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
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
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
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 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 Chylous ascites is an uncommon condition,occurring in less than 1%of ascites cases.It results from traumatic or obstructive disruption of the lymphatic system,causing the leakage of thoracic or intestinal l...BACKGROUND Chylous ascites is an uncommon condition,occurring in less than 1%of ascites cases.It results from traumatic or obstructive disruption of the lymphatic system,causing the leakage of thoracic or intestinal lymph into the abdominal cavity.This leads to the accumulation of a milky,triglyceride-rich fluid.In adults,malignancy and cirrhosis are the primary causes of chylous ascites.Notably,chylous ascites accounts for only 0.5%to 1%of all cirrhosis-related ascites cases.At present,there is a limited understanding of this condition,and effective timely management in clinical practice remains challenging.CASE SUMMARY This case report presents a patient with hepatic cirrhosis complicated by chylous ascites,who had experienced multiple hospitalizations due to abdominal distension.Upon admission,comprehensive examinations and assessments were conducted.The treatment strategy focused on nutritional optimization through a low-sodium,low-fat,and high-protein diet supplemented with medium-chain triglycerides,therapeutic paracentesis,and diuretics.Following a multidiscip-linary discussion and thorough evaluation of the patient’s condition,surgical indications were confirmed.After informing the patient about the benefits and risks,and obtaining consent,a transjugular intrahepatic portosystemic shunt procedure was performed,successfully alleviating the abdominal swelling symptoms.This article details the clinical characteristics and treatment approach for this uncommon case,summarizing current management methods for hepatic cirrhosis complicated by chylous ascites.The aim is to provide valuable insights for clinicians encountering similar situations.CONCLUSION Optimizing nutrition and addressing the underlying cause are essential in the treatment of chylous ascites.When conservative approaches prove ineffective,alternative interventions such as transjugular intrahepatic portosystemic shunt may be considered.展开更多
BACKGROUND Liver fibrosis and cirrhosis are global medical challenges that require safe and effective treatments.In the past two decades,there has been a surge in research on stem cell therapy for liver fibrosis and c...BACKGROUND Liver fibrosis and cirrhosis are global medical challenges that require safe and effective treatments.In the past two decades,there has been a surge in research on stem cell therapy for liver fibrosis and cirrhosis.This study aimed to conduct a comprehensive analysis of the research hotspots and trends in this field through bibliometrics.sters was conducted.RESULTS As of September 20,2024,a total of 1935 documents were retrieved dating from 2004 to 2024,with 1186 strongly relevant publications obtained after screening.China,the United States,and Japan were the major contributors in this field.Cairo University,Zhejiang University and Yamaguchi University were the major institution in this field.The journal Stem Cell Research&Therapy published the most papers.There were 686 authors,with Shuji Terai,Isao Sakaida,Soon Koo Baik,and Lanjuan Li publishing the most papers.The research focused on alcoholic cirrhosis and nonalcoholic fatty liver disease.The emerging areas of interest were extracellular vesicles,exosomes,and their enriched microRNAs.The field is experiencing rapid growth due to the changing research trends and increasing literature.CONCLUSION These findings provide a thorough overview of stem cell therapy in the field of liver fibrosis and cirrhosis.展开更多
BACKGROUND Globally,Liver cirrhosis is the 14th leading cause of death and poses a significant threat to human health.AIM To investigate the effects of a multidisciplinary collaboration model on postoperative recovery...BACKGROUND Globally,Liver cirrhosis is the 14th leading cause of death and poses a significant threat to human health.AIM To investigate the effects of a multidisciplinary collaboration model on postoperative recovery and psychological stress in patients with liver cirrhosis undergoing esophageal variceal bleeding(EVB)surgery within an integrated healthcare system.METHODS Between January 2022 and March 2024,a total of 180 patients with cirrhosis and EVB were admitted and randomly assigned to either a control group(standard care)or an observation group(standard care plus the multidisciplinary collaboration model),with 90 patients in each group.Postoperative recovery indicators(time to symptom improvement,time to start eating,time to bowel sound recovery,time to first flatus,and hospital stay),psychological stress responses[selfrating anxiety scale(SAS);self-rating depression scale(SDS)],subjective wellbeing,and incidence of complications were compared between the two groups.RESULTS Compared to the control group,the observation group showed earlier symptom improvement,earlier return to eating,bowel sound recovery,first flatus,and a shorter hospital stay.Pre-intervention SAS and SDS scores were not significantly different between the groups,but post-intervention scores were significantly lower in the observation group.Similarly,there was no significant difference in the subjective well-being scores before the intervention between the two groups.After the intervention,both groups showed improved scores,with the observation group scoring significantly higher than the control group.CONCLUSION The observation group also had a lower incidence of complications.Therefore,for patients with liver cirrhosis undergoing EVB surgery,a multidisciplinary collaboration model within an integrated healthcare system can promote early postoperative recovery,reduces psychological stress,improves subjective well-being,and reduces complications and rebleeding.展开更多
