BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized p...BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.展开更多
BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,...BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,as it would elucidate the compre-hensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.AIM To compare the levels of burden,stress and depression among family caregivers of cirrhotic and liver transplant patients.METHODS This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital.Instruments included identification cards,interview scripts,the caregiver burden scale Inventory,Lipp’s Stress Symptom Inventory,and the Beck Depression Inventory-Second Edition.Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability.Factor scores were compared with the Mann-Whitney U test,with effect size as the rank-biserial correlation coefficient(r).Statistical analysis was performed with R software(P<0.05).RESULTS Seventy-seven CP caregivers and 65 LT recipient caregivers were included.Most were female(CP:85.7%vs LT:84.6%)and the patients’spouses(76.6%vs 63.1%).The median age and caregiving duration were 55.4(23.3-76.3)vs 54.6(25.7-82.1)and 3.9(1-20)vs 8(1.5-24)years,respectively(P=0.001).LT caregivers were less likely to be at risk of overload(21.5%vs 49.4%),to be under stress(33.8%vs 36.4%)and to show symptoms of depression(15.4%vs 35.1%).Compared with LT caregivers,CP caregivers had greater median factor scores for burden(general tension,P=0.012;isolation,P=0.014;disappointment,P=0.004),depression(P=0.008),and stress(P=0.047),with small to moderate effect sizes.The disappointment(r=0.240)and depression(r=0.225)dimensions had the largest effect sizes.CONCLUSION Family caregivers of LT recipients are less likely to exhibit symptoms of burden,stress,and depression,suggesting that the benefits of LT extend to the patients’family members.展开更多
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,...Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.展开更多
To the Editor:Chylothorax is a serious disease characterized by rupture of the thoracic tube and milky exudation from the pleural cavity,which can lead to a variety of pathological symptoms and is life threatening[1]....To the Editor:Chylothorax is a serious disease characterized by rupture of the thoracic tube and milky exudation from the pleural cavity,which can lead to a variety of pathological symptoms and is life threatening[1].Chylothorax is common after thoracic surgery or trauma.The non-traumatic chylothorax is rare in the clinical practice,and the etiology is complex and often associated with the primary disease[2].Chylothorax is a rare complication of patients with advanced cirrhosis[3],most of which are manifested as dyspnea,cough,chest pain,and the medical treatment effect is relatively poor.We performed orthotopic liver transplantation(OLT)in a patient with advanced cirrhosis combined with massive chylothorax and chyloperitoneum.The 2-year follow-up showed that the patient’s liver function was stable and no recurrence of chylothorax.展开更多
The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of re...The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of restoring the structure and function of the liver,reducing the portal pressure with a positive effect on complications associated with portal hypertension and decreasing the risk of developing hepatocellular carcinoma after elimination of the etiological factor.To create a unified understanding the recompensation of decompensated LC,at the Baveno VII consensus workshop were developed criteria confirming it.At the moment,the efficacy of etiological therapy in achieving established criteria for recompensation has been evaluated only in patients with alcohol-related,as well as hepatitis B virus-related and hepatitis C virus-related decompensated LC.The purpose of the review is to provide up–to-date information on the role of etiological therapy in achieving recompensation of decompensated LC according to Baveno VII criteria.So far,only the first steps have been taken in studying this problem.To further understand it,research is needed to identify pathophysiological mechanisms,modifying factors,predictors,and potential noninvasive biomarkers of recompensation of decompensated LC.展开更多
BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated l...BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.AIM To explore the safety and effect of treating liver cirrhosis with HBV by hUC-MSCs.METHODS Twenty-four participants were recruited,divided into 3 groups,and injected with different amounts of hUC-MSCs via the peripheral vein.Therapy was administered 3 times.A 24-week follow-up examination of each patient’s liver function,coagulation function,general condition,and immune system was performed.Adverse events were also recorded.A 2-year survival assessment was subsequently performed.RESULTS Infusion therapy rapidly improved liver function.Serum albumin transiently increased on days 57 and 85 but returned to baseline by day 169,while prothrombin time activity demonstrated sustained improvement from day 29 through day 169.Interleukin-8 levels decreased persistently throughout treatment.All dosage groups achieved 100%6-month survival;2-year survival rates were 66.7%(low-dose),100%(medium-dose),and 87.5%(high-dose).The interaction between dosage and efficacy was weak.Notably,the improvement in liver function was statistically significant and sustained for almost 3 months,suggesting clinically meaningful therapeutic durability.CONCLUSION hUC-MSCs can be considered a safe treatment for patients with decompensated liver cirrhosis associated with HBV.However,larger-scale randomized controlled trials are needed to prove its therapeutic effect.展开更多
BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly lead...BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly leads to infections or adversely impacts clinical outcomes remains unclear.Clarifying this relationship may help deter-mine the prognostic significance of colonization in these patients.AIM To evaluate the clinical relevance of MDRO colonization and infection at ICU admission in patients with cirrhosis.METHODS This retrospective single-center cohort study included 107 ICU admissions of patients with liver cirrhosis at a tertiary care center(2018-2024).Colonization was assessed by rectal and nasal/pharyngeal swabs within 48 hours of ICU admission.Outcomes analyzed included MDRO infection during ICU stay,concordance between colonizing and infecting strains,organ support requirements,and 28-day transplant free survival.Multivariable logistic regression and Kaplan-Meier analyses were used to evaluate predictors of infection and mortality.RESULTS Nearly one-third(29.9%)of patients were colonized with MDROs on admission,more commonly in the acute-onchronic liver failure phenotype than those with acute decompensation(34.5 vs 10.0%,P=0.033).Although infections were established in the majority(85%)of cases,of which 17.6%due to MDROs,colonization alone did not independently predict these infections[odds ratio(OR)=2.18,P=0.383]nor influenced short-term mortality(OR=1.14,P=0.813).However,once MDRO infection occurred,an 82%concordance was observed between colonizing and infecting strains.MDRO infections,unlike colonization,significantly increased the need for organsupport interventions,including mechanical ventilation and vasopressor therapy and prolonged ICU stays.Only severity of organ dysfunction,quantified by the Sequential Organ Failure Assessment score,independently predicted 28-day mortality(OR=1.38,P=0.024).CONCLUSION MDRO colonization at ICU admission is frequent among critically ill patients with cirrhosis,particularly those with acute-on-chronic liver failure.While colonization alone does not predict infection or early mortality,its clinical value emerges in guiding empirical antibiotic treatment once infection is suspected.Ultimately,short-term survival appears to be more strongly influenced by the severity of organ failure than by either MDRO colonization or infection.展开更多
BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but da...BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but data from cohort studies are scarce.AIM To investigate the association between insulin and pathological LFT,liver disease,and cirrhosis in a populationbased retrospective cohort study.METHODS Anthropometric and cardiometabolic factors of 857 men and 1228 women from prospective cohort studies were used.LFT were obtained at two time points 8 years to 24 years after baseline.Liver disease diagnoses were obtained from nationwide registries.The association between insulin levels and the development of elevated LFT or liver disease and cirrhosis was analyzed.RESULTS Total follow-up was 54054 person-years for women and 27556 person-years for men.Insulin levels were positively correlated with elevated LFT during follow-up,whereas physical activity and coffee consumption were negatively correlated.Individuals with both insulin levels in the upper tertile and alcohol consumption above MASLD thresholds had an increased risk for both liver disease,adjusted hazard ratio(aHR)of 4.3(95%CI:1.6-14.6)and cirrhosis(aHR=4.8,95%CI:1.6-14.6).CONCLUSION This population-based study provides evidence that high insulin levels are a risk factor for development of elevated liver enzymes and clinically manifest liver disease.The results support the concept of metabolic dysfunction associated liver disease.展开更多
BACKGROUND Chronic hepatitis B virus(HBV)infection acquired in childhood frequently presents with mild or nonspecific symptoms,yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis(...BACKGROUND Chronic hepatitis B virus(HBV)infection acquired in childhood frequently presents with mild or nonspecific symptoms,yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis(LC)before adulthood.AIM To identify clinical and pathological characteristics of pediatric HBV-related LC.METHODS A total of 1332 pediatric patients with chronic HBV infection from the Fifth Medical Center of PLA General Hospital from January 2010 to January 2023 were included in this study.We identified 62 pediatric HBV-related LC by liver biopsy from the group.Subsequently,we described the clinical and pathological characteristics of pediatric LC.And 64 pediatric chronic hepatitis B(CHB;age and sex were matched with pediatric LC group)and 69 adult HBV-related LC(sex were matched with pediatric LC group)were enrolled to further demonstrate clinical and pathological differences between pediatric LC,pediatric CHB and adult LC.RESULTS We enrolled 62 pediatric LC,including 54(87.1%)males and 8(12.9%)females.The median age was 11(4-14)years old.The pediatric LC group showed significantly lower median quantitative HBV DNA loads(log10IU/mL:6.3 vs 17.4,P<0.001),reduced HBsAg titers(log10IU/mL:3.11 vs 8.956,P<0.0001),and diminished hepatitis B e antigen-positive positive rate(81.4%vs 93.8%,P<0.05)compared with pediatric CHB.A higher proportion of pediatric patients were asymptomatic(77.4%)compared to adult patients(11.6%)as they first diagnosed as LC,pediatric LC showed milder initial symptoms compared with adult patients such as fatigue(4.8%vs 27.5%),abdominal discomfort(9.7%vs 23.2%),nausea(0%vs 10.1%),and poor appetite(6.5%vs 8.7%;all P<0.0001).Notably,pediatric LC can achieve a significant percentage of functional cure compared with adult LC as 17.4%and 0%.The incidence of progression of LC in children after antiviral therapy continues to be much lower than that in adult LC(hazard ratio=6.102,95%confidence interval:1.72-21.65,P=0.00051).While the incidence of LC remission in children after antiviral therapy continues to be much higher than that in adult LC(hazard ratio=0.055,95%confidence interval:0.07128-0.2802,P<0.0001).CONCLUSION Pediatric patients with HBV-related cirrhosis exhibit elevated virological parameters and heightened transaminase levels than adult patients.However,the frequent paucity of overt clinical symptoms contributes to diagnostic challenges.Notably,early initiation of antiviral therapy in this population substantially improved clinical outcomes.展开更多
BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to...BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to fungal infections.To date,the incidence of spontaneous fungal peritonitis(SFP)has not been determined in Mexico;this endeavor is of great importance because many patients may be suffering from this condition without receiving targeted treatment,which may increase mortality.AIM To report the incidence of SFP in patients presenting with decompensated LC with ascites.METHODS This was a prospective,single-center,descriptive,observational and crosssectional study where patients presenting with decompensated LC with ascites were evaluated from November 2023 to May 2024 in Mexico City.Fungal cultures of ascites were performed and the samples kept in an incubator for 10 days to 14 days,and molecular tests(the API 20 C AUX test)were used for molecular characterization.RESULTS Of the 48 patients included,54.2%were women,77.1%had a comorbidity,47.9%had LC secondary to metabolic dysfunction,43.8%were classified as Child-Pugh C with a model for end-stage liver disease 3.0 median score of 22,and 10.4%were in secondary prophylaxis for spontaneous bacterial peritonitis(SBP).Only four patients had positive cultures where Candida parapsilosis and Candida albicans were isolated,with two of the four patients being positive for Rhodotorula minuta;an SBP incidence of 8.3%was thus calculated.Chronic kidney disease[P=0.012 and relative risk(RR)=15]and secondary prophylaxis for SBP(P=0.049 with RR=8.6)were statistically significant and associated with a high mortality risk(P=0.001 with RR=33).CONCLUSION The presence of infection of fungal origin in ascites in patients presenting with cirrhosis increases short-and medium-term mortality;therefore,it is recommended that fungal culture tests are performed in those patients who visit the emergency room or experience continuous admission with acute decompensation and no bacteria identified in ascites cultures,and even more so in patients with chronic kidney disease and a history of antibiotic use as prophylaxis for SBP.Further studies are needed for the identification of clinical and biochemical data that can help to define SFP so that its presence may be assessed without the need to wait for a positive fungal culture.Thus,treatment may be initiated early in the hope of having a positive impact on the prognosis in this group of patients.展开更多
Conventional wisdom holds that progression from compensated cirrhosis to de-compensated cirrhosis is irreversible in the natural history of the disease.How-ever,in recent years,more and more clinical evidence suggests...Conventional wisdom holds that progression from compensated cirrhosis to de-compensated cirrhosis is irreversible in the natural history of the disease.How-ever,in recent years,more and more clinical evidence suggests that liver cirrhosis can achieve re-compensation,that is,after effective etiological treatment and complication management,the liver function of partially decompensated patients with cirrhosis has improved and gradually stabilized,and decompensation no longer occurs for a long time.Liver regeneration,as one of the powerful intrinsic abilities of the liver,is the key to the restoration of the structure and complex phy-siological functions of the damaged liver.Studies have shown that the restoration of liver regeneration in patients with cirrhosis can promote the occurrence of re-compensation,thereby improving the prognosis of patients.At the same time,monitoring liver regeneration indicators is helpful in assessing patients're-compensation potential for early selection of appropriate treatment options.Insufficient attention has been paid to the role of liver regeneration in the course of liver cirrhosis.Therefore,this article aims to review the value of liver regene-ration in the re-compensation of decompensated cirrhosis.展开更多
BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to...BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.展开更多
