Pub Date : 2025-12-09DOI: 10.1016/j.clinre.2025.102744
Froylan D Martínez-Sánchez , David Aguirre-Villarreal , Eduardo R Argaiz , Luis A Rosales-Rentería , Mario AJ Leal-Villarreal , Ignacio García-Juárez
Point-of-care ultrasound (POCUS) enables physiology-guided hemodynamic assessment in decompensated cirrhosis, moving beyond protocolized albumin use toward individualized therapy. By integrating IVC/IJV indices, lung ultrasound, and intrarenal venous Doppler, clinicians can tailor albumin and vasopressor strategies to fluid tolerance, potentially improving AKI reversal while limiting overload. We outline a pragmatic bedside framework to operationalize POCUS-guided albumin management in routine hepatology practice.
{"title":"Physiology-guided albumin therapy in decompensated cirrhosis: the expanding role of point-of-care ultrasound","authors":"Froylan D Martínez-Sánchez , David Aguirre-Villarreal , Eduardo R Argaiz , Luis A Rosales-Rentería , Mario AJ Leal-Villarreal , Ignacio García-Juárez","doi":"10.1016/j.clinre.2025.102744","DOIUrl":"10.1016/j.clinre.2025.102744","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) enables physiology-guided hemodynamic assessment in decompensated cirrhosis, moving beyond protocolized albumin use toward individualized therapy. By integrating IVC/IJV indices, lung ultrasound, and intrarenal venous Doppler, clinicians can tailor albumin and vasopressor strategies to fluid tolerance, potentially improving AKI reversal while limiting overload. We outline a pragmatic bedside framework to operationalize POCUS-guided albumin management in routine hepatology practice.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102744"},"PeriodicalIF":2.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There are still conflicting data about superiority of ustekinumab over vedolizumab in patients with Crohn’s disease (CD) who failed anti-tumour necrosis factor (anti-TNF).
Aim
To compare the 5-year effectiveness and safety of ustekinumab and vedolizumab in patients with CD who failed anti-TNF in a multicentre retrospective observational cohort.
Methods
This is a retrospective cohort study including all consecutive patients with CD refractory or intolerant to anti-TNF who initiated either vedolizumab or ustekinumab between May 2014 and August 2018. Steroid-free clinical remission, clinical remission and treatment persistence were assessed at year 2, 3 and 5 with intention-to-treat analysis and propensity scores weighted logistic models.
Results
A total of 239 patients were included, 107 received ustekinumab and 132 vedolizumab. At year 5, ustekinumab was associated with a higher rate of steroid-free clinical remission (41.2% vs 20.5%; odds ratio 2.72 [1.43–5.18]) and treatment persistence (46.8% vs 22.5%; OR 3.03 [1.63–5.63]) than vedolizumab but not the rate of CD-related intestinal surgery. Superiority of ustekinumab was more pronounced in patients with ileal CD, stricturing or penetrating behaviour, and history of intestinal CD-related surgery. Patients treated with ustekinumab, were associated with higher treatment persistence compared to patients treated with vedolizumab with low (p < 0.001) or intermediate (p < 0.001) but not with those with high vedolizumab CDST (p = 0.95).
Conclusion
In this study, ustekinumab was associated with higher rate of steroid-free clinical remission and treatment persistence than vedolizumab after 5 years of follow-up, particularly in patients with ileal CD, stricturing or penetrating behaviour and history of CD-related intestinal surgery.
背景：对于抗肿瘤坏死因子（anti-TNF）治疗失败的克罗恩病（CD）患者，ustekinumab优于vedolizumab的数据仍然存在矛盾。目的：在多中心回顾性观察队列中比较ustekinumab和vedolizumab在抗tnf失败的CD患者中的5年有效性和安全性。方法：这是一项回顾性队列研究，包括2014年5月至2018年8月期间接受维多单抗或ustekinumab治疗的所有连续的CD难治性或抗tnf不耐受患者。使用意向治疗分析和倾向得分加权logistic模型，在第2、3和5年评估无类固醇临床缓解、临床缓解和治疗持续性。结果：共纳入239例患者，其中ustekinumab治疗107例，vedolizumab治疗132例。在第5年，与维多单抗相比，ustekinumab与更高的无类固醇临床缓解率（41.2% vs 20.5%；比值比2.72[1.43-5.18]）和治疗持久性（46.8% vs 22.5%; OR 3.03[1.63-5.63]）相关，但与cd相关肠道手术率无关。ustekinumab的优势在回肠CD、狭窄或穿透行为以及肠道CD相关手术史的患者中更为明显。结论：在这项研究中，经过5年的随访，ustekinumab与vedolizumab相比具有更高的无类固醇临床缓解率和治疗持久性，特别是在回肠CD，狭窄或穿透行为以及CD相关肠道手术史的患者中。