BACKGROUND Severe symptoms associated with sepsis syndrome(SS)are considered a severe threat,which not only increases therapeutic difficulty but also causes a prognostic mortality rate.However,at present,few related s...BACKGROUND Severe symptoms associated with sepsis syndrome(SS)are considered a severe threat,which not only increases therapeutic difficulty but also causes a prognostic mortality rate.However,at present,few related studies focused on the application of different score scales for disease and prognosis assessment in liver cirrhosis(LC)complicated with SS.AIM To determine the correlations of the model for end-stage liver disease(MELD),sequential organ failure assessment(SOFA),and modified early warning score(MEWS)points with the prognosis of patients with LC complicated with SS.METHODS This retrospective analysis included 426 LC cases from February 2019 to April 2022.Of them,225 cases that were complicated with SS were assigned to the LC+SS group,and 201 simple LC cases were included in the LC group.Intergroup differences in MELD,SOFA,and MEWS scores were compared,as well as their diagnostic value for LC+SS.The correlations of the three scores with the progno-sis of patients with LC+SS were further analyzed,as well as the related risk factors affecting patients’outcomes,after the follow-up investigation.RESULTS MELD,SOFA,and MEWS scores were all higher in the LC+SS group vs the LC group,and their combined assessment for LC+SS revealed a diagnostic sensi-tivity and a specificity of 89.66%and 90.84%,respectively(P<0.05).The LC+SS group reported 58 deaths,with an overall mortality rate of 25.78%.Deceased pa-tients presented higher MELD,SOFA,and MEWS points than those who survived(P<0.05).MELD,SOFA,and MEWS scores were determined by COX analysis as factors independently affecting the prognosis of patients with LC+SS(P<0.05).CONCLUSION MELD,SOFA,and MEWS effectively diagnosed LC in patients complicated with SS,and they demonstrated great significance in assessing prognosis,which provides a reliable prognosis guarantee for patients with LC+SS.However,their assessment effects remain limited,which is worthy of further investigation by more in-depth and rigorous experimental analysis.展开更多
Hepatocrinology explores the intricate relationship between liver function and the endocrine system.Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein sy...Hepatocrinology explores the intricate relationship between liver function and the endocrine system.Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption.Despite its importance,assessing endocrine issues in cirrhotic patients is frequently neglected.This article provides a comprehensive review of the epidemiology,pathophysiology,diagnosis,and treatment of endocrine disturbances in liver cirrhosis.The review was conducted using the PubMed/Medline,EMBASE,and Scielo databases,encompassing 172 articles.Liver cirrhosis is associated with endocrine disturbances,including diabetes,hypoglycemia,sarcopenia,thyroid dysfunction,hypogonadotropic hypogonadism,bone disease,adrenal insufficiency,growth hormone dysfunction,and secondary hyperaldosteronism.The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system,respectively.Sarcopenia can be assessed through imaging and functional tests,while other endocrine disorders are evaluated using hormonal assays and imaging studies.Treatment options include metformin,glucagon-like peptide-1 analogs,sodium-glucose co-transporter-2 inhibitors,and insulin,which are effective and safe for diabetes control.Established standards are followed for managing hypoglycemia,and hormone replacement therapy is often necessary for other endocrine dysfunctions.Liver transplantation can address some of these problems.展开更多
BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to deco...BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to decompensated advanced chronic liver disease(dACLD)can occur through two modalities referred to as acute decompensation(AD)and non-AD(NAD),respectively.Clinically Significant Portal Hypertension(CSPH)is considered the strongest predictor of decompensation in these patients.However,due to its invasiveness and costs,CSPH is almost never evaluated in clinical practice.Therefore,recognizing noninvasively predicting tools still have more appeal across healthcare systems.The red cell distribution width to platelet ratio(RPR)has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD).However,its predictive role for the decompensation has never been explored.AIM In this observational study,we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients.METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up(FUP)semiannually for 3 years.At baseline,biochemical,clinical,and Liver Stiffness Measurement(LSM),Child-Pugh(CP),Model for End-Stage Liver Disease(MELD),aspartate aminotransferase/platelet count ratio index(APRI),Fibrosis-4(FIB-4),Albumin-Bilirubin(ALBI),ALBI-FIB-4,and RPR were collected.During FUP,DEs(timing and modaities)were recorded.CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines.RESULTS Of 150 MASLD-related cACLD patients,43(28.6%)progressed to dACLD at a median time of 28.9 months(29 NAD and 14 AD).Baseline RPR values were significantly higher in cACLD in comparison to controls,as well as MELD,CP,APRI,FIB-4,ALBI,ALBI-FIB-4,and LSM in dACLD-progressing compared to cACLD individuals[all P<0.0001,except for FIB-4(P:0.007)and ALBI(P:0.011)].Receiving operator curve analysis revealed RPR>0.472 and>0.894 as the best cut-offs in the prediction respectively of 3-year first DE,as well as its superiority compared to the other non-invasive tools examined.RPR(P:0.02)and the presence of baseline-CSPH(P:0.04)were significantly and independently associated with the DE.Patients presenting baseline-CSPH and RPR>0.472 showed higher risk of decompensation(P:0.0023).CONCLUSION Altogether these findings suggest the RPR as a valid and potentially applicable non-invasive tool in the prediction of timing and modalities of decompensation in MASLD-related cACLD patients.展开更多
