BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized p...BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.展开更多
BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study...BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.METHODS We searched the PubMed,Web of Science,EMBASE,and Cochrane databases using two keywords,HE,and gut microbiome.According to the inclusion and exclusion criteria,suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE.The data were analyzed using RevMan and STATA.RESULTS Seventeen studies were included:(1)A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE[-0.20,95%confidence interval(CI):-0.28 to-0.13,I2=20%];(2)The relative abundances of Lachnospiraceae(-2.73,95%CI:-4.58 to-0.87,I2=38%)and Ruminococcaceae(-2.93,95%CI:-4.29 to-1.56,I2=0%)in liver cirrhosis patients with HE was significantly lower than those in patients without HE;(3)In patients with HE,Enterococcus,Proteobacteria,Enterococcaceae,and Enterobacteriaceae proportions increased,but Ruminococcaceae,Lachnospiraceae,Prevotellaceae,and Bacteroidetes proportions decreased;(4)Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected;and(5)Differential gut microbiomes may serve as diagnostic and prognostic tools.CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ.Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.展开更多
BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This resear...BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This research article explores the relationship between these two conditions.AIM To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF,focusing on inpatient mortality,septic shock,length of stay,and hospital costs.METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample.Cases were identified as pa-tients with both NF and cirrhosis,while controls were non-cirrhotic.The study focused on inpatient mortality as the primary outcome,with secondary outcomes including surgical limb amputation,mechanical ventilation rates,septic shock,length of stay,and hospital costs.RESULTS A total of 14920 patients were admitted to the hospital for management of NF,of which 2.11%had liver cirrhosis.Inpatient mortality was higher in cirrhotic patients(9.5%vs 3%;adjusted odds ratio=3.78;P value=0.02).Cirrhotic patients also had higher rates of septic shock(10.5%vs 4.9%,P value<0.01).Length of hospital stay,total charges,and rates of mechanical ventilation were not statistically different between groups.CONCLUSION Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF.Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.展开更多
BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival...BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.AIM To assess the potential of preoperative total bilirubin-albumin(B/A)ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.METHODS A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study.Normality test,t-test,Wilcoxon test,χ2 test,or Fisher’s exact test was employed to analyze the intraoperative and postoperative conditions of the patients.Receiver operating characteristic(ROC)curve analysis was utilized to depict the 10-year overall survival rate.RESULTS During the follow-up period,85.99%of the patients survived,with a median survival time of 64.6 months.Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival(P=0.037).ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value.Consequently,the patients were categorized into two groups:High B/A group(n=64)and low B/A group(n=193).The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months,respectively(P=0.045).Notably,the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group(P<0.001).Patients with hepatocellular carcinoma(HCC)had lower overall survival rates.Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not,early Child-Pugh grade,low albumin-bilirubin grade,and model for end-stage liver disease score≥10(log-rank test,P<0.001 for all).CONCLUSION The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virusrelated cirrhosis following splenectomy,and a higher B/A ratio may suggest a poorer prognosis.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
Pregnancy in cirrhotic-woman is a rare event [1] [2]. It causes particular risks related to liver disease and its treatments, with maternal and fetal consequences. The largest reported series to date is by Welton’s w...Pregnancy in cirrhotic-woman is a rare event [1] [2]. It causes particular risks related to liver disease and its treatments, with maternal and fetal consequences. The largest reported series to date is by Welton’s with 13 cases [3]. In Africa, few cases were reported. The purpose of this work was to report the hepatic and obstetric complications in pregnant women in Burkina Faso, a low-income country. It was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2013 to December 31, 2023. All the women diagnosed with cirrhosis through clinical basis, biological and imaging arguments associated with a pregnancy confirmed by ultrasound were included. A total of ten women were included in the study. Among them, two were known cirrhotics and were being followed. In the other eight cases, cirrhosis was discovered during pregnancy. Eight women were HBsAg positive and two of them had only the contact marker of hepatitis B virus (anti- HBc antibody). The evolution was, ascitic decompensation in nine cases, digestive hemorrhage due to rupture of esophageal varices in two cases, nine cases of anemia, two cases of ascitic fluid infection and one case of conjunctival jaundice. Two cases of probable hepatocellular carcinoma were noted with one case of extensive portal thrombosis. The evolution was without maternal complications in one case. Regarding fetal and neonatal complications, there were three cases of hypotrophy, one case of prematurity, one case of acute neonatal distress, two cases of fetal death in utero and one case of fetal tachycardia. Four pregnancies had a favorable evolution without any complications. The association of cirrhosis and pregnancy is an uncommon event, and maternal and fetal complications can occur, making this pregnancy a high-risk pregnancy.展开更多
