Cl] = 1.07 [1.02, 1.14]). Compared with members in the low group, those in the high group had a 100% higher likelihood of getting gallbladder stones (OR [95% CI] = 2.00 [1.31, 3.04]), and this stabilizing connection was always present in the different subgroups. With the help of smooth curve fitting, the research also showed that there was a connection that was formed like an upside-down L shape between GHR and gallbladder stones. The analysis of the threshold effect revealed that the inflection point was 4.28.

Conclusion

The results revealed an inverted L-shaped connection between GHR and gallbladder stones. Keeping GHR levels within a certain range is associated with a lower incidence of gallstones in the general population.

The CYP4/20-HETE/GPR75 axis in the progression metabolic dysfunction-associated steatosis liver disease (MASLD) to chronic liver disease

Introduction

Metabolic-dysfunction-associated steatosis liver disease (MASLD) is a progressive liver disease from simple steatosis, steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Chronic liver diseases (CLDs) can lead to portal hypertension, which is a major cause of complications of cirrhosis. CLDs cause structural alterations across the liver through increased contents of extracellular matrix (ECM), driving dysfunction of liver sinusoidal endothelial cells (LSECs) alongside hepatic stellate cells (HSCs) and activated resident or infiltrating immune cells. Bioactive arachidonic metabolites have diverse roles in the progression of MASLD. Both secreted levels of 20-hydroxyeicosatetraenoic acid (20-HETE) and epoxyeicosatrienoic acid (EET) are elevated in patients with liver cirrhosis.

Methods

CLD samples were evaluated for changes in free fatty acids (FFA), cholesterol, bilirubin, bile acid, reactive oxygen species (ROD), lipid peroxidation, myeloperoxidase activity and hydroxyproline levels to evaluate the degrees of liver damage and fibrosis. To address the role of the CYP4/20-HETE/GPR75 axis, we measured the amount and the synthesis of 20-HETE in patients with CLD, specifically during the progression of MASLD. Additionally, we evaluated gene expression and protein levels of GPR75, a high-affinity receptor for 20-HETE across CLD patient samples.

Results

We observed an increase in 20-HETE levels and synthesis during the progression of MASLD. Increased synthesis of 20-HETE correlated with the expression of CYP4A11 genes but not CYP4F2. These results were confirmed by increased P4504A11 protein levels and decreased P4504F2 protein levels during the development and progression of MASLD. The gene expression and protein levels of GPR75, the major receptor for 20-HETE, increased in the progression of MASLD. Interestingly, the CYP4A11 and GPR75 mRNA levels increased in steatohepatitis but dramatically dropped in cirrhosis and then increased in patients with HCC. Also, protein levels of P4504A11 and GPR75 mirrored their mRNA levels.

Discussion

These results indicate that the CYP4A11 and subsequent GPR75 genes are coordinately regulated in the progression of MASLD and may have multiple roles, including 20-HETE activation of peroxisome proliferator-activated receptor α (PPARα) in steatosis and GPR75 in CLD through either increased cell proliferation or vasoconstriction in portal hypertension during cirrhosis. The abrupt reduction in CYP4A11 and GPR75 in patients with cirrhosis may also be due to increased 20-HETE, serving as a feedback mechanism via GPR75, leading to reduced CYP4A11 and GPR75 gene expression. This work illustrates key correlations associated with the CYP4/20-HETE/GPR75 axis and the progression of liver disease in humans.

Prevalence and predictors of cirrhosis and portal hypertension in the United States

BACKGROUND AND AIMS

There is a paucity of data about the prevalence of cirrhosis and portal hypertension in the US general population.