BACKGROUND Cirrhotic patients face heightened energy demands,leading to rapid glycogen depletion,protein degradation,oxidative stress,and inflammation,which drive disease progression and complications.These disruption...BACKGROUND Cirrhotic patients face heightened energy demands,leading to rapid glycogen depletion,protein degradation,oxidative stress,and inflammation,which drive disease progression and complications.These disruptions cause cellular damage and parenchymal changes,resulting in vascular alterations,portal hypertension,and liver dysfunction,significantly affecting patient prognosis.AIM To analyze the association between Child–Turcotte–Pugh(CTP)scores and di-fferent nutritional indicators with survival in a 15-year follow-up cohort.METHODS This was a retrospective cohort study with 129 cirrhotic patients of both sexes aged>18 years.Diagnosis of cirrhosis was made by liver biopsy.The first year of data collection was 2007,and data regarding outcomes were collected in 2023.Data were gathered from medical records,and grouped by different methods,including CTP,handgrip strength,and triceps skinfold cutoffs.The prognostic values for mortality were assessed using Kaplan–Meier curves and multivariate binary logistic regression models.RESULTS The coefficient for CTP was the only statistically significant variable(Wald=5.193,P=0.023).This suggests that with a negative change in CTP classification score,the odds of survival decrease 52.6%.The other evaluated variables did not significantly predict survival outcomes in the model.Kaplan–Meier survival curves also indicated that CTP classification was the only significant predictor.CONCLUSION Although different classifications showed specific differences in stratification,only CTP showed significant predictive potential.CTP score remains a simple and effective predictive tool for cirrhotic patients even after longer follow-up.展开更多
Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,...Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,having a tool to identify patients at higher risk of complications and mortality is an ideal goal.Currently,the validated scores for this purpose are the model for end-stage liver disease score and the Child-Pugh score.However,these scores have limitations,as they do not account for other factors associated with liver cirrhosis that are equally relevant from a prognostic perspective.Among these,alterations in body composition,particularly sarcopenia,increase the risk of mortality and should therefore be considered in the comprehensive assessment of patients with liver cirrhosis.展开更多
BACKGROUND The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing.It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer.Such an association would...BACKGROUND The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing.It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer.Such an association would have significant clinical implications,particularly for cancer screening prior to liver transplantation.AIM To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.METHODS An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis.Study-specific standardized incidence ratios(SIR)along with corresponding 95%CI for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model.Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.RESULTS We identified 5054 articles;4 studies were selected for data extraction.The overall incidence of all cancers was significantly higher in patients with cirrhosis,with an SIR of 2.79(95%CI:2.18–3.57).When stratified by cirrhosis etiology,the incidence of luminal cancers remained significantly elevated for alcohol(SIR=3.13,95%CI:2.24–4.39),Primary Biliary Cholangitis(SIR=1.40,95%CI:1.10–1.79),and unspecified cirrhosis(SIR=3.52,95%CI:1.87–6.65).CONCLUSION The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis.Oral cavity,pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer.Therefore,increased screening of luminal cancers,and in particular these upper luminal tract subtypes,should be considered in this population.展开更多
The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic ...The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.展开更多
A multicenter study recently published introduced a novel prognostic model for predicting esophagogastric variceal rebleeding after endoscopic treatment in patients with cirrhosis.The model incorporated six readily av...A multicenter study recently published introduced a novel prognostic model for predicting esophagogastric variceal rebleeding after endoscopic treatment in patients with cirrhosis.The model incorporated six readily available clinical variables—albumin level,aspartate aminotransferase level,white blood cell count,ascites,portal vein thrombosis,and bleeding signs—and demonstrated promising predictive performance.However,limitations,including the retrospective design and exclusion of patients with hepatocellular carcinoma,may affect the generaliz-ability of the model.Additionally,further improvement is needed in the model’s discrimination between intermediate-and high-risk groups in external.Prospec-tive validation and inclusion of additional variables are recommended to enhan-ce predictive accuracy across diverse clinical scenarios.展开更多
BACKGROUND The pathogenesis of hepatic encephalopathy(HE)remains unclear,and the classical theory of ammonia toxicity lacks sufficient justification.AIM To investigate the potential of bile acids as intervention targe...BACKGROUND The pathogenesis of hepatic encephalopathy(HE)remains unclear,and the classical theory of ammonia toxicity lacks sufficient justification.AIM To investigate the potential of bile acids as intervention targets for HE.METHODS This study employed 42 wild-type male SD rats weighing 200±20 g.Using a random number table method,two rats were randomly selected to undergo common bile duct ligation(BDL).The remaining 40 rats were randomly assigned to four groups serving as controls:The vehicle+control diet(VC)group,the thioacetamide(TAA)group,the TAA+total bile acids(TAAT)group,and the TAA+cholestyramine(TAAC)group.Except for the VC group,all rats were intraperitoneally injected with 100 mg/kg TAA solution once daily for ten consecutive days to establish a HE model.Simultaneously,the TAAT and TAAC groups were administered a diet containing 0.3%bile acids(derived from BDL rats)and 2%cholestyramine,respectively,by gavage for ten days.For the BDL rat model group,the common BDL procedure was performed following the aforementioned protocol.After four weeks,laparotomy revealed swollen bile ducts at the ligation site,and bile was collected.Following successful modeling,behavioral tests,including the elevated plus maze and open field test,were conducted to assess the HE status of the rats.Peripheral blood,liver,and cerebral cortex tissue samples were collected,and the total bile acid content in the serum and cerebral cortex was measured using an enzyme cycling method.The