In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)i...In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)in cirrhosis patients.Traditional MHE screening methods,while highly sensitive and specific,are often complex,time-consuming,and require controlled environmental con-ditions,limiting their widespread clinical use.The EncephalApp Stroop test si-mplifies the screening process,enhances diagnostic efficiency,and is applicable across diverse cultural contexts.However,the combination of additional bio-markers could further improve diagnostic accuracy.Despite its promising po-tential,more multicenter clinical studies are required to validate its effectiveness and applicability on a global scale.展开更多
Objective:To screen and identify the key active molecules,signaling pathways,and therapeutic targets of Shuxuening(SXN)injection for treating liver cirrhosis(LC)and to evaluate its therapeutic potential using a mouse ...Objective:To screen and identify the key active molecules,signaling pathways,and therapeutic targets of Shuxuening(SXN)injection for treating liver cirrhosis(LC)and to evaluate its therapeutic potential using a mouse model.Methods:Target genes of SXN and LC were retrieved from public databases,and enrichment analysis was performed.A proteineprotein interaction(PPI)network was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins(STRING),and hub genes were identified using Molecular Complex Detection(MCODE).LC was induced in rats and mice via intraperitoneal injections of diethylnitrosamine and carbon tetrachloride(CCl4)for 12 weeks.Starting at week 7,SXN was administered intraperitoneally to the mice in the treatment group.Serum and liver tissues of the mice were collected for the detection of indicators,pathological staining,and expression analysis of hub targets using quantitative real-time polymerase chain reaction(qRT-PCR).Results:We identified 368 overlapping genes(OLGs)between SXN and LC targets.These OLGs were subsequently used to build a PPI network and to screen for hub genes.Enrichment analysis showed that these genes were associated with cancer-related pathways,including phosphoinositide-3-kinase/Akt and mitogen-activated protein kinase signaling and various cellular processes,such as responses to chemicals and metabolic regulation.In vivo experiments demonstrated that SXN treatment significantly improved liver function and pathology in CCl4-induced LC mice by reducing inflammation and collagen deposition.Furthermore,qRT-PCR demonstrated that SXN regulated the expression of MAPK8,AR and CASP3 in the livers of LC mice.Conclusion:This study highlighted the therapeutic effects of SXN in alleviating LC using both bioinformatics and experimental methods.The observed effect was associated with modulation of hub gene expression,particularly MAPK8,and CASP3.展开更多
In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a comp...In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a complex interplay of renal and hepatic pathophysiology,with AKI acting as an initiator through maladaptive repair mechanisms.These mechanisms—such as tubular cell cycle arrest,inflammatory cascades,and fibrotic processes—are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis.Following AKI episodes,persistent kidney dysfunction or acute kidney disease(AKD)often serves as a bridge to CKD.AKD represents a critical phase in renal deterioration,characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI.The progression from AKD to CKD is further influenced by recurrent AKI episodes,impaired renal autoregu-lation,and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease,which compound kidney damage.The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury,the application of novel biomarkers,and precision interventions.Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression,necessitating novel biomarkers for early detection and intervention.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 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
Aim: To describe electrical and echocardiographic abnormalities in patients with viral cirrhosis B. Methodology: Prospective cross-sectional study with an analytical aim carried out in the hospitalization and outpatie...Aim: To describe electrical and echocardiographic abnormalities in patients with viral cirrhosis B. Methodology: Prospective cross-sectional study with an analytical aim carried out in the hospitalization and outpatient departments of the Hepato-Gastroenterology department and in the emergency department of the Cocody University Hospital during the period from January 15 to July 15, 2022. Any patient with viral B cirrhosis and having performed an echocardiography and an electrocardiogram was included. The significance threshold was stopped at p Results: 40 patients were selected. The prevalence of viral B cirrhosis was 16.8% and that of cirrhotic cardiomyopathy in cirrhotic patients was 33.9%. The average age of the patients was 43.9 ± 14.1. There was a male predominance with a sex ratio of 3.4. The two main clinical signs found in patients were ascites (77.5%) and edema (75%). There was a lowering of TP (70%), albumin (72.5%) and platelets (87.5%). Bilirubin was elevated in 60% of patients. All patients had a liver with irregular contours. 80% of our population had not performed Fibroscan®, 5% had fibrosis between F3-F4 and 35% F4 fibrosis. The main complication found was portal hypertension (esophageal varices at any stage) at 85%. Cirrhosis was active (virological) in 32.5% of patients. 75% of patients were classified as Child B. The two main abnormalities on echocardiography were left ventricular hypertrophy (32.5%) and dilatation of the left atrium (7.5%). The electrical abnormalities found were mainly QT prolongation (32.5%) and sinus tachycardia (12.5%). We did not find a statistically significant association between the severity of cirrhosis and electrical abnormalities. There was a statistically significant association between the severity of cirrhosis and the dilation of the left atrium (p = 0.04). Conclusion: Cirrhotic cardiomyopathy is a rare complication of cirrhosis.展开更多
Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole ...Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this context.In the absence of established heart disease,cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney disease.It is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological abnormalities.Despite the clinical description of these potential cardiac-related complications of the liver,the role of the heart has traditionally been an overlooked aspect of circulatory dysfunction in HRS.Yet from a physiological sense,temporality(prior onset)of cardiorenal interactions in HRS and positive effects stemming from portosystemic shunting demonstrated an important role of the heart in the development and progression of kidney dysfunction in cirrhotic patients.In this review,we discuss current concepts surrounding how the heart may influence the development and progression of HRS,and the role of systemic inflammation and endothelial dysfunction causing circulatory dysfunction within this setting.The temporality of heart and kidney dysfunction in HRS will be discussed.For a subgroup of patients who receive portosystemic shunting,the dynamics of cardiorenal interactions following treatment is reviewed.Continued research to determine the unknowns in this topic is anticipated,hopefully to further clarify the intricacies surrounding the liver-heart-kidney connection and improve strategies for management.展开更多
BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virologic...BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.AIM To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.METHODS This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019.Baseline assessments included chemistry,serologic,and viral markers.χ^(2) tests,Mann-Whitney U tests,and logistic regression analyses were used to identify the determinants of cirrhosis.Tenofovir disoproxil fumarate(TDF)was initiated using treatment criteria from the Ethiopian CHB pilot program.RESULTS A total of 132 patients(68.4%)were men,with a median age of 30 years[interquartile range(IQR):24-38].At enrollment,60(31.1%)patients had cirrhosis,of whom 35(58.3%)had decompensated cirrhosis.Khat use,hepatitis B envelope antigen positivity,and a high viral load were independently associated with cirrhosis.Additionally,66 patients(33.4%)fulfilled the treatment criteria and 59(30.6%)started TDF.Among 29 patients who completed 24 months of treatment,the median aspartate aminotransferase to platelet ratio index declined from 1.54(IQR:0.66-2.91)to 1.10(IQR:0.75-2.53)(P=0.002),and viral suppression was achieved in 80.9%and 100%of patients after 12 months and 24 months of treatment,respectively.Among the treated patients,12(20.3%)died within the first 6 months of treatment,of whom 8 had decompensated cirrhosis.CONCLUSION This study highlights the high prevalence of cirrhosis,initial mortality,and the efficacy of TDF treatment.Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.展开更多
BACKGROUND The prognosis for hepatocellular carcinoma(HCC)in the presence of cirrhosis is unfavourable,primarily attributable to the high incidence of recurrence.AIM To develop a machine learning model for predicting ...BACKGROUND The prognosis for hepatocellular carcinoma(HCC)in the presence of cirrhosis is unfavourable,primarily attributable to the high incidence of recurrence.AIM To develop a machine learning model for predicting early recurrence(ER)of posthepatectomy HCC in patients with cirrhosis and to stratify patients’overall survival(OS)based on the predicted risk of recurrence.METHODS In this retrospective study,214 HCC patients with cirrhosis who underwent curative hepatectomy were examined.Radiomics feature selection was conducted using the least absolute shrinkage and selection operator and recursive feature elimination methods.Clinical-radiologic features were selected through univariate and multivariate logistic regression analyses.Five machine learning methods were used for model comparison,aiming to identify the optimal model.The model’s performance was evaluated using the receiver operating characteristic curve[area under the curve(AUC)],calibration,and decision curve analysis.Additionally,the Kaplan-Meier(K-M)curve was used to evaluate the stratification effect of the model on patient OS.RESULTS Within this study,the most effective predictive performance for ER of post-hepatectomy HCC in the background of cirrhosis was demonstrated by a model that integrated radiomics features and clinical-radiologic features.In the training cohort,this model attained an AUC of 0.844,while in the validation cohort,it achieved a value of 0.790.The K-M curves illustrated that the combined model not only facilitated risk stratification but also exhibited significant discriminatory ability concerning patients’OS.CONCLUSION The combined model,integrating both radiomics and clinical-radiologic characteristics,exhibited excellent performance in HCC with cirrhosis.The K-M curves assessing OS revealed statistically significant differences.展开更多
