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 Transjugular intrahepatic portosystemic shunt(TIPS)is the standard second-line treatment option for individuals with complications of decompensated cirrhosis,such as variceal bleeding and refractory ascites...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is the standard second-line treatment option for individuals with complications of decompensated cirrhosis,such as variceal bleeding and refractory ascites.AIM To investigate whether recompensation existed in TIPS-treated patients with decompensated cirrhosis according to Baveno VII criteria.METHODS This retrospective analysis was performed on 64 patients who received TIPS for variceal bleeding or refractory ascites.The definition of recompensation referred to Baveno VII criteria and previous study.Clinical events,laboratory tests,and radiological examinations were regularly conducted during a preset follow-up period.The recompensation ratio in this cohort was calculated.Beyond that,univariate and multivariate regression models were conducted to identify the predictors of recompensation.RESULTS Of the 64 patients with a 12-mo follow-up,20(31%)achieved recompensation.Age[odds ratio(OR):1.124;95%confidence interval(CI):1.034-1.222]and postTIPS portal pressure gradient<12 mmHg(OR:0.119;95%CI:0.024-0.584)were identified as independent predictors of recompensation in patients with decompensated cirrhosis after TIPS.CONCLUSION The present study demonstrated that nearly one-third of the TIPS-treated patients achieved recompensation within this cohort.According to our findings,recompensation is more likely to be achieved in younger patients.In addition,postoperative portal pressure gradient reduction below 12 mmHg contributes to the occurrence of recompensation.展开更多
The Baveno VII criteria redefine the management of decompensated liver cirrhosis,introducing the concept of hepatic recompensation marking a significant departure from the conventional view of irreversible decline.Cen...The Baveno VII criteria redefine the management of decompensated liver cirrhosis,introducing the concept of hepatic recompensation marking a significant departure from the conventional view of irreversible decline.Central to this concept is addressing the underlying cause of cirrhosis through tailored therapies,including antivirals and lifestyle modifications.Studies on alcohol,hepatitis C virus,and hepatitis B virus-related cirrhosis demonstrate the efficacy of these interventions in improving liver function and patient outcomes.Transjugular intrahepatic portosystemic shunt(TIPS)emerges as a promising intervention,effectively resolving complications of portal hypertension and facilitating recompensation.However,optimal timing and patient selection for TIPS remain unresolved.Despite challenges,TIPS offers renewed hope for hepatic recompensation,marking a significant advancement in cirrhosis management.Further research is needed to refine its implementation and maximize its benefits.In conclusion,TIPS stands as a promising avenue for improving hepatic function and patient outcomes in decompensated liver cirrhosis within the framework of the Baveno VII criteria.展开更多
Transjugular intrahepatic portosystemic shunt is a therapeutic modality done through interventional radiology.It is aimed to decrease portal pressure in special situations for patients with decompensated liver disease...Transjugular intrahepatic portosystemic shunt is a therapeutic modality done through interventional radiology.It is aimed to decrease portal pressure in special situations for patients with decompensated liver disease with portal hypertension.It represents a potential addition to the therapeutic modalities that could achieve hepatic recompensation in those patients based on Baveno VII criteria.展开更多
This is a retrospective study focused on recompensation after transjugular intrahepatic portosystemic shunt(TIPS)procedure.The authors confirmed TIPS could be a treatment for recompensation of patients with cirrhosis ...This is a retrospective study focused on recompensation after transjugular intrahepatic portosystemic shunt(TIPS)procedure.The authors confirmed TIPS could be a treatment for recompensation of patients with cirrhosis according to Baveno VII.The paper identified age and post-TIPS portal pressure gradient as independent predictors of recompensation in patients with decompensated cirrhosis after TIPS.These results need to be validated in a larger prospective cohort.展开更多