levels of inflammatory factors in the serum and cerebral cortex were analyzed using enzyme-linked immunosorbent assay.Liver histological examination was performed using the hematoxylin-eosin double-labeling method.Reverse transcription polymerase chain reaction,western blot,immunohistochemistry,and other techniques were employed to observe the expression of microglial activation marker ionized calcium-binding adaptor molecule-1 and Takeda G protein-coupled receptor 5(TGR5)protein.RESULTS Compared to the VC group,the TAA group exhibited an exacerbation of HE in rats.The total bile acid content,proinflammatory factors[interleukin-1β(IL-1β),IL-6],and the anti-inflammatory factor IL-10 in both the serum and cerebral cortex were significantly elevated.Similarly,the expression of the TGR5 receptor in the cerebral cortex was upregulated.To investigate the impact of total bile acids on HE in rats,comparisons were made with the TAA group.In the TAAT group,the severity of HE was further aggravated,accompanied by increased total bile acid content in the serum and cerebral cortex,elevated pro-inflammatory factors(IL-1β,IL-6),reduced levels of the antiinflammatory factor IL-10,and decreased expression of the TGR5 receptor in the cerebral cortex.In the TAAC group,the severity of HE was alleviated.This group showed reductions in total bile acid content in the serum and cerebral cortex,decreased pro-inflammatory factors(IL-1β,IL-6),increased levels of the anti-inflammatory factor IL-10,and enhanced expression of the TGR5 receptor in the cerebral cortex.CONCLUSION This study demonstrated that the total bile acid content in the serum and cerebral cortex of TAA-induced liver cirrhosis rats was elevated.Furthermore,total bile acids exacerbate the progression of HE in rats.This effect may be attributed to bile acids’involvement in the development of neurological dysfunction by mediating TGR5 expression and regulating neuroinflammation.展开更多
To the Editor: Fatty liver diseases, including nonalcoholic fatty liver disease and alcohol related fatty liver disease, have become a major public health concern [ 1, 2 ]. Fatty liver diseases have been shown to prog...To the Editor: Fatty liver diseases, including nonalcoholic fatty liver disease and alcohol related fatty liver disease, have become a major public health concern [ 1, 2 ]. Fatty liver diseases have been shown to progress through various stages, from steatosis or necrosis with inflammation and hepatocyte damage to the development of fibrosis and eventual cirrhosis with an increased risk of carcinoma [ 2, 3 ].展开更多
Objective: To treat ascites in patients with grade 3 liver cirrhosis using traditional Chinese medicine, evaluate effectiveness and safety by observing improvements in physical and mental symptoms, explore optimal tre...Objective: To treat ascites in patients with grade 3 liver cirrhosis using traditional Chinese medicine, evaluate effectiveness and safety by observing improvements in physical and mental symptoms, explore optimal treatment measures, and benefit clinical practice. Methods: 40 patients with ascites of liver cirrhosis admitted to our department from October 2020 to October 2022 were selected. According to a random number table, all patients were divided into an observation group treated with Yao Medicine and a control group treated with conventional Western medicine, with 20 cases in each group. The improvement of adverse emotions was evaluated before and after treatment using the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS). The changes in liver function indicators were observed to judge the efficacy and safety. Results: The effective rate in the observation group was 95.00%, and in the control group was 90.00%. The comparison between the two groups showed a significant increase in the effective rate in the observation group, with a statistically significant difference (P P P > 0.05). After treatment, compared with the control group, the observation group showed a significant decrease in SDS and SAS scores, with a statistically significant difference (P < 0.05). Conclusion: Yao Medicine can effectively improve the physical and mental symptoms of patients with ascites of liver cirrhosis, with good effectiveness and high safety.展开更多
BACKGROUND Cirrhosis is a common liver disease,and ascites is one of the common clinical conditions.However,the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationsh...BACKGROUND Cirrhosis is a common liver disease,and ascites is one of the common clinical conditions.However,the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationship to patient prognosis have not been fully studied.AIM To explore the clinical manifestations,prognostic factors,and relationships of ascites with hyponatremia in patients with cirrhosis to provide better diagnostic and treatment strategies.METHODS In this study,we retrospectively analyzed the clinical data of 150 patients diagnosed with cirrhosis and ascites between 2017 and 2022.Patients were divided into two groups:ascites combined with hyponatremia group and ascites group.We compared the general characteristics,degree of hyponatremia,complications,treatment,and prognosis between the two groups.RESULTS In the study results,patients in the ascites combined with hyponatremia group showed an older average age(58.2±8.9 years),64.4%were male,and had a significantly longer hospitalization time(12.7±5.3 d).Hyponatremia was more severe in this group,with a mean serum sodium concentration of 128.5±4.3 mmol/L,which was significantly different from the ascites group of 137.6±2.1 mmol/L.Patients with ascites and hyponatremia were more likely to develop hepatic encephalopathy(56.2%vs 39.0%),renal impairment(45.2%vs 28.6%)and infection(37.0%vs 23.4%).Regarding treatment,this group more frequently used diuretics(80.8%vs 62.3%)and salt supplements(60.3%vs 38.9%).Multiple logistic regression analysis identified older age[Odds ratio(OR)=1.06,P=0.025]and male gender(OR=1.72,P=0.020)as risk factors for hyponatremia combined with ascites.Overall,patients with ascites and hyponatremia present a clear high-risk status,accompanied by severe complications and poor prognosis.CONCLUSION In patients with cirrhosis,ascites with hyponatremia is a high-risk condition that is often associated with severe complications.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.