BACKGROUND Clinically significant portal hypertension(CSPH)is a crucial prognostic deter-minant for liver-related events(LREs)in patients with compensated viral cir-rhosis.Liver stiffness measurement(LSM)-related mark...BACKGROUND Clinically significant portal hypertension(CSPH)is a crucial prognostic deter-minant for liver-related events(LREs)in patients with compensated viral cir-rhosis.Liver stiffness measurement(LSM)-related markers may help to predict the risk of LREs.AIM To evaluate the value of LSM and its composite biomarkers[LSM-platelet ratio(LPR),LSM-albumin ratio(LAR)]in predicting LREs.METHODS This study retrospectively enrolled compensated viral cirrhosis patients with CSPH.The Cox regression model was employed to examine the prediction of LSM,LPR,and LAR for LREs.The model performance was assessed through receiver operating characteristic,decision curve,and time-dependent area under the curve analysis.The Kaplan-Meier curve was used to evaluate the cumulative incidence of LREs,and further stratified analysis of different LREs was per-formed.RESULTS A total of 598 patients were included,and 319 patients(53.3%)developed LREs during follow-up.Multivariate proportional hazards modeling demonstrated that LSM,LPR,and LAR were independent predictors of LREs.LPR had better performance in predicting LREs than LAR and LSM(area under the curve=0.780,0.727,0.683,respectively,all P<0.05).The cumulative incidence of LREs in the high-risk group were significantly higher than that in the low-risk group(P<0.001).Among the different LREs,LPR was superior to LSM and LAR in predicting liver decompensation,while the difference in predicting hepatocellular carcinoma and liver-related death was relatively small.CONCLUSION LPR is superior to LSM and LAR in predicting LREs in compensated viral cirrhosis patients with CSPH,especially in predicting liver decompensation.展开更多
BACKGROUND Liver cirrhosis(LC)affect millions of people worldwide.The pathogenesis of cirrhosis involves complex interactions between immune responses and gut microbiota.Recent studies have highlighted the role of the...BACKGROUND Liver cirrhosis(LC)affect millions of people worldwide.The pathogenesis of cirrhosis involves complex interactions between immune responses and gut microbiota.Recent studies have highlighted the role of the interleukin-36(IL-36)subfamily in inflammation and immune regulation.However,the relationship between serum IL-36 subfamily levels and gut microbiota in cirrhosis patients remains unclear.This study aimed to explore the clinical significance of serum IL-36 subfamily levels and their association with gut microbiota in cirrhosis patients.AIM To explore the clinical significance of serum IL-36 subfamily levels and their relationship with gut microbiota among cirrhosis patients.METHODS Sixty-one cirrhosis patients were enrolled from Lihuili Hospital of Ningbo University from May 2022 to November 2023 as the LC group and 29 healthy volunteers as the healthy control(HC)group.The serum expressions of IL-36α,IL-36β, IL-36γ, IL-36Ra, and IL-38 were measured through ELISA, while 16S rRNA gene sequencing was employed torate microbial community in human fecal samples.RESULTSThe serum levels of IL-36α, IL-36γ, IL-36Ra, and IL-38 in the LC group remarkably exceeded those in the HC group(P < 0.05). IL-36α, IL-36γ, and IL-38 were related positively to the Child-Pugh score (P < 0.05) and prominentlyexceeded those in the Child-Pugh C group (P < 0.05). The absolute abundance of harmful bacteria (Bacteroides,Bifidobacterium, Faecalibacterium) remarkably rose, while the beneficial bacteria (Firmicutes, Bacteroides, Escherichia-Shigella) notably decreased in the LC group (P < 0.05). IL-36α, IL-36γ, and IL-38 related positively to Lactobacillus(P < 0.05), while IL-38 negatively related to Fusicatenibacter (P < 0.05).CONCLUSIONIL-36γ and IL-38 show promise as potential biomarkers for LC progression, but further validation is required.展开更多
BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establ...BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establish a diagnostic nomogram.METHODS Patients with liver cirrhosis who met the inclusion criteria were randomly divided into training and validation cohorts in a 6:4 ratio in this retrospective research.Univariate analysis,least absolute shrinkage and selection operator regression,and multivariate analysis were employed to establish the nomogram model.Calibration curve,the area under the receiver operating characteristic curve(AUC),and decision curve analysis(DCA)were applied to assess the discrimination,accuracy,and clinical practicability of the nomogram,respectively.RESULTS A total of 1115 patients were enrolled in this study.The nomogram was established based on white blood cells(P<0.001),hemoglobin(P<0.001),fibrinogen(P<0.001),total bilirubin(P=0.007),activated partial thromboplastin time(P=0.002),total bile acid(P=0.012),and ascites(P=0.006).The calibration curve indicated that the actual observation results were in good agreement with the prediction results of the model.The AUC values of the diagnostic model were 0.861 and 0.859 in the training and validation cohorts,respectively,which were higher than that of the aspartate aminotransferase-to-platelet ratio index,fibrosis index based on 4 factors,and aspartate aminotransferase-to-alanine aminotransferase ratio.Additionally,DCA indicated that the net benefit value of the model was higher than that of the other models.CONCLUSION This research constructed and validated a nomogram with perfect performance for predicting EGVB events in patients with liver cirrhosis,which could help clinicians with timely diagnosis,individualized treatment,and follow-up.展开更多
BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders...BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders(VEs),and vasoactive agents are used to manage patients with cirrhosis.Despite numerous clinical trials,a comprehensive meta-analysis comparing the effectiveness of albumin infusion against alternative treatments is limited.This study provides the current and comprehensive synthesis of evidence,offering key insights for optimizing therapeutic strategies in patients with liver cirrhosis.AIM To systematically update available data on therapies of liver cirrhosis,we performed a meta-analysis to evaluate and compare the clinical efficacy of albumin infusion vs other VEs and vasoactive agents in patients with liver cirrhosis.METHODS A literature search from the PubMed and Embase databases(inception till June 2024)focused on hyponatremia(primary outcome)and various outcomes such as gastrointestinal bleeding,hepatic encephalopathy,severe infection,post-paracentesis-induced circulatory dysfunction(PICD),ascites reappearance,spontaneous bacterial peritonitis,hepatorenal syndrome,renal impairment,hospital stay,mortality,and safety was performed.The primary analysis pooled studies that compared albumin infusion with control.In the subgroup analysis,comparisons were made within the stratified treatment categories included in the control group.RESULTS Of the 2957 studies retrieved,31 studies(27 randomized controlled trials and 4 observational studies)comprising 6255 patients were included.Albumin use was significant in reducing odds of hyponatremia[odds ratio(OR)=0.67;95%confidence interval(95%CI)=0.53-0.85]and PICD(OR=0.38;95%CI=0.20-0.71),whereas the reduction in severe infection(OR=0.55;95%CI=0.28-1.07)did not reach statistical significance.In the subgroup analysis,albumin demonstrated a favorable improvement in lowering the incidence of hyponatremia vs inactive/standard medical therapy(OR=0.54;95%CI=0.27-1.09).For PICD,albumin use was significant compared with other VEs(OR=0.31;95%CI=0.11-0.85)but not with vasoconstrictors(OR=0.63;95%CI=0.21-1.91).In the overall subgroup analysis,a significant reduction was observed in hyponatremia(OR=0.67;95%CI=0.53-0.85)and PICD(OR=0.38;95%CI=0.20-0.71).CONCLUSION Human albumin has been shown to significantly reduce the incidence of hyponatremia and PICD in patients with liver cirrhosis,whereas its effect on severe infection remains suggestive but not statistically significant.展开更多
Objective:To screen and identify the key active molecules,signaling pathways,and therapeutic targets of Shuxuening(SXN)injection for treating liver cirrhosis(LC)and to evaluate its therapeutic potential using a mouse ...Objective:To screen and identify the key active molecules,signaling pathways,and therapeutic targets of Shuxuening(SXN)injection for treating liver cirrhosis(LC)and to evaluate its therapeutic potential using a mouse model.Methods:Target genes of SXN and LC were retrieved from public databases,and enrichment analysis was performed.A proteineprotein interaction(PPI)network was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins(STRING),and hub genes were identified using Molecular Complex Detection(MCODE).LC was induced in rats and mice via intraperitoneal injections of diethylnitrosamine and carbon tetrachloride(CCl4)for 12 weeks.Starting at week 7,SXN was administered intraperitoneally to the mice in the treatment group.Serum and liver tissues of the mice were collected for the detection of indicators,pathological staining,and expression analysis of hub targets using quantitative real-time polymerase chain reaction(qRT-PCR).Results:We identified 368 overlapping genes(OLGs)between SXN and LC targets.These OLGs were subsequently used to build a PPI network and to screen for hub genes.Enrichment analysis showed that these genes were associated with cancer-related pathways,including phosphoinositide-3-kinase/Akt and mitogen-activated protein kinase signaling and various cellular processes,such as responses to chemicals and metabolic regulation.In vivo experiments demonstrated that SXN treatment significantly improved liver function and pathology in CCl4-induced LC mice by reducing inflammation and collagen deposition.Furthermore,qRT-PCR demonstrated that SXN regulated the expression of MAPK8,AR and CASP3 in the livers of LC mice.Conclusion:This study highlighted the therapeutic effects of SXN in alleviating LC using both bioinformatics and experimental methods.The observed effect was associated with modulation of hub gene expression,particularly MAPK8,and CASP3.展开更多
Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious...Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious complications,such as portal hypertension,esophagogastric variceal bleeding,and refractory ascites.All these factors have a serious impact on patients’quality of life and prognosis.This article evaluates the current evidence on the management of PVT in cirrhosis and explores the role of direct oral anticoagulants,but data on individualized anticoagulation strategies are limited and lacking for the treatment of PVT in cirrhosis,and it is hoped that it will inform a broad range of clinicians on the treatment of cirrhosis combined with PVT.展开更多
BACKGROUND Liver cirrhosis often leads to significant impairments in functional capacity,which are associated with disease severity and prognosis.Simple,reliable,and low-cost tests are essential to monitor these patie...BACKGROUND Liver cirrhosis often leads to significant impairments in functional capacity,which are associated with disease severity and prognosis.Simple,reliable,and low-cost tests are essential to monitor these patients in clinical practice.The 6-min walk test(6MWT)is widely used in other chronic conditions,but its measurement properties in cirrhosis remain underexplored.AIM To assess the reliability of the 6MWT in patients with liver cirrhosis(LC).METHODS This cross-sectional study was conducted at a teaching hospital in Juiz de Fora-Minas Gerais.Patients diagnosed with LC at any stage of the disease and under clinical follow-up were included.Patients with grade 2 or higher encephalopathy,respiratory,and/or musculoskeletal diseases or who did not understand the test were excluded.Initially,anamnesis and anthropometric evaluation were performed,followed by the 6MWT.After 24 h the test was repeated.Descriptive statistics were used to present the data.Continuous variables were tested for normality using the Shapiro-Wilk test.The reliability of the 6MWT was tested through Bland-Altman analysis,typical error of measurement,and intraclass correlation coefficient(ICC)as well as a one-sample t-test.A paired Student’s ttest was used to check for differences between means,and Pearson’s correlation coefficient was used to verify the relationship between the two moments[first 6MWT(6MWT-1)and second 6MWT(6MWT-2)].RESULTS The mean difference between 6MWT-2 and 6MWT-1 was-18.9 m;the lower limit of the Bland-Altman agreement was-83.5 m,and the upper limit was 45.7 m.One participant was excluded from further analyses for being outside these limits.The typical error of measurement was 18.9 m.The ICC showed excellent reliability between the two tests(ICC=0.97,95%confidence internal:0.90-0.99,P<0.001).The Student’s one-sample t-value was-2.35(P=0.03).The paired t-value was 2.35(P=0.03).Pearson’s correlation coefficient between the 6MWT-1 and 6MWT-2 was r=0.98(P=0.0001).CONCLUSION The 6MWT is a test with excellent reliability.It is safe,easy to administer,inexpensive,and can be introduced into routine practice without loss of diagnostic precision in estimating the functional capacity of patients with LC.展开更多
BACKGROUND Hepatitis B and C and alcoholic liver disease are the principal causes of hepaticrelated morbidity and mortality.However,evidence of the associations between diabetes without the above risk factors and hepa...BACKGROUND Hepatitis B and C and alcoholic liver disease are the principal causes of hepaticrelated morbidity and mortality.However,evidence of the associations between diabetes without the above risk factors and hepatic-related study endpoints is not well understood.In addition,the effects of associated metabolic dysfunction and exercise on hepatic outcomes are still not clear.AIM To investigate the incidence and relative hazards of cirrhosis of the liver,hepato cellular carcinoma(HCC),hepatic-related complications and mortality in patients with type 2 diabetes(T2D)who were nonalcoholic and serologically negative for hepatitis B and C in Taiwan,China.METHODS A total of 33184 T2D patients and 648746 nondiabetic subjects selected from Taiwan’s,China adult preventive health care service were linked to various National Health Insurance databases,cancer registry,and death registry to identify cirrhosis of the liver,HCC,hepatic-related complications,and mortality.The Poisson assumption and Cox proportional hazard regression model were used to estimate the incidences and relative hazards of all hepatic-related study endpoints,respectively.We also compared the risk of hepatic outcomes stratified by age,sex,associated metabolic dysfunctions,and regular exercise between T2D patients and nondiabetic subjects.RESULTS Compared with nondiabetic subjects,T2D patients had a significantly greater incidence(6.32 vs 17.20 per 10000 person-years)and greater risk of cirrhosis of the liver[adjusted hazard ratio(aHR)1.45;95%CI:1.30-1.62].The aHRs for HCC,hepatic complications,and mortality were 1.81,1.87,and 2.08,respectively.An older age,male sex,obesity,hypertension,and dyslipidemia further increased the risks of all hepatic-related study endpoints,and regular exercise decreased the risk,irrespective of diabetes status.CONCLUSION Patients with T2D are at increased risk of cirrhosis of the liver,HCC,hepatic-related complications,and mortality,and associated metabolic dysfunctions provide additional hazard.Coordinated interprofessional care for high-risk T2D patients and diabetes education,with an emphasis on the importance of physical activity,are crucial for minimizing hepatic outcomes.展开更多
基金Supported by National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.
文摘BACKGROUND Family caregivers of cirrhosis patients(CPs)often experience burden,stress,and depression.Investigating whether these conditions improve following the patient undergoing liver transplantation(LT)is crucial,as it would elucidate the compre-hensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.AIM To compare the levels of burden,stress and depression among family caregivers of cirrhotic and liver transplant patients.METHODS This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital.Instruments included identification cards,interview scripts,the caregiver burden scale Inventory,Lipp’s Stress Symptom Inventory,and the Beck Depression Inventory-Second Edition.Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability.Factor scores were compared with the Mann-Whitney U test,with effect size as the rank-biserial correlation coefficient(r).Statistical analysis was performed with R software(P<0.05).RESULTS Seventy-seven CP caregivers and 65 LT recipient caregivers were included.Most were female(CP:85.7%vs LT:84.6%)and the patients’spouses(76.6%vs 63.1%).The median age and caregiving duration were 55.4(23.3-76.3)vs 54.6(25.7-82.1)and 3.9(1-20)vs 8(1.5-24)years,respectively(P=0.001).LT caregivers were less likely to be at risk of overload(21.5%vs 49.4%),to be under stress(33.8%vs 36.4%)and to show symptoms of depression(15.4%vs 35.1%).Compared with LT caregivers,CP caregivers had greater median factor scores for burden(general tension,P=0.012;isolation,P=0.014;disappointment,P=0.004),depression(P=0.008),and stress(P=0.047),with small to moderate effect sizes.The disappointment(r=0.240)and depression(r=0.225)dimensions had the largest effect sizes.CONCLUSION Family caregivers of LT recipients are less likely to exhibit symptoms of burden,stress,and depression,suggesting that the benefits of LT extend to the patients’family members.