Cirrhosis is considered a growing cause of morbidity and mortality,which represents a significant public health problem.Currently,there is no effective treatment to reverse cirrhosis.Treatment primarily centers on add...Cirrhosis is considered a growing cause of morbidity and mortality,which represents a significant public health problem.Currently,there is no effective treatment to reverse cirrhosis.Treatment primarily centers on addressing the underlying liver condition,monitoring,and managing portal hypertension-related complications,and evaluating the potential for liver transplantation in cases of decompensated cirrhosis,marked by rapid progression and the emer-gence of complications like variceal bleeding,hepatic encephalopathy,ascites,malnutrition,and more.Malnutrition,a prevalent complication across all disease stages,is often underdiagnosed in cirrhosis due to the complexities of nutritional assessment in patients with fluid retention and/or obesity,despite its crucial impact on prognosis.Increasing emphasis has been placed on the collaboration of nutritionists within hepatology and Liver transplant teams to deliver compre-hensive care,a practice that has shown to improve outcomes.This review covers appropriate screening and assessment methods for evaluating the nutritional status of this population,diagnostic approaches for malnutrition,and context-specific nutrition treatments.It also discusses evidence-based recommendations for supplementation and physical exercise,both essential elements of the standard care provided to cirrhotic patients.展开更多
Cirrhosis is frequently associated with sarcopenia,with reported rates of over 80%in patients with decompensated alcohol-related liver disease.Sarcopenia nega-tively impacts the prognosis of cirrhotic patients and aff...Cirrhosis is frequently associated with sarcopenia,with reported rates of over 80%in patients with decompensated alcohol-related liver disease.Sarcopenia nega-tively impacts the prognosis of cirrhotic patients and affects the response to treatment of patients with hepatocellular carcinoma(HCC).For these reasons,identifying an easy-to-perform method to assess sarcopenia in is a key element in the optimization of care in this patient population.Assessment of muscle mass by computed tomography is considered the standard of care for the diagnosis of sarcopenia,but exposure to radiation and high costs limit its application in this setting,especially for repeated assessments.We believe that ultrasound,a cheap and harmless technique also used for HCC screening in cirrhotic patients,could have an expanding role in the diagnosis and follow-up of sarcopenia in these patients.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 Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features...BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.RESULTS The RC model yielded the best predictive performance and accurately predicted the EVB risk of patients with cirrhosis.Ascites,portal vein thrombosis,and plasma prothrombin time were identified as independent clinical risk factors.The area under the receiver operating characteristic curve(AUC)values for the RC model,Rad-score(liver+spleen+esophagus),Rad-score(liver),Rad-score(spleen),Rad-score(esophagus),and clinical model in the training cohort were 0.951,0.930,0.801,0.831,0.864,and 0.727,respectively.The corresponding AUC values in the validation cohort were 0.930,0.886,0.763,0.792,0.857,and 0.692.CONCLUSION In patients with cirrhosis,combined multi-organ radiomics and clinical model can be used to non-invasively predict the probability of the first secondary EVB.展开更多
BACKGROUND The hemodynamic alterations seen in liver cirrhosis lead to renal vasoconstriction,ultimately causing acute kidney injury(AKI).The renal resistive index(RRI)is the most common Doppler ultrasound variable fo...BACKGROUND The hemodynamic alterations seen in liver cirrhosis lead to renal vasoconstriction,ultimately causing acute kidney injury(AKI).The renal resistive index(RRI)is the most common Doppler ultrasound variable for measuring intrarenal vascular resistance.AIM To evaluate the association of the RRI with AKI in patients with liver cirrhosis and to identify risk factors for high RRI.METHODS This was a prospective observational study,where RRI was measured using Doppler ultrasound in 200 consecutive hospitalized patients with cirrhosis.The association of RRI with AKI was studied.The receiver operating characteristic(ROC)curve analysis was utilized to determine discriminatory cut-offs of RRI for various AKI phenotypes.Multivariate analysis was conducted to determine the predictors of high RRI.RESULTS The mean patient age was 49.08±11.68 years,with the majority(79.5%)being male;the predominant etiology of cirrhosis was alcohol(39%).The mean RRI for the study cohort was 0.68±0.09,showing a progressive increase with higher Child-Pugh class of cirrhosis.Overall,AKI was present in 129(64.5%)patients.The mean RRI was significantly higher in patients with AKI compared to those without it(0.72±0.06 vs 0.60±0.08;P<0.001).A total of 82 patients(41%)had hepatorenal syndrome(HRS)-AKI,29(22.4%)had prerenal AKI(PRA),and 18(13.9%)had acute tubular necrosis(ATN)-AKI.The mean RRI was significantly higher in the ATN-AKI(0.80±0.02)and HRS-AKI(0.73±0.03)groups than in the PRA(0.63±0.07)and non-AKI(0.60±0.07)groups.RRI demonstrated excellent discriminatory ability in distinguishing ATN-AKI from non-ATN-AKI(area under ROC curve:93.9%).AKI emerged as an independent predictor of high RRI(adjusted odds ratio[OR]:11.52),and high RRI independently predicted mortality among AKI patients(adjusted OR:3.18).CONCLUSION In cirrhosis patients,RRI exhibited a significant association with AKI,effectively differentiated between AKI phenotypes,and predicted AKI mortality.展开更多
基金Supported by National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.