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 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.
文摘BACKGROUND Chylous ascites is an uncommon condition,occurring in less than 1%of ascites cases.It results from traumatic or obstructive disruption of the lymphatic system,causing the leakage of thoracic or intestinal lymph into the abdominal cavity.This leads to the accumulation of a milky,triglyceride-rich fluid.In adults,malignancy and cirrhosis are the primary causes of chylous ascites.Notably,chylous ascites accounts for only 0.5%to 1%of all cirrhosis-related ascites cases.At present,there is a limited understanding of this condition,and effective timely management in clinical practice remains challenging.CASE SUMMARY This case report presents a patient with hepatic cirrhosis complicated by chylous ascites,who had experienced multiple hospitalizations due to abdominal distension.Upon admission,comprehensive examinations and assessments were conducted.The treatment strategy focused on nutritional optimization through a low-sodium,low-fat,and high-protein diet supplemented with medium-chain triglycerides,therapeutic paracentesis,and diuretics.Following a multidiscip-linary discussion and thorough evaluation of the patient’s condition,surgical indications were confirmed.After informing the patient about the benefits and risks,and obtaining consent,a transjugular intrahepatic portosystemic shunt procedure was performed,successfully alleviating the abdominal swelling symptoms.This article details the clinical characteristics and treatment approach for this uncommon case,summarizing current management methods for hepatic cirrhosis complicated by chylous ascites.The aim is to provide valuable insights for clinicians encountering similar situations.CONCLUSION Optimizing nutrition and addressing the underlying cause are essential in the treatment of chylous ascites.When conservative approaches prove ineffective,alternative interventions such as transjugular intrahepatic portosystemic shunt may be considered.
基金Supported by the School-Level Project Fund of Chongqing Medical and Pharmaceutical College,No.Ygzrc2023109the Science and Technology Research Program of Chongqing Municipal Education Commission,No.KJQN202302822+1 种基金the Special Fund for Agro-Scientific Research in The Public Interest,No.201303040-05the Special Project for Fundamental Work of Science and Technology,No.2013FY110600-03.
文摘BACKGROUND Liver fibrosis and cirrhosis are global medical challenges that require safe and effective treatments.In the past two decades,there has been a surge in research on stem cell therapy for liver fibrosis and cirrhosis.This study aimed to conduct a comprehensive analysis of the research hotspots and trends in this field through bibliometrics.sters was conducted.RESULTS As of September 20,2024,a total of 1935 documents were retrieved dating from 2004 to 2024,with 1186 strongly relevant publications obtained after screening.China,the United States,and Japan were the major contributors in this field.Cairo University,Zhejiang University and Yamaguchi University were the major institution in this field.The journal Stem Cell Research&Therapy published the most papers.There were 686 authors,with Shuji Terai,Isao Sakaida,Soon Koo Baik,and Lanjuan Li publishing the most papers.The research focused on alcoholic cirrhosis and nonalcoholic fatty liver disease.The emerging areas of interest were extracellular vesicles,exosomes,and their enriched microRNAs.The field is experiencing rapid growth due to the changing research trends and increasing literature.CONCLUSION These findings provide a thorough overview of stem cell therapy in the field of liver fibrosis and cirrhosis.
文摘BACKGROUND Globally,Liver cirrhosis is the 14th leading cause of death and poses a significant threat to human health.AIM To investigate the effects of a multidisciplinary collaboration model on postoperative recovery and psychological stress in patients with liver cirrhosis undergoing esophageal variceal bleeding(EVB)surgery within an integrated healthcare system.METHODS Between January 2022 and March 2024,a total of 180 patients with cirrhosis and EVB were admitted and randomly assigned to either a control group(standard care)or an observation group(standard care plus the multidisciplinary collaboration model),with 90 patients in each group.Postoperative recovery indicators(time to symptom improvement,time to start eating,time to bowel sound recovery,time to first flatus,and hospital stay),psychological stress responses[selfrating anxiety scale(SAS);self-rating depression scale(SDS)],subjective wellbeing,and incidence of complications were compared between the two groups.RESULTS Compared to the control group,the observation group showed earlier symptom improvement,earlier return to eating,bowel sound recovery,first flatus,and a shorter hospital stay.Pre-intervention SAS and SDS scores were not significantly different between the groups,but post-intervention scores were significantly lower in the observation group.Similarly,there was no significant difference in the subjective well-being scores before the intervention between the two groups.After the intervention,both groups showed improved scores,with the observation group scoring significantly higher than the control group.CONCLUSION The observation group also had a lower incidence of complications.Therefore,for patients with liver cirrhosis undergoing EVB surgery,a multidisciplinary collaboration model within an integrated healthcare system can promote early postoperative recovery,reduces psychological stress,improves subjective well-being,and reduces complications and rebleeding.