{"title":"Five-year effectiveness of either ustekinumab or vedolizumab in 239 patients with Crohn's disease refractory to anti-tumour necrosis factor","authors":"Aurélien Amiot , Julien Kirchgesner , Hadrien Alric , Xavier Tréton , Mathieu Uzzan , Nassim Hammoudi , Matthieu Allez , Clément Bresteau , Yoram Bouhnik , Philippe Seksik , Franck Carbonnel , Antoine Meyer","doi":"10.1016/j.clinre.2025.102741","DOIUrl":"10.1016/j.clinre.2025.102741","url":null,"abstract":"<div><h3>Background</h3><div>There are still conflicting data about superiority of ustekinumab over vedolizumab in patients with Crohn’s disease (CD) who failed anti-tumour necrosis factor (anti-TNF).</div></div><div><h3>Aim</h3><div>To compare the 5-year effectiveness and safety of ustekinumab and vedolizumab in patients with CD who failed anti-TNF in a multicentre retrospective observational cohort.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study including all consecutive patients with CD refractory or intolerant to anti-TNF who initiated either vedolizumab or ustekinumab between May 2014 and August 2018. Steroid-free clinical remission, clinical remission and treatment persistence were assessed at year 2, 3 and 5 with intention-to-treat analysis and propensity scores weighted logistic models.</div></div><div><h3>Results</h3><div>A total of 239 patients were included, 107 received ustekinumab and 132 vedolizumab. At year 5, ustekinumab was associated with a higher rate of steroid-free clinical remission (41.2% vs 20.5%; odds ratio 2.72 [1.43–5.18]) and treatment persistence (46.8% vs 22.5%; OR 3.03 [1.63–5.63]) than vedolizumab but not the rate of CD-related intestinal surgery. Superiority of ustekinumab was more pronounced in patients with ileal CD, stricturing or penetrating behaviour, and history of intestinal CD-related surgery. Patients treated with ustekinumab, were associated with higher treatment persistence compared to patients treated with vedolizumab with low (<em>p</em> < 0.001) or intermediate (<em>p</em> < 0.001) but not with those with high vedolizumab CDST (<em>p</em> = 0.95).</div></div><div><h3>Conclusion</h3><div>In this study, ustekinumab was associated with higher rate of steroid-free clinical remission and treatment persistence than vedolizumab after 5 years of follow-up, particularly in patients with ileal CD, stricturing or penetrating behaviour and history of CD-related intestinal surgery.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102741"},"PeriodicalIF":2.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.clinre.2025.102742
Hüseyin Köseoğlu , Berkant Bebek , Tolga Düzenli
Background
Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed invasive procedure, with post-ERCP pancreatitis (PEP) being the most frequent and clinically significant complication. Rectal non-steroidal anti-inflammatory drugs (NSAIDs), particularly diclofenac and indomethacin, have been shown to reduce the incidence of PEP. However, real-world data comparing their efficacy remains limited. This study aimed to compare the efficacy of rectal diclofenac and indomethacin in preventing PEP among patients undergoing ERCP and to identify patient subgroups that may benefit more from one drug over the other.
Methods
A single-center, retrospective observational study was conducted, analyzing ERCP procedures. A total of 2344 procedures were evaluated, whereas 767 patients were included after exclusion of whom 322 received rectal indomethacin and 445 received rectal diclofenac. The primary outcome was the incidence of PEP, while secondary outcomes included post-ERCP bleeding, cardiorespiratory complications, and other adverse events. Subgroup analyses were performed to evaluate the effectiveness of each drug based on clinical risk factors.
Results
The overall incidence of PEP was 6.6%, with approaching but not reaching significant difference between the indomethacin (8.7%) and diclofenac (5.2%) groups (p = 0.057). Subgroup analyses revealed that diclofenac was more effective in preventing PEP in patients with a naive papilla undergoing sphincterotomy (p = 0.048).
Conclusions
This study suggests that rectal diclofenac may offer a slight advantage over indomethacin in preventing PEP, particularly in high-risk groups, such as patients undergoing sphincterotomy; which was not previously published in the existing literature.