文摘BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.METHODS We searched the PubMed,Web of Science,EMBASE,and Cochrane databases using two keywords,HE,and gut microbiome.According to the inclusion and exclusion criteria,suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE.The data were analyzed using RevMan and STATA.RESULTS Seventeen studies were included:(1)A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE[-0.20,95%confidence interval(CI):-0.28 to-0.13,I2=20%];(2)The relative abundances of Lachnospiraceae(-2.73,95%CI:-4.58 to-0.87,I2=38%)and Ruminococcaceae(-2.93,95%CI:-4.29 to-1.56,I2=0%)in liver cirrhosis patients with HE was significantly lower than those in patients without HE;(3)In patients with HE,Enterococcus,Proteobacteria,Enterococcaceae,and Enterobacteriaceae proportions increased,but Ruminococcaceae,Lachnospiraceae,Prevotellaceae,and Bacteroidetes proportions decreased;(4)Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected;and(5)Differential gut microbiomes may serve as diagnostic and prognostic tools.CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ.Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.
文摘BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This research article explores the relationship between these two conditions.AIM To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF,focusing on inpatient mortality,septic shock,length of stay,and hospital costs.METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample.Cases were identified as pa-tients with both NF and cirrhosis,while controls were non-cirrhotic.The study focused on inpatient mortality as the primary outcome,with secondary outcomes including surgical limb amputation,mechanical ventilation rates,septic shock,length of stay,and hospital costs.RESULTS A total of 14920 patients were admitted to the hospital for management of NF,of which 2.11%had liver cirrhosis.Inpatient mortality was higher in cirrhotic patients(9.5%vs 3%;adjusted odds ratio=3.78;P value=0.02).Cirrhotic patients also had higher rates of septic shock(10.5%vs 4.9%,P value<0.01).Length of hospital stay,total charges,and rates of mechanical ventilation were not statistically different between groups.CONCLUSION Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF.Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.
文摘BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.AIM To assess the potential of preoperative total bilirubin-albumin(B/A)ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.METHODS A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study.Normality test,t-test,Wilcoxon test,χ2 test,or Fisher’s exact test was employed to analyze the intraoperative and postoperative conditions of the patients.Receiver operating characteristic(ROC)curve analysis was utilized to depict the 10-year overall survival rate.RESULTS During the follow-up period,85.99%of the patients survived,with a median survival time of 64.6 months.Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival(P=0.037).ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value.Consequently,the patients were categorized into two groups:High B/A group(n=64)and low B/A group(n=193).The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months,respectively(P=0.045).Notably,the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group(P<0.001).Patients with hepatocellular carcinoma(HCC)had lower overall survival rates.Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not,early Child-Pugh grade,low albumin-bilirubin grade,and model for end-stage liver disease score≥10(log-rank test,P<0.001 for all).CONCLUSION The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virusrelated cirrhosis following splenectomy,and a higher B/A ratio may suggest a poorer prognosis.
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Pregnancy in cirrhotic-woman is a rare event [1] [2]. It causes particular risks related to liver disease and its treatments, with maternal and fetal consequences. The largest reported series to date is by Welton’s with 13 cases [3]. In Africa, few cases were reported. The purpose of this work was to report the hepatic and obstetric complications in pregnant women in Burkina Faso, a low-income country. It was a descriptive cross-sectional study with retrospective data collection covering the period from January 1, 2013 to December 31, 2023. All the women diagnosed with cirrhosis through clinical basis, biological and imaging arguments associated with a pregnancy confirmed by ultrasound were included. A total of ten women were included in the study. Among them, two were known cirrhotics and were being followed. In the other eight cases, cirrhosis was discovered during pregnancy. Eight women were HBsAg positive and two of them had only the contact marker of hepatitis B virus (anti- HBc antibody). The evolution was, ascitic decompensation in nine cases, digestive hemorrhage due to rupture of esophageal varices in two cases, nine cases of anemia, two cases of ascitic fluid infection and one case of conjunctival jaundice. Two cases of probable hepatocellular carcinoma were noted with one case of extensive portal thrombosis. The evolution was without maternal complications in one case. Regarding fetal and neonatal complications, there were three cases of hypotrophy, one case of prematurity, one case of acute neonatal distress, two cases of fetal death in utero and one case of fetal tachycardia. Four pregnancies had a favorable evolution without any complications. The association of cirrhosis and pregnancy is an uncommon event, and maternal and fetal complications can occur, making this pregnancy a high-risk pregnancy.