APPROACH AND RESULTS

We used National Health and Nutrition Examination Surveys (NHANES 2017-2020) to estimate the prevalence of cirrhosis and clinically significant (CS)-portal hypertension in alcohol-associated liver disease (ALD), MetALD, viral hepatitis to include chronic hepatitis B (CHB) and chronic hepatitis C (CHC), and metabolic dysfunction-associated steatotic liver disease (MASLD). Cirrhosis was evaluated using liver stiffness measurement by transient elastography or FIB-4 score; CS-portal hypertension was defined through liver stiffness measurement and platelet count or the use of nonselective beta-blockers in the presence of cirrhosis.The prevalence of chronic liver disease etiologies was ALD 0.85%, MetALD 3.38%, CHB 0.23%, CHC 0.73%, ALD + viral hepatitis 0.16%, and MASLD 33.05%. In the general population, the prevalence of ALD-cirrhosis was 0.08%, MetALD-cirrhosis 0.19%, CHB-cirrhosis 0.01%, CHC-cirrhosis 0.10%, MASLD-cirrhosis 1.27%, ALD + viral hepatitis-cirrhosis 0.08%, and other cirrhosis 0.87%. The prevalence of CS-portal hypertension in chronic liver disease was 1.31% in MetALD, 1.60% in CHB, 4.73% in CHC, 2.00% in MASLD, and 0.35% in controls, to yield a population prevalence of 0.98%. In multivariate analysis, excessive alcohol use, CHC, male sex, obesity, type 2 diabetes, and hypertension were independently associated with an increased risk of cirrhosis (all p <0.05). Predictors of having CS-portal hypertension in chronic liver disease included CHC, obesity, and type 2 diabetes (all p <0.05).

CONCLUSIONS

The prevalence of cirrhosis in the United States is 2.6% while the prevalence of CS-portal hypertension is 0.98%. Individuals with MASLD comprise the majority of US residents with cirrhosis.

Deep Learning and Hyperspectral Imaging for Liver Cancer Staging and Cirrhosis Differentiation

Liver malignancies, particularly hepatocellular carcinoma (HCC), pose a formidable global health challenge. Conventional diagnostic techniques frequently fall short in precision, especially at advanced HCC stages. In response, we have developed a novel diagnostic strategy that integrates hyperspectral imaging with deep learning. This innovative approach captures detailed spectral data from tissue samples, pinpointing subtle cellular differences that elude traditional methods. A sophisticated deep convolutional neural network processes this data, effectively distinguishing high-grade liver cancer from cirrhosis with an accuracy of 89.45%, a sensitivity of 90.29%, and a specificity of 88.64%. For HCC differentiation specifically, it achieves an impressive accuracy of 93.73%, sensitivity of 92.53%, and specificity of 90.07%. Our results underscore the potential of this technique as a precise, rapid, and non-invasive diagnostic tool that surpasses existing clinical methods in staging liver cancer and differentiating cirrhosis.

Do Child-Turcotte-Pugh and nutritional assessments predict survival in cirrhosis: A longitudinal study

BACKGROUND

Cirrhotic patients face heightened energy demands, leading to rapid glycogen depletion, protein degradation, oxidative stress, and inflammation, which drive disease progression and complications. These disruptions cause cellular damage and parenchymal changes, resulting in vascular alterations, portal hypertension, and liver dysfunction, significantly affecting patient prognosis.

AIM

To analyze the association between Child-Turcotte-Pugh (CTP) scores and different nutritional indicators with survival in a 15-year follow-up cohort.

METHODS

This was a retrospective cohort study with 129 cirrhotic patients of both sexes aged > 18 years. Diagnosis of cirrhosis was made by liver biopsy. The first year of data collection was 2007, and data regarding outcomes were collected in 2023. Data were gathered from medical records, and grouped by different methods, including CTP, handgrip strength, and triceps skinfold cutoffs. The prognostic values for mortality were assessed using Kaplan-Meier curves and multivariate binary logistic regression models.

RESULTS

The coefficient for CTP was the only statistically significant variable (Wald = 5.193, P = 0.023). This suggests that with a negative change in CTP classification score, the odds of survival decrease 52.6%. The other evaluated variables did not significantly predict survival outcomes in the model. Kaplan-Meier survival curves also indicated that CTP classification was the only significant predictor.

CONCLUSION

Although different classifications showed specific differences in stratification, only CTP showed significant predictive potential. CTP score remains a simple and effective predictive tool for cirrhotic patients even after longer follow-up.