Liver cirrhosis has long been considered a point of no return,with limited hope for recovery.However,recent advancements,particularly the Baveno VII criteria and the utilization of transjugular intrahepatic portosyste...Liver cirrhosis has long been considered a point of no return,with limited hope for recovery.However,recent advancements,particularly the Baveno VII criteria and the utilization of transjugular intrahepatic portosystemic shunt(TIPS),have illuminated the concept of hepatic recompensation.In this editorial we comment on the article by Gao et al published in the recent issue.This editorial provides a comprehensive overview of the evolution of understanding cirrhosis,the criteria for recompensation,and the efficacy of TIPS in achieving recompensation.We discuss key findings from recent studies,including the promising outcomes observed in patients who achieved recompensation post-TIPS insertion.While further research is needed to validate these findings and elucidate the mechanisms underlying recompensation,the insights presented here offer renewed hope for patients with decompensated cirrhosis and highlight the potential of TIPS as a therapeutic option in their management.展开更多
Hepatic recompensation is firstly described in the Baveno VII criteria,which requires the fulfillment of strict criteria.First,a primary cause of cirrhosis must be addressed,suppressed,or cured.Second,complications of...Hepatic recompensation is firstly described in the Baveno VII criteria,which requires the fulfillment of strict criteria.First,a primary cause of cirrhosis must be addressed,suppressed,or cured.Second,complications of liver cirrhosis,inclu-ding ascites,encephalopathy,and variceal hemorrhage,must disappear without any intervention.Finally,liver function indicators must be improved.Moreover,without addressing/suppressing/curing cirrhosis and improvement in liver syn-thetic function,complications,including ascites and variceal hemorrhage can be improved by a transjugular intrahepatic portosystemic shunt(TIPS),which is not evidence of hepatic recompensation.Therefore,on the basis of the definition of hepatic recompensation,TIPS does not achieve hepatic recompensation.展开更多
Aims:Accurately predicting recompensation in patients with decompensated hepatitis B-related cirrhosis is crucial for guiding treatment strategies.As a reliable model for accurately predicting recompensation is curren...Aims:Accurately predicting recompensation in patients with decompensated hepatitis B-related cirrhosis is crucial for guiding treatment strategies.As a reliable model for accurately predicting recompensation is currently lacking,this study aimed to develop a contrast-enhanced computed tomography(CECT)radiomics model specifically for assessing recompensation outcomes in this patient population.Methods:A retrospective cohort of 218 patients with decompensated hepatitis B-related cirrhosis was included.Patients were randomly divided into training(n=152)and testing cohorts(n=66)at a 7:3 ratio by random number generator.Radiomic features(N=2922)were extracted from arterial phase(AP),venous phase,and delayed phase CECT images.Three machinelearning algorithms were used to develop radiomic signatures.Independent clinical factors were identified using logistic regression.A combined model integrating radiomic signatures and clinical factors was then constructed.The Shapley Additive Explanation(SHAP)method was employed to visualize and interpret model predictions for individual patients.Model performance was evaluated based on calibration,discrimination,and clinical utility.Results:A radiomic signature comprising 10 selected features extracted from AP images using logistic regression showed a significant association with recompensation outcomes(p<0.001).This signature demonstrated strong discrimination,with an area under the curve(AUC)of 0.929(95%confidence interval[CI],0.882-0.968)in the training cohort and 0.853(95%CI,0.756-0.960)in the testing cohort.Serum total bilirubin and serum albumin levels were independently associated with recompensation outcomes(p=0.033 and p<0.001,respectively).The combined model incorporating both radiomic signatures and clinical factors exhibited comparable predictive performance to the radiomic signature alone,with AUCs of 0.925(95%CI,0.871-0.964;p=0.487)in the training cohort and 0.865(95%CI,0.762-0.963;p=0.669)in the testing cohort.SHAP analysis provided insights into the interpretability of the radiomics model,highlighting the importance of specific radiomic features in predicting recompensation.All prediction models demonstrated good calibration.Decision curve analysis confirmed the clinical utility of the radiomic signature.Conclusions:This study demonstrates the strong potential of a CECT-based computational approach,integrating clinical factors and radiomic features,for predicting recompensation outcomes in patients with hepatitis B-related decompensated cirrhosis.However,the addition of clinical factors did not provide statistically significant improvement in predictive performance compared to the radiomic signature alone.展开更多