文摘BACKGROUND Severe symptoms associated with sepsis syndrome(SS)are considered a severe threat,which not only increases therapeutic difficulty but also causes a prognostic mortality rate.However,at present,few related studies focused on the application of different score scales for disease and prognosis assessment in liver cirrhosis(LC)complicated with SS.AIM To determine the correlations of the model for end-stage liver disease(MELD),sequential organ failure assessment(SOFA),and modified early warning score(MEWS)points with the prognosis of patients with LC complicated with SS.METHODS This retrospective analysis included 426 LC cases from February 2019 to April 2022.Of them,225 cases that were complicated with SS were assigned to the LC+SS group,and 201 simple LC cases were included in the LC group.Intergroup differences in MELD,SOFA,and MEWS scores were compared,as well as their diagnostic value for LC+SS.The correlations of the three scores with the progno-sis of patients with LC+SS were further analyzed,as well as the related risk factors affecting patients’outcomes,after the follow-up investigation.RESULTS MELD,SOFA,and MEWS scores were all higher in the LC+SS group vs the LC group,and their combined assessment for LC+SS revealed a diagnostic sensi-tivity and a specificity of 89.66%and 90.84%,respectively(P<0.05).The LC+SS group reported 58 deaths,with an overall mortality rate of 25.78%.Deceased pa-tients presented higher MELD,SOFA,and MEWS points than those who survived(P<0.05).MELD,SOFA,and MEWS scores were determined by COX analysis as factors independently affecting the prognosis of patients with LC+SS(P<0.05).CONCLUSION MELD,SOFA,and MEWS effectively diagnosed LC in patients complicated with SS,and they demonstrated great significance in assessing prognosis,which provides a reliable prognosis guarantee for patients with LC+SS.However,their assessment effects remain limited,which is worthy of further investigation by more in-depth and rigorous experimental analysis.
文摘Hepatocrinology explores the intricate relationship between liver function and the endocrine system.Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption.Despite its importance,assessing endocrine issues in cirrhotic patients is frequently neglected.This article provides a comprehensive review of the epidemiology,pathophysiology,diagnosis,and treatment of endocrine disturbances in liver cirrhosis.The review was conducted using the PubMed/Medline,EMBASE,and Scielo databases,encompassing 172 articles.Liver cirrhosis is associated with endocrine disturbances,including diabetes,hypoglycemia,sarcopenia,thyroid dysfunction,hypogonadotropic hypogonadism,bone disease,adrenal insufficiency,growth hormone dysfunction,and secondary hyperaldosteronism.The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system,respectively.Sarcopenia can be assessed through imaging and functional tests,while other endocrine disorders are evaluated using hormonal assays and imaging studies.Treatment options include metformin,glucagon-like peptide-1 analogs,sodium-glucose co-transporter-2 inhibitors,and insulin,which are effective and safe for diabetes control.Established standards are followed for managing hypoglycemia,and hormone replacement therapy is often necessary for other endocrine dysfunctions.Liver transplantation can address some of these problems.
文摘BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to decompensated advanced chronic liver disease(dACLD)can occur through two modalities referred to as acute decompensation(AD)and non-AD(NAD),respectively.Clinically Significant Portal Hypertension(CSPH)is considered the strongest predictor of decompensation in these patients.However,due to its invasiveness and costs,CSPH is almost never evaluated in clinical practice.Therefore,recognizing noninvasively predicting tools still have more appeal across healthcare systems.The red cell distribution width to platelet ratio(RPR)has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD).However,its predictive role for the decompensation has never been explored.AIM In this observational study,we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients.METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up(FUP)semiannually for 3 years.At baseline,biochemical,clinical,and Liver Stiffness Measurement(LSM),Child-Pugh(CP),Model for End-Stage Liver Disease(MELD),aspartate aminotransferase/platelet count ratio index(APRI),Fibrosis-4(FIB-4),Albumin-Bilirubin(ALBI),ALBI-FIB-4,and RPR were collected.During FUP,DEs(timing and modaities)were recorded.CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines.RESULTS Of 150 MASLD-related cACLD patients,43(28.6%)progressed to dACLD at a median time of 28.9 months(29 NAD and 14 AD).Baseline RPR values were significantly higher in cACLD in comparison to controls,as well as MELD,CP,APRI,FIB-4,ALBI,ALBI-FIB-4,and LSM in dACLD-progressing compared to cACLD individuals[all P<0.0001,except for FIB-4(P:0.007)and ALBI(P:0.011)].Receiving operator curve analysis revealed RPR>0.472 and>0.894 as the best cut-offs in the prediction respectively of 3-year first DE,as well as its superiority compared to the other non-invasive tools examined.RPR(P:0.02)and the presence of baseline-CSPH(P:0.04)were significantly and independently associated with the DE.Patients presenting baseline-CSPH and RPR>0.472 showed higher risk of decompensation(P:0.0023).CONCLUSION Altogether these findings suggest the RPR as a valid and potentially applicable non-invasive tool in the prediction of timing and modalities of decompensation in MASLD-related cACLD patients.