基金Supported by The Basic and Clinical Integration Project of Xi'an Jiaotong University,No.YXJLRH2022067.
文摘In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)in cirrhosis patients.Traditional MHE screening methods,while highly sensitive and specific,are often complex,time-consuming,and require controlled environmental con-ditions,limiting their widespread clinical use.The EncephalApp Stroop test si-mplifies the screening process,enhances diagnostic efficiency,and is applicable across diverse cultural contexts.However,the combination of additional bio-markers could further improve diagnostic accuracy.Despite its promising po-tential,more multicenter clinical studies are required to validate its effectiveness and applicability on a global scale.
基金Our study was funded by the Clinical Research Special Fund of Wu Jieping Medical Foundation(320.6750.2022-25-8)the Fundamental Research Funds for the Cornell University(2024-JYBXJSJJ042 and 2024-JYB-JBZD-058).
文摘Objective:To screen and identify the key active molecules,signaling pathways,and therapeutic targets of Shuxuening(SXN)injection for treating liver cirrhosis(LC)and to evaluate its therapeutic potential using a mouse model.Methods:Target genes of SXN and LC were retrieved from public databases,and enrichment analysis was performed.A proteineprotein interaction(PPI)network was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins(STRING),and hub genes were identified using Molecular Complex Detection(MCODE).LC was induced in rats and mice via intraperitoneal injections of diethylnitrosamine and carbon tetrachloride(CCl4)for 12 weeks.Starting at week 7,SXN was administered intraperitoneally to the mice in the treatment group.Serum and liver tissues of the mice were collected for the detection of indicators,pathological staining,and expression analysis of hub targets using quantitative real-time polymerase chain reaction(qRT-PCR).Results:We identified 368 overlapping genes(OLGs)between SXN and LC targets.These OLGs were subsequently used to build a PPI network and to screen for hub genes.Enrichment analysis showed that these genes were associated with cancer-related pathways,including phosphoinositide-3-kinase/Akt and mitogen-activated protein kinase signaling and various cellular processes,such as responses to chemicals and metabolic regulation.In vivo experiments demonstrated that SXN treatment significantly improved liver function and pathology in CCl4-induced LC mice by reducing inflammation and collagen deposition.Furthermore,qRT-PCR demonstrated that SXN regulated the expression of MAPK8,AR and CASP3 in the livers of LC mice.Conclusion:This study highlighted the therapeutic effects of SXN in alleviating LC using both bioinformatics and experimental methods.The observed effect was associated with modulation of hub gene expression,particularly MAPK8,and CASP3.
文摘In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a complex interplay of renal and hepatic pathophysiology,with AKI acting as an initiator through maladaptive repair mechanisms.These mechanisms—such as tubular cell cycle arrest,inflammatory cascades,and fibrotic processes—are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis.Following AKI episodes,persistent kidney dysfunction or acute kidney disease(AKD)often serves as a bridge to CKD.AKD represents a critical phase in renal deterioration,characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI.The progression from AKD to CKD is further influenced by recurrent AKI episodes,impaired renal autoregu-lation,and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease,which compound kidney damage.The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury,the application of novel biomarkers,and precision interventions.Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression,necessitating novel biomarkers for early detection and intervention.
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.
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Aim: To describe electrical and echocardiographic abnormalities in patients with viral cirrhosis B. Methodology: Prospective cross-sectional study with an analytical aim carried out in the hospitalization and outpatient departments of the Hepato-Gastroenterology department and in the emergency department of the Cocody University Hospital during the period from January 15 to July 15, 2022. Any patient with viral B cirrhosis and having performed an echocardiography and an electrocardiogram was included. The significance threshold was stopped at p Results: 40 patients were selected. The prevalence of viral B cirrhosis was 16.8% and that of cirrhotic cardiomyopathy in cirrhotic patients was 33.9%. The average age of the patients was 43.9 ± 14.1. There was a male predominance with a sex ratio of 3.4. The two main clinical signs found in patients were ascites (77.5%) and edema (75%). There was a lowering of TP (70%), albumin (72.5%) and platelets (87.5%). Bilirubin was elevated in 60% of patients. All patients had a liver with irregular contours. 80% of our population had not performed Fibroscan®, 5% had fibrosis between F3-F4 and 35% F4 fibrosis. The main complication found was portal hypertension (esophageal varices at any stage) at 85%. Cirrhosis was active (virological) in 32.5% of patients. 75% of patients were classified as Child B. The two main abnormalities on echocardiography were left ventricular hypertrophy (32.5%) and dilatation of the left atrium (7.5%). The electrical abnormalities found were mainly QT prolongation (32.5%) and sinus tachycardia (12.5%). We did not find a statistically significant association between the severity of cirrhosis and electrical abnormalities. There was a statistically significant association between the severity of cirrhosis and the dilation of the left atrium (p = 0.04). Conclusion: Cirrhotic cardiomyopathy is a rare complication of cirrhosis.