文摘Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes.
基金supported by grants from the Clinical Research and Development Program of Zhongnan Hospital of Wuhan University(LCYF 202205)the National Natural Science Foundation of China(82370671)。
文摘To the Editor:Chylothorax is a serious disease characterized by rupture of the thoracic tube and milky exudation from the pleural cavity,which can lead to a variety of pathological symptoms and is life threatening[1].Chylothorax is common after thoracic surgery or trauma.The non-traumatic chylothorax is rare in the clinical practice,and the etiology is complex and often associated with the primary disease[2].Chylothorax is a rare complication of patients with advanced cirrhosis[3],most of which are manifested as dyspnea,cough,chest pain,and the medical treatment effect is relatively poor.We performed orthotopic liver transplantation(OLT)in a patient with advanced cirrhosis combined with massive chylothorax and chyloperitoneum.The 2-year follow-up showed that the patient’s liver function was stable and no recurrence of chylothorax.
文摘The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis(LC)is currently being questioned.This is due to the appearance of data indicating the possibility of restoring the structure and function of the liver,reducing the portal pressure with a positive effect on complications associated with portal hypertension and decreasing the risk of developing hepatocellular carcinoma after elimination of the etiological factor.To create a unified understanding the recompensation of decompensated LC,at the Baveno VII consensus workshop were developed criteria confirming it.At the moment,the efficacy of etiological therapy in achieving established criteria for recompensation has been evaluated only in patients with alcohol-related,as well as hepatitis B virus-related and hepatitis C virus-related decompensated LC.The purpose of the review is to provide up–to-date information on the role of etiological therapy in achieving recompensation of decompensated LC according to Baveno VII criteria.So far,only the first steps have been taken in studying this problem.To further understand it,research is needed to identify pathophysiological mechanisms,modifying factors,predictors,and potential noninvasive biomarkers of recompensation of decompensated LC.
基金Supported by the Foundation of Health Commission of Hubei Province,No.WJ2019H053Natural Science Foundation of Hubei Province,No.2023AFB169+1 种基金Foundation of Health Commission of Hubei Province,No.ZY2021Q019Open Fund Hubei Provincial Clinical Research Center for Umbilical Cord Blood Hematopoietic Stem Cells,Taihe Hospital,No.2024SCOF008.
文摘BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.AIM To explore the safety and effect of treating liver cirrhosis with HBV by hUC-MSCs.METHODS Twenty-four participants were recruited,divided into 3 groups,and injected with different amounts of hUC-MSCs via the peripheral vein.Therapy was administered 3 times.A 24-week follow-up examination of each patient’s liver function,coagulation function,general condition,and immune system was performed.Adverse events were also recorded.A 2-year survival assessment was subsequently performed.RESULTS Infusion therapy rapidly improved liver function.Serum albumin transiently increased on days 57 and 85 but returned to baseline by day 169,while prothrombin time activity demonstrated sustained improvement from day 29 through day 169.Interleukin-8 levels decreased persistently throughout treatment.All dosage groups achieved 100%6-month survival;2-year survival rates were 66.7%(low-dose),100%(medium-dose),and 87.5%(high-dose).The interaction between dosage and efficacy was weak.Notably,the improvement in liver function was statistically significant and sustained for almost 3 months,suggesting clinically meaningful therapeutic durability.CONCLUSION hUC-MSCs can be considered a safe treatment for patients with decompensated liver cirrhosis associated with HBV.However,larger-scale randomized controlled trials are needed to prove its therapeutic effect.
基金approved by the Institutional Review Board of the University Hospital Centre Zagreb(Approval No:02/013 AG).
文摘BACKGROUND Colonization with multidrug-resistant organisms(MDROs)is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units(ICUs).However,whether colonization directly leads to infections or adversely impacts clinical outcomes remains unclear.Clarifying this relationship may help deter-mine the prognostic significance of colonization in these patients.AIM To evaluate the clinical relevance of MDRO colonization and infection at ICU admission in patients with cirrhosis.METHODS This retrospective single-center cohort study included 107 ICU admissions of patients with liver cirrhosis at a tertiary care center(2018-2024).Colonization was assessed by rectal and nasal/pharyngeal swabs within 48 hours of ICU admission.Outcomes analyzed included MDRO infection during ICU stay,concordance between colonizing and infecting strains,organ support requirements,and 28-day transplant free survival.Multivariable logistic regression and Kaplan-Meier analyses were used to evaluate predictors of infection and mortality.RESULTS Nearly one-third(29.9%)of patients were colonized with MDROs on admission,more commonly in the acute-onchronic liver failure phenotype than those with acute decompensation(34.5 vs 10.0%,P=0.033).Although infections were established in the majority(85%)of cases,of which 17.6%due to MDROs,colonization alone did not independently predict these infections[odds ratio(OR)=2.18,P=0.383]nor influenced short-term mortality(OR=1.14,P=0.813).However,once MDRO infection occurred,an 82%concordance was observed between colonizing and infecting strains.MDRO infections,unlike colonization,significantly increased the need for organsupport interventions,including mechanical ventilation and vasopressor therapy and prolonged ICU stays.Only severity of organ dysfunction,quantified by the Sequential Organ Failure Assessment score,independently predicted 28-day mortality(OR=1.38,P=0.024).CONCLUSION MDRO colonization at ICU admission is frequent among critically ill patients with cirrhosis,particularly those with acute-on-chronic liver failure.While colonization alone does not predict infection or early mortality,its clinical value emerges in guiding empirical antibiotic treatment once infection is suspected.Ultimately,short-term survival appears to be more strongly influenced by the severity of organ failure than by either MDRO colonization or infection.
文摘BACKGROUND Insulin resistance is a cardiometabolic risk factor characterized by elevated insulin levels.It is associated with fatty liver disease and elevated liver function tests(LFT)in cross-sectional studies,but data from cohort studies are scarce.AIM To investigate the association between insulin and pathological LFT,liver disease,and cirrhosis in a populationbased retrospective cohort study.METHODS Anthropometric and cardiometabolic factors of 857 men and 1228 women from prospective cohort studies were used.LFT were obtained at two time points 8 years to 24 years after baseline.Liver disease diagnoses were obtained from nationwide registries.The association between insulin levels and the development of elevated LFT or liver disease and cirrhosis was analyzed.RESULTS Total follow-up was 54054 person-years for women and 27556 person-years for men.Insulin levels were positively correlated with elevated LFT during follow-up,whereas physical activity and coffee consumption were negatively correlated.Individuals with both insulin levels in the upper tertile and alcohol consumption above MASLD thresholds had an increased risk for both liver disease,adjusted hazard ratio(aHR)of 4.3(95%CI:1.6-14.6)and cirrhosis(aHR=4.8,95%CI:1.6-14.6).CONCLUSION This population-based study provides evidence that high insulin levels are a risk factor for development of elevated liver enzymes and clinically manifest liver disease.The results support the concept of metabolic dysfunction associated liver disease.