文摘BACKGROUND Cirrhotic patients face heightened energy demands,leading to rapid glycogen depletion,protein degradation,oxidative stress,and inflammation,which drive disease progression and complications.These disruptions cause cellular damage and parenchymal changes,resulting in vascular alterations,portal hypertension,and liver dysfunction,significantly affecting patient prognosis.AIM To analyze the association between Child–Turcotte–Pugh(CTP)scores and di-fferent nutritional indicators with survival in a 15-year follow-up cohort.METHODS This was a retrospective cohort study with 129 cirrhotic patients of both sexes aged>18 years.Diagnosis of cirrhosis was made by liver biopsy.The first year of data collection was 2007,and data regarding outcomes were collected in 2023.Data were gathered from medical records,and grouped by different methods,including CTP,handgrip strength,and triceps skinfold cutoffs.The prognostic values for mortality were assessed using Kaplan–Meier curves and multivariate binary logistic regression models.RESULTS The coefficient for CTP was the only statistically significant variable(Wald=5.193,P=0.023).This suggests that with a negative change in CTP classification score,the odds of survival decrease 52.6%.The other evaluated variables did not significantly predict survival outcomes in the model.Kaplan–Meier survival curves also indicated that CTP classification was the only significant predictor.CONCLUSION Although different classifications showed specific differences in stratification,only CTP showed significant predictive potential.CTP score remains a simple and effective predictive tool for cirrhotic patients even after longer follow-up.
文摘Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,having a tool to identify patients at higher risk of complications and mortality is an ideal goal.Currently,the validated scores for this purpose are the model for end-stage liver disease score and the Child-Pugh score.However,these scores have limitations,as they do not account for other factors associated with liver cirrhosis that are equally relevant from a prognostic perspective.Among these,alterations in body composition,particularly sarcopenia,increase the risk of mortality and should therefore be considered in the comprehensive assessment of patients with liver cirrhosis.
文摘BACKGROUND The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing.It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer.Such an association would have significant clinical implications,particularly for cancer screening prior to liver transplantation.AIM To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.METHODS An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis.Study-specific standardized incidence ratios(SIR)along with corresponding 95%CI for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model.Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.RESULTS We identified 5054 articles;4 studies were selected for data extraction.The overall incidence of all cancers was significantly higher in patients with cirrhosis,with an SIR of 2.79(95%CI:2.18–3.57).When stratified by cirrhosis etiology,the incidence of luminal cancers remained significantly elevated for alcohol(SIR=3.13,95%CI:2.24–4.39),Primary Biliary Cholangitis(SIR=1.40,95%CI:1.10–1.79),and unspecified cirrhosis(SIR=3.52,95%CI:1.87–6.65).CONCLUSION The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis.Oral cavity,pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer.Therefore,increased screening of luminal cancers,and in particular these upper luminal tract subtypes,should be considered in this population.
文摘The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.
文摘A multicenter study recently published introduced a novel prognostic model for predicting esophagogastric variceal rebleeding after endoscopic treatment in patients with cirrhosis.The model incorporated six readily available clinical variables—albumin level,aspartate aminotransferase level,white blood cell count,ascites,portal vein thrombosis,and bleeding signs—and demonstrated promising predictive performance.However,limitations,including the retrospective design and exclusion of patients with hepatocellular carcinoma,may affect the generaliz-ability of the model.Additionally,further improvement is needed in the model’s discrimination between intermediate-and high-risk groups in external.Prospec-tive validation and inclusion of additional variables are recommended to enhan-ce predictive accuracy across diverse clinical scenarios.
基金Supported by the National Natural Science Foundation of China,No.82200650the Key Research and Development Projects of Shanxi Province,No.202102130501014the Natural Science Foundation of Shanxi Province,No.202203021211021,No.202203021212046,and No.20210302123258.