Transjugular intrahepatic portosystemic shunt(TIPS)is a medical procedure that has been used to manage variceal bleeding and ascites in patients with cirrhosis.It can prevent further decompensation and improve the sur...Transjugular intrahepatic portosystemic shunt(TIPS)is a medical procedure that has been used to manage variceal bleeding and ascites in patients with cirrhosis.It can prevent further decompensation and improve the survival of high-risk decompensated patients.Recent research indicates that TIPS could increase the possibility of recompensation of decompensated cirrhosis when it is combined with adequate suppression of the causative factor of liver disease.However,the results of the studies have been based on retrospective analysis,and further validation is required by conducting randomized controlled studies.In this context,we highlight the limitations of the current studies and emphasize the issues that must be addressed before TIPS can be recommended as a potential recompensating tool.展开更多
Based on reviews of the literature and experts’consensus,the Chinese Society of Hepatology developed guidelines for the diagnosis and treatment of liver cirrhosis,in order to improve clinical practice.In addition to ...Based on reviews of the literature and experts’consensus,the Chinese Society of Hepatology developed guidelines for the diagnosis and treatment of liver cirrhosis,in order to improve clinical practice.In addition to what has been covered in previously published guidelines on the management of cirrhosis complications,these guidelines add new sections and provide updates.The guidelines emphasize the early diagnosis of the cause and assessment of complications.Comprehensive treatments including etiological treatment and complication management should be initiated immediately.In addition,regular monitoring,especially surveillance of hepatocellular carcinoma,is crucial for managing patients.展开更多
The Baveno Cooperation is a consortium of internationally renowned experts committed to setting standards for the clinical management of patients with advanced chronic liver disease,with a particular emphasis on compl...The Baveno Cooperation is a consortium of internationally renowned experts committed to setting standards for the clinical management of patients with advanced chronic liver disease,with a particular emphasis on complications related to portal hypertension.Updated every five years and endorsed by major scientific societies,the Baveno recommendations have significantly influenced clinical practice and improved patient outcomes worldwide.The latest Baveno consensus,Baveno Ⅶ,provided a series of recommendations that have shifted our understanding of chronic liver disease and portal hypertension and profoundly shaped clinical practice.However,many areas of research remain to be explored in the short to intermediate term to enable a more personalized medicine approach.This review highlights some of the most relevant advancements introduced in Baveno Ⅶ and discusses future challenges.展开更多
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Natural Science Foundation of China,No.82200650Key Research and Development(R and D)Projects of Shanxi Province,No.202102130501014+3 种基金Shanxi Provincial Clinical Research Center for Interventional Medicine,No.202204010501004Natural Science Foundation of Shanxi Province,No.202203021211021Natural Science Foundation of Shanxi Province,No.202203021212046Natural Science Foundation of Shanxi Province,No.20210302123258.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is the standard second-line treatment option for individuals with complications of decompensated cirrhosis,such as variceal bleeding and refractory ascites.AIM To investigate whether recompensation existed in TIPS-treated patients with decompensated cirrhosis according to Baveno VII criteria.METHODS This retrospective analysis was performed on 64 patients who received TIPS for variceal bleeding or refractory ascites.The definition of recompensation referred to Baveno VII criteria and previous study.Clinical events,laboratory tests,and radiological examinations were regularly conducted during a preset follow-up period.The recompensation ratio in this cohort was calculated.Beyond that,univariate and multivariate regression models were conducted to identify the predictors of recompensation.RESULTS Of the 64 patients with a 12-mo follow-up,20(31%)achieved recompensation.Age[odds ratio(OR):1.124;95%confidence interval(CI):1.034-1.222]and postTIPS portal pressure gradient<12 mmHg(OR:0.119;95%CI:0.024-0.584)were identified as independent predictors of recompensation in patients with decompensated cirrhosis after TIPS.CONCLUSION The present study demonstrated that nearly one-third of the TIPS-treated patients achieved recompensation within this cohort.According to our findings,recompensation is more likely to be achieved in younger patients.In addition,postoperative portal pressure gradient reduction below 12 mmHg contributes to the occurrence of recompensation.