基金Supported by National Key R&D Program of China,No.2023YFC2308104Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support,No.ZLRK202301National Natural Science Foundation of China,No.92159305.
文摘BACKGROUND Chronic hepatitis B virus(HBV)infection acquired in childhood frequently presents with mild or nonspecific symptoms,yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis(LC)before adulthood.AIM To identify clinical and pathological characteristics of pediatric HBV-related LC.METHODS A total of 1332 pediatric patients with chronic HBV infection from the Fifth Medical Center of PLA General Hospital from January 2010 to January 2023 were included in this study.We identified 62 pediatric HBV-related LC by liver biopsy from the group.Subsequently,we described the clinical and pathological characteristics of pediatric LC.And 64 pediatric chronic hepatitis B(CHB;age and sex were matched with pediatric LC group)and 69 adult HBV-related LC(sex were matched with pediatric LC group)were enrolled to further demonstrate clinical and pathological differences between pediatric LC,pediatric CHB and adult LC.RESULTS We enrolled 62 pediatric LC,including 54(87.1%)males and 8(12.9%)females.The median age was 11(4-14)years old.The pediatric LC group showed significantly lower median quantitative HBV DNA loads(log10IU/mL:6.3 vs 17.4,P<0.001),reduced HBsAg titers(log10IU/mL:3.11 vs 8.956,P<0.0001),and diminished hepatitis B e antigen-positive positive rate(81.4%vs 93.8%,P<0.05)compared with pediatric CHB.A higher proportion of pediatric patients were asymptomatic(77.4%)compared to adult patients(11.6%)as they first diagnosed as LC,pediatric LC showed milder initial symptoms compared with adult patients such as fatigue(4.8%vs 27.5%),abdominal discomfort(9.7%vs 23.2%),nausea(0%vs 10.1%),and poor appetite(6.5%vs 8.7%;all P<0.0001).Notably,pediatric LC can achieve a significant percentage of functional cure compared with adult LC as 17.4%and 0%.The incidence of progression of LC in children after antiviral therapy continues to be much lower than that in adult LC(hazard ratio=6.102,95%confidence interval:1.72-21.65,P=0.00051).While the incidence of LC remission in children after antiviral therapy continues to be much higher than that in adult LC(hazard ratio=0.055,95%confidence interval:0.07128-0.2802,P<0.0001).CONCLUSION Pediatric patients with HBV-related cirrhosis exhibit elevated virological parameters and heightened transaminase levels than adult patients.However,the frequent paucity of overt clinical symptoms contributes to diagnostic challenges.Notably,early initiation of antiviral therapy in this population substantially improved clinical outcomes.
文摘BACKGROUND Individuals with liver cirrhosis(LC)are likely to experience multiple infectious processes due to the immune dysfunction caused by the disease.Our hypothesis is that this group of patients is predisposed to fungal infections.To date,the incidence of spontaneous fungal peritonitis(SFP)has not been determined in Mexico;this endeavor is of great importance because many patients may be suffering from this condition without receiving targeted treatment,which may increase mortality.AIM To report the incidence of SFP in patients presenting with decompensated LC with ascites.METHODS This was a prospective,single-center,descriptive,observational and crosssectional study where patients presenting with decompensated LC with ascites were evaluated from November 2023 to May 2024 in Mexico City.Fungal cultures of ascites were performed and the samples kept in an incubator for 10 days to 14 days,and molecular tests(the API 20 C AUX test)were used for molecular characterization.RESULTS Of the 48 patients included,54.2%were women,77.1%had a comorbidity,47.9%had LC secondary to metabolic dysfunction,43.8%were classified as Child-Pugh C with a model for end-stage liver disease 3.0 median score of 22,and 10.4%were in secondary prophylaxis for spontaneous bacterial peritonitis(SBP).Only four patients had positive cultures where Candida parapsilosis and Candida albicans were isolated,with two of the four patients being positive for Rhodotorula minuta;an SBP incidence of 8.3%was thus calculated.Chronic kidney disease[P=0.012 and relative risk(RR)=15]and secondary prophylaxis for SBP(P=0.049 with RR=8.6)were statistically significant and associated with a high mortality risk(P=0.001 with RR=33).CONCLUSION The presence of infection of fungal origin in ascites in patients presenting with cirrhosis increases short-and medium-term mortality;therefore,it is recommended that fungal culture tests are performed in those patients who visit the emergency room or experience continuous admission with acute decompensation and no bacteria identified in ascites cultures,and even more so in patients with chronic kidney disease and a history of antibiotic use as prophylaxis for SBP.Further studies are needed for the identification of clinical and biochemical data that can help to define SFP so that its presence may be assessed without the need to wait for a positive fungal culture.Thus,treatment may be initiated early in the hope of having a positive impact on the prognosis in this group of patients.
文摘Conventional wisdom holds that progression from compensated cirrhosis to de-compensated cirrhosis is irreversible in the natural history of the disease.How-ever,in recent years,more and more clinical evidence suggests that liver cirrhosis can achieve re-compensation,that is,after effective etiological treatment and complication management,the liver function of partially decompensated patients with cirrhosis has improved and gradually stabilized,and decompensation no longer occurs for a long time.Liver regeneration,as one of the powerful intrinsic abilities of the liver,is the key to the restoration of the structure and complex phy-siological functions of the damaged liver.Studies have shown that the restoration of liver regeneration in patients with cirrhosis can promote the occurrence of re-compensation,thereby improving the prognosis of patients.At the same time,monitoring liver regeneration indicators is helpful in assessing patients're-compensation potential for early selection of appropriate treatment options.Insufficient attention has been paid to the role of liver regeneration in the course of liver cirrhosis.Therefore,this article aims to review the value of liver regene-ration in the re-compensation of decompensated cirrhosis.
文摘BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.
基金Supported by the High-Level Chinese Medicine Key Discipline Construction Project,No.zyyzdxk-2023005Capital’s Funds for Health Improvement and Research,No.2024-1-2173+2 种基金National Natural Science Foundation of China,No.82474419 and No.82474426Beijing Municipal Natural Science Foundation,No.7232272Beijing Traditional Chinese Medicine Technology Development Fund Project,No.BJZYZD-2023-12.