文摘Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this context.In the absence of established heart disease,cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney disease.It is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological abnormalities.Despite the clinical description of these potential cardiac-related complications of the liver,the role of the heart has traditionally been an overlooked aspect of circulatory dysfunction in HRS.Yet from a physiological sense,temporality(prior onset)of cardiorenal interactions in HRS and positive effects stemming from portosystemic shunting demonstrated an important role of the heart in the development and progression of kidney dysfunction in cirrhotic patients.In this review,we discuss current concepts surrounding how the heart may influence the development and progression of HRS,and the role of systemic inflammation and endothelial dysfunction causing circulatory dysfunction within this setting.The temporality of heart and kidney dysfunction in HRS will be discussed.For a subgroup of patients who receive portosystemic shunting,the dynamics of cardiorenal interactions following treatment is reviewed.Continued research to determine the unknowns in this topic is anticipated,hopefully to further clarify the intricacies surrounding the liver-heart-kidney connection and improve strategies for management.
基金Supported by the Norwegian Research Council,220622/H10.
文摘BACKGROUND Chronic hepatitis B(CHB)virus infection is a major cause of liver-associated morbidity and mortality,particularly in low-income countries.A better understanding of the epidemiological,clinical,and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.AIM To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.METHODS This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019.Baseline assessments included chemistry,serologic,and viral markers.χ^(2) tests,Mann-Whitney U tests,and logistic regression analyses were used to identify the determinants of cirrhosis.Tenofovir disoproxil fumarate(TDF)was initiated using treatment criteria from the Ethiopian CHB pilot program.RESULTS A total of 132 patients(68.4%)were men,with a median age of 30 years[interquartile range(IQR):24-38].At enrollment,60(31.1%)patients had cirrhosis,of whom 35(58.3%)had decompensated cirrhosis.Khat use,hepatitis B envelope antigen positivity,and a high viral load were independently associated with cirrhosis.Additionally,66 patients(33.4%)fulfilled the treatment criteria and 59(30.6%)started TDF.Among 29 patients who completed 24 months of treatment,the median aspartate aminotransferase to platelet ratio index declined from 1.54(IQR:0.66-2.91)to 1.10(IQR:0.75-2.53)(P=0.002),and viral suppression was achieved in 80.9%and 100%of patients after 12 months and 24 months of treatment,respectively.Among the treated patients,12(20.3%)died within the first 6 months of treatment,of whom 8 had decompensated cirrhosis.CONCLUSION This study highlights the high prevalence of cirrhosis,initial mortality,and the efficacy of TDF treatment.Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.
基金Supported by Anhui Provincial Key Research and Development Plan,No.202104j07020048.
文摘BACKGROUND The prognosis for hepatocellular carcinoma(HCC)in the presence of cirrhosis is unfavourable,primarily attributable to the high incidence of recurrence.AIM To develop a machine learning model for predicting early recurrence(ER)of posthepatectomy HCC in patients with cirrhosis and to stratify patients’overall survival(OS)based on the predicted risk of recurrence.METHODS In this retrospective study,214 HCC patients with cirrhosis who underwent curative hepatectomy were examined.Radiomics feature selection was conducted using the least absolute shrinkage and selection operator and recursive feature elimination methods.Clinical-radiologic features were selected through univariate and multivariate logistic regression analyses.Five machine learning methods were used for model comparison,aiming to identify the optimal model.The model’s performance was evaluated using the receiver operating characteristic curve[area under the curve(AUC)],calibration,and decision curve analysis.Additionally,the Kaplan-Meier(K-M)curve was used to evaluate the stratification effect of the model on patient OS.RESULTS Within this study,the most effective predictive performance for ER of post-hepatectomy HCC in the background of cirrhosis was demonstrated by a model that integrated radiomics features and clinical-radiologic features.In the training cohort,this model attained an AUC of 0.844,while in the validation cohort,it achieved a value of 0.790.The K-M curves illustrated that the combined model not only facilitated risk stratification but also exhibited significant discriminatory ability concerning patients’OS.CONCLUSION The combined model,integrating both radiomics and clinical-radiologic characteristics,exhibited excellent performance in HCC with cirrhosis.The K-M curves assessing OS revealed statistically significant differences.