文摘The Baveno VII criteria redefine the management of decompensated liver cirrhosis,introducing the concept of hepatic recompensation marking a significant departure from the conventional view of irreversible decline.Central to this concept is addressing the underlying cause of cirrhosis through tailored therapies,including antivirals and lifestyle modifications.Studies on alcohol,hepatitis C virus,and hepatitis B virus-related cirrhosis demonstrate the efficacy of these interventions in improving liver function and patient outcomes.Transjugular intrahepatic portosystemic shunt(TIPS)emerges as a promising intervention,effectively resolving complications of portal hypertension and facilitating recompensation.However,optimal timing and patient selection for TIPS remain unresolved.Despite challenges,TIPS offers renewed hope for hepatic recompensation,marking a significant advancement in cirrhosis management.Further research is needed to refine its implementation and maximize its benefits.In conclusion,TIPS stands as a promising avenue for improving hepatic function and patient outcomes in decompensated liver cirrhosis within the framework of the Baveno VII criteria.
文摘Transjugular intrahepatic portosystemic shunt is a therapeutic modality done through interventional radiology.It is aimed to decrease portal pressure in special situations for patients with decompensated liver disease with portal hypertension.It represents a potential addition to the therapeutic modalities that could achieve hepatic recompensation in those patients based on Baveno VII criteria.
文摘This is a retrospective study focused on recompensation after transjugular intrahepatic portosystemic shunt(TIPS)procedure.The authors confirmed TIPS could be a treatment for recompensation of patients with cirrhosis according to Baveno VII.The paper identified age and post-TIPS portal pressure gradient as independent predictors of recompensation in patients with decompensated cirrhosis after TIPS.These results need to be validated in a larger prospective cohort.
文摘Liver cirrhosis has long been considered a point of no return,with limited hope for recovery.However,recent advancements,particularly the Baveno VII criteria and the utilization of transjugular intrahepatic portosystemic shunt(TIPS),have illuminated the concept of hepatic recompensation.In this editorial we comment on the article by Gao et al published in the recent issue.This editorial provides a comprehensive overview of the evolution of understanding cirrhosis,the criteria for recompensation,and the efficacy of TIPS in achieving recompensation.We discuss key findings from recent studies,including the promising outcomes observed in patients who achieved recompensation post-TIPS insertion.While further research is needed to validate these findings and elucidate the mechanisms underlying recompensation,the insights presented here offer renewed hope for patients with decompensated cirrhosis and highlight the potential of TIPS as a therapeutic option in their management.
基金National Natural Science Foundation of China,No.82170679and Beijing Physician Scientist Training Project,China,No.BJPSTP-2024-28.
文摘Hepatic recompensation is firstly described in the Baveno VII criteria,which requires the fulfillment of strict criteria.First,a primary cause of cirrhosis must be addressed,suppressed,or cured.Second,complications of liver cirrhosis,inclu-ding ascites,encephalopathy,and variceal hemorrhage,must disappear without any intervention.Finally,liver function indicators must be improved.Moreover,without addressing/suppressing/curing cirrhosis and improvement in liver syn-thetic function,complications,including ascites and variceal hemorrhage can be improved by a transjugular intrahepatic portosystemic shunt(TIPS),which is not evidence of hepatic recompensation.Therefore,on the basis of the definition of hepatic recompensation,TIPS does not achieve hepatic recompensation.
基金supported by the Natural Science Foundation of Jiangxi Province of China(No.20232BAB216016)Youth Talent Research Cultivation Fund of the First Affiliated Hospital of Nanchang University(No.YFYPY202222).