文摘BACKGROUND Clinically significant portal hypertension(CSPH)is a crucial prognostic deter-minant for liver-related events(LREs)in patients with compensated viral cir-rhosis.Liver stiffness measurement(LSM)-related markers may help to predict the risk of LREs.AIM To evaluate the value of LSM and its composite biomarkers[LSM-platelet ratio(LPR),LSM-albumin ratio(LAR)]in predicting LREs.METHODS This study retrospectively enrolled compensated viral cirrhosis patients with CSPH.The Cox regression model was employed to examine the prediction of LSM,LPR,and LAR for LREs.The model performance was assessed through receiver operating characteristic,decision curve,and time-dependent area under the curve analysis.The Kaplan-Meier curve was used to evaluate the cumulative incidence of LREs,and further stratified analysis of different LREs was per-formed.RESULTS A total of 598 patients were included,and 319 patients(53.3%)developed LREs during follow-up.Multivariate proportional hazards modeling demonstrated that LSM,LPR,and LAR were independent predictors of LREs.LPR had better performance in predicting LREs than LAR and LSM(area under the curve=0.780,0.727,0.683,respectively,all P<0.05).The cumulative incidence of LREs in the high-risk group were significantly higher than that in the low-risk group(P<0.001).Among the different LREs,LPR was superior to LSM and LAR in predicting liver decompensation,while the difference in predicting hepatocellular carcinoma and liver-related death was relatively small.CONCLUSION LPR is superior to LSM and LAR in predicting LREs in compensated viral cirrhosis patients with CSPH,especially in predicting liver decompensation.
基金Supported by Key Project of the Ningbo Natural Science Foundation,Zhejiang Province,China,No.2022J253Key Technology R&D Project of Ningbo City,No.2023Z208+1 种基金Traditional Chinese Medicine project,Zhejiang Province,No.2024ZF028the Key Project of Health Science and Technology Foundation,Zhejiang Province,China,No.WKJ-ZJ-2551.
文摘BACKGROUND Liver cirrhosis(LC)affect millions of people worldwide.The pathogenesis of cirrhosis involves complex interactions between immune responses and gut microbiota.Recent studies have highlighted the role of the interleukin-36(IL-36)subfamily in inflammation and immune regulation.However,the relationship between serum IL-36 subfamily levels and gut microbiota in cirrhosis patients remains unclear.This study aimed to explore the clinical significance of serum IL-36 subfamily levels and their association with gut microbiota in cirrhosis patients.AIM To explore the clinical significance of serum IL-36 subfamily levels and their relationship with gut microbiota among cirrhosis patients.METHODS Sixty-one cirrhosis patients were enrolled from Lihuili Hospital of Ningbo University from May 2022 to November 2023 as the LC group and 29 healthy volunteers as the healthy control(HC)group.The serum expressions of IL-36α,IL-36β, IL-36γ, IL-36Ra, and IL-38 were measured through ELISA, while 16S rRNA gene sequencing was employed torate microbial community in human fecal samples.RESULTSThe serum levels of IL-36α, IL-36γ, IL-36Ra, and IL-38 in the LC group remarkably exceeded those in the HC group(P < 0.05). IL-36α, IL-36γ, and IL-38 were related positively to the Child-Pugh score (P < 0.05) and prominentlyexceeded those in the Child-Pugh C group (P < 0.05). The absolute abundance of harmful bacteria (Bacteroides,Bifidobacterium, Faecalibacterium) remarkably rose, while the beneficial bacteria (Firmicutes, Bacteroides, Escherichia-Shigella) notably decreased in the LC group (P < 0.05). IL-36α, IL-36γ, and IL-38 related positively to Lactobacillus(P < 0.05), while IL-38 negatively related to Fusicatenibacter (P < 0.05).CONCLUSIONIL-36γ and IL-38 show promise as potential biomarkers for LC progression, but further validation is required.
基金Supported by the National Natural Science Foundation of China,No.82270594the National Natural Science Foundation for Youths of China,No.82103151+1 种基金the Fundamental Research Funds for the Central Universities of Central South University,No.2022ZZTS0265the Graduate Research Innovation Project of Hunan Province,No.CX20220347.
文摘BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establish a diagnostic nomogram.METHODS Patients with liver cirrhosis who met the inclusion criteria were randomly divided into training and validation cohorts in a 6:4 ratio in this retrospective research.Univariate analysis,least absolute shrinkage and selection operator regression,and multivariate analysis were employed to establish the nomogram model.Calibration curve,the area under the receiver operating characteristic curve(AUC),and decision curve analysis(DCA)were applied to assess the discrimination,accuracy,and clinical practicability of the nomogram,respectively.RESULTS A total of 1115 patients were enrolled in this study.The nomogram was established based on white blood cells(P<0.001),hemoglobin(P<0.001),fibrinogen(P<0.001),total bilirubin(P=0.007),activated partial thromboplastin time(P=0.002),total bile acid(P=0.012),and ascites(P=0.006).The calibration curve indicated that the actual observation results were in good agreement with the prediction results of the model.The AUC values of the diagnostic model were 0.861 and 0.859 in the training and validation cohorts,respectively,which were higher than that of the aspartate aminotransferase-to-platelet ratio index,fibrosis index based on 4 factors,and aspartate aminotransferase-to-alanine aminotransferase ratio.Additionally,DCA indicated that the net benefit value of the model was higher than that of the other models.CONCLUSION This research constructed and validated a nomogram with perfect performance for predicting EGVB events in patients with liver cirrhosis,which could help clinicians with timely diagnosis,individualized treatment,and follow-up.
基金Supported by National Natural Science Foundation of China,No.82070604 and No.82270618the Shanghai Municipal Key Clinical Specialty,China,No.shslczdzk01103。
文摘BACKGROUND Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes.Various therapies including albumin infusion,volume expanders(VEs),and vasoactive agents are used to manage patients with cirrhosis.Despite numerous clinical trials,a comprehensive meta-analysis comparing the effectiveness of albumin infusion against alternative treatments is limited.This study provides the current and comprehensive synthesis of evidence,offering key insights for optimizing therapeutic strategies in patients with liver cirrhosis.AIM To systematically update available data on therapies of liver cirrhosis,we performed a meta-analysis to evaluate and compare the clinical efficacy of albumin infusion vs other VEs and vasoactive agents in patients with liver cirrhosis.METHODS A literature search from the PubMed and Embase databases(inception till June 2024)focused on hyponatremia(primary outcome)and various outcomes such as gastrointestinal bleeding,hepatic encephalopathy,severe infection,post-paracentesis-induced circulatory dysfunction(PICD),ascites reappearance,spontaneous bacterial peritonitis,hepatorenal syndrome,renal impairment,hospital stay,mortality,and safety was performed.The primary analysis pooled studies that compared albumin infusion with control.In the subgroup analysis,comparisons were made within the stratified treatment categories included in the control group.RESULTS Of the 2957 studies retrieved,31 studies(27 randomized controlled trials and 4 observational studies)comprising 6255 patients were included.Albumin use was significant in reducing odds of hyponatremia[odds ratio(OR)=0.67;95%confidence interval(95%CI)=0.53-0.85]and PICD(OR=0.38;95%CI=0.20-0.71),whereas the reduction in severe infection(OR=0.55;95%CI=0.28-1.07)did not reach statistical significance.In the subgroup analysis,albumin demonstrated a favorable improvement in lowering the incidence of hyponatremia vs inactive/standard medical therapy(OR=0.54;95%CI=0.27-1.09).For PICD,albumin use was significant compared with other VEs(OR=0.31;95%CI=0.11-0.85)but not with vasoconstrictors(OR=0.63;95%CI=0.21-1.91).In the overall subgroup analysis,a significant reduction was observed in hyponatremia(OR=0.67;95%CI=0.53-0.85)and PICD(OR=0.38;95%CI=0.20-0.71).CONCLUSION Human albumin has been shown to significantly reduce the incidence of hyponatremia and PICD in patients with liver cirrhosis,whereas its effect on severe infection remains suggestive but not statistically significant.