文摘BACKGROUND The pathogenesis of hepatic encephalopathy(HE)remains unclear,and the classical theory of ammonia toxicity lacks sufficient justification.AIM To investigate the potential of bile acids as intervention targets for HE.METHODS This study employed 42 wild-type male SD rats weighing 200±20 g.Using a random number table method,two rats were randomly selected to undergo common bile duct ligation(BDL).The remaining 40 rats were randomly assigned to four groups serving as controls:The vehicle+control diet(VC)group,the thioacetamide(TAA)group,the TAA+total bile acids(TAAT)group,and the TAA+cholestyramine(TAAC)group.Except for the VC group,all rats were intraperitoneally injected with 100 mg/kg TAA solution once daily for ten consecutive days to establish a HE model.Simultaneously,the TAAT and TAAC groups were administered a diet containing 0.3%bile acids(derived from BDL rats)and 2%cholestyramine,respectively,by gavage for ten days.For the BDL rat model group,the common BDL procedure was performed following the aforementioned protocol.After four weeks,laparotomy revealed swollen bile ducts at the ligation site,and bile was collected.Following successful modeling,behavioral tests,including the elevated plus maze and open field test,were conducted to assess the HE status of the rats.Peripheral blood,liver,and cerebral cortex tissue samples were collected,and the total bile acid content in the serum and cerebral cortex was measured using an enzyme cycling method.The levels of inflammatory factors in the serum and cerebral cortex were analyzed using enzyme-linked immunosorbent assay.Liver histological examination was performed using the hematoxylin-eosin double-labeling method.Reverse transcription polymerase chain reaction,western blot,immunohistochemistry,and other techniques were employed to observe the expression of microglial activation marker ionized calcium-binding adaptor molecule-1 and Takeda G protein-coupled receptor 5(TGR5)protein.RESULTS Compared to the VC group,the TAA group exhibited an exacerbation of HE in rats.The total bile acid content,proinflammatory factors[interleukin-1β(IL-1β),IL-6],and the anti-inflammatory factor IL-10 in both the serum and cerebral cortex were significantly elevated.Similarly,the expression of the TGR5 receptor in the cerebral cortex was upregulated.To investigate the impact of total bile acids on HE in rats,comparisons were made with the TAA group.In the TAAT group,the severity of HE was further aggravated,accompanied by increased total bile acid content in the serum and cerebral cortex,elevated pro-inflammatory factors(IL-1β,IL-6),reduced levels of the antiinflammatory factor IL-10,and decreased expression of the TGR5 receptor in the cerebral cortex.In the TAAC group,the severity of HE was alleviated.This group showed reductions in total bile acid content in the serum and cerebral cortex,decreased pro-inflammatory factors(IL-1β,IL-6),increased levels of the anti-inflammatory factor IL-10,and enhanced expression of the TGR5 receptor in the cerebral cortex.CONCLUSION This study demonstrated that the total bile acid content in the serum and cerebral cortex of TAA-induced liver cirrhosis rats was elevated.Furthermore,total bile acids exacerbate the progression of HE in rats.This effect may be attributed to bile acids’involvement in the development of neurological dysfunction by mediating TGR5 expression and regulating neuroinflammation.
文摘To the Editor: Fatty liver diseases, including nonalcoholic fatty liver disease and alcohol related fatty liver disease, have become a major public health concern [ 1, 2 ]. Fatty liver diseases have been shown to progress through various stages, from steatosis or necrosis with inflammation and hepatocyte damage to the development of fibrosis and eventual cirrhosis with an increased risk of carcinoma [ 2, 3 ].
文摘Objective: To treat ascites in patients with grade 3 liver cirrhosis using traditional Chinese medicine, evaluate effectiveness and safety by observing improvements in physical and mental symptoms, explore optimal treatment measures, and benefit clinical practice. Methods: 40 patients with ascites of liver cirrhosis admitted to our department from October 2020 to October 2022 were selected. According to a random number table, all patients were divided into an observation group treated with Yao Medicine and a control group treated with conventional Western medicine, with 20 cases in each group. The improvement of adverse emotions was evaluated before and after treatment using the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS). The changes in liver function indicators were observed to judge the efficacy and safety. Results: The effective rate in the observation group was 95.00%, and in the control group was 90.00%. The comparison between the two groups showed a significant increase in the effective rate in the observation group, with a statistically significant difference (P P P > 0.05). After treatment, compared with the control group, the observation group showed a significant decrease in SDS and SAS scores, with a statistically significant difference (P < 0.05). Conclusion: Yao Medicine can effectively improve the physical and mental symptoms of patients with ascites of liver cirrhosis, with good effectiveness and high safety.
文摘BACKGROUND Cirrhosis is a common liver disease,and ascites is one of the common clinical conditions.However,the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationship to patient prognosis have not been fully studied.AIM To explore the clinical manifestations,prognostic factors,and relationships of ascites with hyponatremia in patients with cirrhosis to provide better diagnostic and treatment strategies.METHODS In this study,we retrospectively analyzed the clinical data of 150 patients diagnosed with cirrhosis and ascites between 2017 and 2022.Patients were divided into two groups:ascites combined with hyponatremia group and ascites group.We compared the general characteristics,degree of hyponatremia,complications,treatment,and prognosis between the two groups.RESULTS In the study results,patients in the ascites combined with hyponatremia group showed an older average age(58.2±8.9 years),64.4%were male,and had a significantly longer hospitalization time(12.7±5.3 d).Hyponatremia was more severe in this group,with a mean serum sodium concentration of 128.5±4.3 mmol/L,which was significantly different from the ascites group of 137.6±2.1 mmol/L.Patients with ascites and hyponatremia were more likely to develop hepatic encephalopathy(56.2%vs 39.0%),renal impairment(45.2%vs 28.6%)and infection(37.0%vs 23.4%).Regarding treatment,this group more frequently used diuretics(80.8%vs 62.3%)and salt supplements(60.3%vs 38.9%).Multiple logistic regression analysis identified older age[Odds ratio(OR)=1.06,P=0.025]and male gender(OR=1.72,P=0.020)as risk factors for hyponatremia combined with ascites.Overall,patients with ascites and hyponatremia present a clear high-risk status,accompanied by severe complications and poor prognosis.CONCLUSION In patients with cirrhosis,ascites with hyponatremia is a high-risk condition that is often associated with severe complications.