文摘Aims:Accurately predicting recompensation in patients with decompensated hepatitis B-related cirrhosis is crucial for guiding treatment strategies.As a reliable model for accurately predicting recompensation is currently lacking,this study aimed to develop a contrast-enhanced computed tomography(CECT)radiomics model specifically for assessing recompensation outcomes in this patient population.Methods:A retrospective cohort of 218 patients with decompensated hepatitis B-related cirrhosis was included.Patients were randomly divided into training(n=152)and testing cohorts(n=66)at a 7:3 ratio by random number generator.Radiomic features(N=2922)were extracted from arterial phase(AP),venous phase,and delayed phase CECT images.Three machinelearning algorithms were used to develop radiomic signatures.Independent clinical factors were identified using logistic regression.A combined model integrating radiomic signatures and clinical factors was then constructed.The Shapley Additive Explanation(SHAP)method was employed to visualize and interpret model predictions for individual patients.Model performance was evaluated based on calibration,discrimination,and clinical utility.Results:A radiomic signature comprising 10 selected features extracted from AP images using logistic regression showed a significant association with recompensation outcomes(p<0.001).This signature demonstrated strong discrimination,with an area under the curve(AUC)of 0.929(95%confidence interval[CI],0.882-0.968)in the training cohort and 0.853(95%CI,0.756-0.960)in the testing cohort.Serum total bilirubin and serum albumin levels were independently associated with recompensation outcomes(p=0.033 and p<0.001,respectively).The combined model incorporating both radiomic signatures and clinical factors exhibited comparable predictive performance to the radiomic signature alone,with AUCs of 0.925(95%CI,0.871-0.964;p=0.487)in the training cohort and 0.865(95%CI,0.762-0.963;p=0.669)in the testing cohort.SHAP analysis provided insights into the interpretability of the radiomics model,highlighting the importance of specific radiomic features in predicting recompensation.All prediction models demonstrated good calibration.Decision curve analysis confirmed the clinical utility of the radiomic signature.Conclusions:This study demonstrates the strong potential of a CECT-based computational approach,integrating clinical factors and radiomic features,for predicting recompensation outcomes in patients with hepatitis B-related decompensated cirrhosis.However,the addition of clinical factors did not provide statistically significant improvement in predictive performance compared to the radiomic signature alone.
文摘Transjugular intrahepatic portosystemic shunt(TIPS)is a medical procedure that has been used to manage variceal bleeding and ascites in patients with cirrhosis.It can prevent further decompensation and improve the survival of high-risk decompensated patients.Recent research indicates that TIPS could increase the possibility of recompensation of decompensated cirrhosis when it is combined with adequate suppression of the causative factor of liver disease.However,the results of the studies have been based on retrospective analysis,and further validation is required by conducting randomized controlled studies.In this context,we highlight the limitations of the current studies and emphasize the issues that must be addressed before TIPS can be recommended as a potential recompensating tool.
文摘Based on reviews of the literature and experts’consensus,the Chinese Society of Hepatology developed guidelines for the diagnosis and treatment of liver cirrhosis,in order to improve clinical practice.In addition to what has been covered in previously published guidelines on the management of cirrhosis complications,these guidelines add new sections and provide updates.The guidelines emphasize the early diagnosis of the cause and assessment of complications.Comprehensive treatments including etiological treatment and complication management should be initiated immediately.In addition,regular monitoring,especially surveillance of hepatocellular carcinoma,is crucial for managing patients.
基金supported by:FIS 23/00997 funded by“Instituto de Salud Carlos Ⅲ”and co-funded by the European Union“CIBEREHD”funded by“Instituto de Salud Carlos Ⅲ”by the European Union’s Horizon 2020 research and innovation program under grant agreement N°825575(RiTA)+5 种基金“CIBEREHD”funded by“Instituto de Salud Carlos Ⅲ”the“Commissioner for Universities and Research from the Department of Economy and Knowledge”of the“Generalitat de Catalunya”(AGAUR SGR202101115)the National Natural Science Foundation of China(No.82470640)the 135 projects for disciplines of excellence,West China Hospital,Sichuan University(No.ZYGD23031)the National Key R&D Program of China(No.2023YFC2507500)the Provincial Natural Science Foundation of Shandong,China(Nos.ZR2022MH010 and ZR2023MH295).
文摘The Baveno Cooperation is a consortium of internationally renowned experts committed to setting standards for the clinical management of patients with advanced chronic liver disease,with a particular emphasis on complications related to portal hypertension.Updated every five years and endorsed by major scientific societies,the Baveno recommendations have significantly influenced clinical practice and improved patient outcomes worldwide.The latest Baveno consensus,Baveno Ⅶ,provided a series of recommendations that have shifted our understanding of chronic liver disease and portal hypertension and profoundly shaped clinical practice.However,many areas of research remain to be explored in the short to intermediate term to enable a more personalized medicine approach.This review highlights some of the most relevant advancements introduced in Baveno Ⅶ and discusses future challenges.