基金Our study was funded by the Clinical Research Special Fund of Wu Jieping Medical Foundation(320.6750.2022-25-8)the Fundamental Research Funds for the Cornell University(2024-JYBXJSJJ042 and 2024-JYB-JBZD-058).
文摘Objective:To screen and identify the key active molecules,signaling pathways,and therapeutic targets of Shuxuening(SXN)injection for treating liver cirrhosis(LC)and to evaluate its therapeutic potential using a mouse model.Methods:Target genes of SXN and LC were retrieved from public databases,and enrichment analysis was performed.A proteineprotein interaction(PPI)network was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins(STRING),and hub genes were identified using Molecular Complex Detection(MCODE).LC was induced in rats and mice via intraperitoneal injections of diethylnitrosamine and carbon tetrachloride(CCl4)for 12 weeks.Starting at week 7,SXN was administered intraperitoneally to the mice in the treatment group.Serum and liver tissues of the mice were collected for the detection of indicators,pathological staining,and expression analysis of hub targets using quantitative real-time polymerase chain reaction(qRT-PCR).Results:We identified 368 overlapping genes(OLGs)between SXN and LC targets.These OLGs were subsequently used to build a PPI network and to screen for hub genes.Enrichment analysis showed that these genes were associated with cancer-related pathways,including phosphoinositide-3-kinase/Akt and mitogen-activated protein kinase signaling and various cellular processes,such as responses to chemicals and metabolic regulation.In vivo experiments demonstrated that SXN treatment significantly improved liver function and pathology in CCl4-induced LC mice by reducing inflammation and collagen deposition.Furthermore,qRT-PCR demonstrated that SXN regulated the expression of MAPK8,AR and CASP3 in the livers of LC mice.Conclusion:This study highlighted the therapeutic effects of SXN in alleviating LC using both bioinformatics and experimental methods.The observed effect was associated with modulation of hub gene expression,particularly MAPK8,and CASP3.
基金Supported by the Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_2067Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province,No.CXPJJH123009-079.
文摘Portal vein thrombosis(PVT)is one of the most common serious complications in patients with liver cirrhosis.The occurrence of PVT not only aggravates the condition of liver cirrhosis but can also cause several serious complications,such as portal hypertension,esophagogastric variceal bleeding,and refractory ascites.All these factors have a serious impact on patients’quality of life and prognosis.This article evaluates the current evidence on the management of PVT in cirrhosis and explores the role of direct oral anticoagulants,but data on individualized anticoagulation strategies are limited and lacking for the treatment of PVT in cirrhosis,and it is hoped that it will inform a broad range of clinicians on the treatment of cirrhosis combined with PVT.
文摘BACKGROUND Liver cirrhosis often leads to significant impairments in functional capacity,which are associated with disease severity and prognosis.Simple,reliable,and low-cost tests are essential to monitor these patients in clinical practice.The 6-min walk test(6MWT)is widely used in other chronic conditions,but its measurement properties in cirrhosis remain underexplored.AIM To assess the reliability of the 6MWT in patients with liver cirrhosis(LC).METHODS This cross-sectional study was conducted at a teaching hospital in Juiz de Fora-Minas Gerais.Patients diagnosed with LC at any stage of the disease and under clinical follow-up were included.Patients with grade 2 or higher encephalopathy,respiratory,and/or musculoskeletal diseases or who did not understand the test were excluded.Initially,anamnesis and anthropometric evaluation were performed,followed by the 6MWT.After 24 h the test was repeated.Descriptive statistics were used to present the data.Continuous variables were tested for normality using the Shapiro-Wilk test.The reliability of the 6MWT was tested through Bland-Altman analysis,typical error of measurement,and intraclass correlation coefficient(ICC)as well as a one-sample t-test.A paired Student’s ttest was used to check for differences between means,and Pearson’s correlation coefficient was used to verify the relationship between the two moments[first 6MWT(6MWT-1)and second 6MWT(6MWT-2)].RESULTS The mean difference between 6MWT-2 and 6MWT-1 was-18.9 m;the lower limit of the Bland-Altman agreement was-83.5 m,and the upper limit was 45.7 m.One participant was excluded from further analyses for being outside these limits.The typical error of measurement was 18.9 m.The ICC showed excellent reliability between the two tests(ICC=0.97,95%confidence internal:0.90-0.99,P<0.001).The Student’s one-sample t-value was-2.35(P=0.03).The paired t-value was 2.35(P=0.03).Pearson’s correlation coefficient between the 6MWT-1 and 6MWT-2 was r=0.98(P=0.0001).CONCLUSION The 6MWT is a test with excellent reliability.It is safe,easy to administer,inexpensive,and can be introduced into routine practice without loss of diagnostic precision in estimating the functional capacity of patients with LC.
基金Supported by The Far Eastern Memorial Hospital,No.FEMH-2022-C-015,No.FEMH-2022-C-017 and No.FEMH-2023-C-082.
文摘BACKGROUND Hepatitis B and C and alcoholic liver disease are the principal causes of hepaticrelated morbidity and mortality.However,evidence of the associations between diabetes without the above risk factors and hepatic-related study endpoints is not well understood.In addition,the effects of associated metabolic dysfunction and exercise on hepatic outcomes are still not clear.AIM To investigate the incidence and relative hazards of cirrhosis of the liver,hepato cellular carcinoma(HCC),hepatic-related complications and mortality in patients with type 2 diabetes(T2D)who were nonalcoholic and serologically negative for hepatitis B and C in Taiwan,China.METHODS A total of 33184 T2D patients and 648746 nondiabetic subjects selected from Taiwan’s,China adult preventive health care service were linked to various National Health Insurance databases,cancer registry,and death registry to identify cirrhosis of the liver,HCC,hepatic-related complications,and mortality.The Poisson assumption and Cox proportional hazard regression model were used to estimate the incidences and relative hazards of all hepatic-related study endpoints,respectively.We also compared the risk of hepatic outcomes stratified by age,sex,associated metabolic dysfunctions,and regular exercise between T2D patients and nondiabetic subjects.RESULTS Compared with nondiabetic subjects,T2D patients had a significantly greater incidence(6.32 vs 17.20 per 10000 person-years)and greater risk of cirrhosis of the liver[adjusted hazard ratio(aHR)1.45;95%CI:1.30-1.62].The aHRs for HCC,hepatic complications,and mortality were 1.81,1.87,and 2.08,respectively.An older age,male sex,obesity,hypertension,and dyslipidemia further increased the risks of all hepatic-related study endpoints,and regular exercise decreased the risk,irrespective of diabetes status.CONCLUSION Patients with T2D are at increased risk of cirrhosis of the liver,HCC,hepatic-related complications,and mortality,and associated metabolic dysfunctions provide additional hazard.Coordinated interprofessional care for high-risk T2D patients and diabetes education,with an emphasis on the importance of physical activity,are crucial for minimizing hepatic outcomes.