文摘Cirrhosis is considered a growing cause of morbidity and mortality,which represents a significant public health problem.Currently,there is no effective treatment to reverse cirrhosis.Treatment primarily centers on addressing the underlying liver condition,monitoring,and managing portal hypertension-related complications,and evaluating the potential for liver transplantation in cases of decompensated cirrhosis,marked by rapid progression and the emer-gence of complications like variceal bleeding,hepatic encephalopathy,ascites,malnutrition,and more.Malnutrition,a prevalent complication across all disease stages,is often underdiagnosed in cirrhosis due to the complexities of nutritional assessment in patients with fluid retention and/or obesity,despite its crucial impact on prognosis.Increasing emphasis has been placed on the collaboration of nutritionists within hepatology and Liver transplant teams to deliver compre-hensive care,a practice that has shown to improve outcomes.This review covers appropriate screening and assessment methods for evaluating the nutritional status of this population,diagnostic approaches for malnutrition,and context-specific nutrition treatments.It also discusses evidence-based recommendations for supplementation and physical exercise,both essential elements of the standard care provided to cirrhotic patients.
文摘Cirrhosis is frequently associated with sarcopenia,with reported rates of over 80%in patients with decompensated alcohol-related liver disease.Sarcopenia nega-tively impacts the prognosis of cirrhotic patients and affects the response to treatment of patients with hepatocellular carcinoma(HCC).For these reasons,identifying an easy-to-perform method to assess sarcopenia in is a key element in the optimization of care in this patient population.Assessment of muscle mass by computed tomography is considered the standard of care for the diagnosis of sarcopenia,but exposure to radiation and high costs limit its application in this setting,especially for repeated assessments.We believe that ultrasound,a cheap and harmless technique also used for HCC screening in cirrhotic patients,could have an expanding role in the diagnosis and follow-up of sarcopenia in these patients.
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 Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.RESULTS The RC model yielded the best predictive performance and accurately predicted the EVB risk of patients with cirrhosis.Ascites,portal vein thrombosis,and plasma prothrombin time were identified as independent clinical risk factors.The area under the receiver operating characteristic curve(AUC)values for the RC model,Rad-score(liver+spleen+esophagus),Rad-score(liver),Rad-score(spleen),Rad-score(esophagus),and clinical model in the training cohort were 0.951,0.930,0.801,0.831,0.864,and 0.727,respectively.The corresponding AUC values in the validation cohort were 0.930,0.886,0.763,0.792,0.857,and 0.692.CONCLUSION In patients with cirrhosis,combined multi-organ radiomics and clinical model can be used to non-invasively predict the probability of the first secondary EVB.
文摘BACKGROUND The hemodynamic alterations seen in liver cirrhosis lead to renal vasoconstriction,ultimately causing acute kidney injury(AKI).The renal resistive index(RRI)is the most common Doppler ultrasound variable for measuring intrarenal vascular resistance.AIM To evaluate the association of the RRI with AKI in patients with liver cirrhosis and to identify risk factors for high RRI.METHODS This was a prospective observational study,where RRI was measured using Doppler ultrasound in 200 consecutive hospitalized patients with cirrhosis.The association of RRI with AKI was studied.The receiver operating characteristic(ROC)curve analysis was utilized to determine discriminatory cut-offs of RRI for various AKI phenotypes.Multivariate analysis was conducted to determine the predictors of high RRI.RESULTS The mean patient age was 49.08±11.68 years,with the majority(79.5%)being male;the predominant etiology of cirrhosis was alcohol(39%).The mean RRI for the study cohort was 0.68±0.09,showing a progressive increase with higher Child-Pugh class of cirrhosis.Overall,AKI was present in 129(64.5%)patients.The mean RRI was significantly higher in patients with AKI compared to those without it(0.72±0.06 vs 0.60±0.08;P<0.001).A total of 82 patients(41%)had hepatorenal syndrome(HRS)-AKI,29(22.4%)had prerenal AKI(PRA),and 18(13.9%)had acute tubular necrosis(ATN)-AKI.The mean RRI was significantly higher in the ATN-AKI(0.80±0.02)and HRS-AKI(0.73±0.03)groups than in the PRA(0.63±0.07)and non-AKI(0.60±0.07)groups.RRI demonstrated excellent discriminatory ability in distinguishing ATN-AKI from non-ATN-AKI(area under ROC curve:93.9%).AKI emerged as an independent predictor of high RRI(adjusted odds ratio[OR]:11.52),and high RRI independently predicted mortality among AKI patients(adjusted OR:3.18).CONCLUSION In cirrhosis patients,RRI exhibited a significant association with AKI,effectively differentiated between AKI phenotypes,and predicted AKI mortality.