{"title":"Comparison of rectal indomethacin and diclofenac for post ERCP pancreatitis prophylaxis: A single center study","authors":"Hüseyin Köseoğlu , Berkant Bebek , Tolga Düzenli","doi":"10.1016/j.clinre.2025.102742","DOIUrl":"10.1016/j.clinre.2025.102742","url":null,"abstract":"<div><h3>Background</h3><div>Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed invasive procedure, with post-ERCP pancreatitis (PEP) being the most frequent and clinically significant complication. Rectal non-steroidal anti-inflammatory drugs (NSAIDs), particularly diclofenac and indomethacin, have been shown to reduce the incidence of PEP. However, real-world data comparing their efficacy remains limited. This study aimed to compare the efficacy of rectal diclofenac and indomethacin in preventing PEP among patients undergoing ERCP and to identify patient subgroups that may benefit more from one drug over the other.</div></div><div><h3>Methods</h3><div>A single-center, retrospective observational study was conducted, analyzing ERCP procedures. A total of 2344 procedures were evaluated, whereas 767 patients were included after exclusion of whom 322 received rectal indomethacin and 445 received rectal diclofenac. The primary outcome was the incidence of PEP, while secondary outcomes included post-ERCP bleeding, cardiorespiratory complications, and other adverse events. Subgroup analyses were performed to evaluate the effectiveness of each drug based on clinical risk factors.</div></div><div><h3>Results</h3><div>The overall incidence of PEP was 6.6%, with approaching but not reaching significant difference between the indomethacin (8.7%) and diclofenac (5.2%) groups (p = 0.057). Subgroup analyses revealed that diclofenac was more effective in preventing PEP in patients with a naive papilla undergoing sphincterotomy (p = 0.048).</div></div><div><h3>Conclusions</h3><div>This study suggests that rectal diclofenac may offer a slight advantage over indomethacin in preventing PEP, particularly in high-risk groups, such as patients undergoing sphincterotomy; which was not previously published in the existing literature.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102742"},"PeriodicalIF":2.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.clinre.2025.102735
Vincent Zimmer
{"title":"Easy-going cholangioscopy during upper endoscopy after Roux-en-Y reconstructed pylorus-preserving pancreaticoduodenectomy","authors":"Vincent Zimmer","doi":"10.1016/j.clinre.2025.102735","DOIUrl":"10.1016/j.clinre.2025.102735","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102735"},"PeriodicalIF":2.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.clinre.2025.102734
Muhammad Mohid Haroon
{"title":"The critical next question: Is the association between proton pump inhibitors and hepatic encephalopathy dose-dependent?","authors":"Muhammad Mohid Haroon","doi":"10.1016/j.clinre.2025.102734","DOIUrl":"10.1016/j.clinre.2025.102734","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102734"},"PeriodicalIF":2.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Durvalumab in combination with gemcitabine/cisplatin (GemCis) has expanded therapeutic options for advanced biliary tract cancers (BTCs), raising both clinical and economic considerations. We aim to describe the efficacy, safety and economic impact of durvalumab addition.
Methods
This retrospective study analyzed cohorts of patients receiving GemCis ± durvalumab. Progression-Free Survival (PFS) and Overall Survival (OS) were estimated using the Kaplan–Meier method. The economic impact of different dosing strategies was explored through scenario-based analyses.
Results
Median PFS was 7.4 months (95 %CI: 5.4–10.8) in the GemCis-durvalumab group and 6.1 months (95 %CI: 4.0–7.1) in the GemCis group. Median OS was 10.0 months (95 %CI: 5.9–12.8) and 9.7 months (95 %CI: 6.5–12.8), respectively. No severe immune related adverse events were reported. The median treatment cost per patient was €36,342 for GemCis-Durvalumab versus €173 for GemCis alone. Economic analysis suggested that adjusting durvalumab dosing (20mg/kg instead of a flat dose) could lead to saved costs of €344 to €2547 per infusion without affecting outcomes.
Conclusions
This study confirms effectiveness of durvalumab, aligning with clinical trial results. However, the substantial economic burden underscores the importance of optimizing dosing strategies. The recent approval of pembrolizumab further highlights the need for prospective cost-benefit comparisons studies incorporating predictive biomarkers.
{"title":"Clinical and economic outcomes of adding durvalumab to gemcitabine/cisplatin in advanced biliary tract cancers: A multicenter descriptive study","authors":"Lena Luciani , Claire Carlier , Léonie Leuk , Justine Clarenne , Violaine Lepage , Marine Perrier , Olivier Bouché , Elia Gigante , Florian Slimano","doi":"10.1016/j.clinre.2025.102733","DOIUrl":"10.1016/j.clinre.2025.102733","url":null,"abstract":"<div><h3>Background</h3><div>Durvalumab in combination with gemcitabine/cisplatin (GemCis) has expanded therapeutic options for advanced biliary tract cancers (BTCs), raising both clinical and economic considerations. We aim to describe the efficacy, safety and economic impact of durvalumab addition.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed cohorts of patients receiving GemCis ± durvalumab. Progression-Free Survival (PFS) and Overall Survival (OS) were estimated using the Kaplan–Meier method. The economic impact of different dosing strategies was explored through scenario-based analyses.</div></div><div><h3>Results</h3><div>Median PFS was 7.4 months (95 %CI: 5.4–10.8) in the GemCis-durvalumab group and 6.1 months (95 %CI: 4.0–7.1) in the GemCis group. Median OS was 10.0 months (95 %CI: 5.9–12.8) and 9.7 months (95 %CI: 6.5–12.8), respectively. No severe immune related adverse events were reported. The median treatment cost per patient was €36,342 for GemCis-Durvalumab versus €173 for GemCis alone. Economic analysis suggested that adjusting durvalumab dosing (20mg/kg instead of a flat dose) could lead to saved costs of €344 to €2547 per infusion without affecting outcomes.</div></div><div><h3>Conclusions</h3><div>This study confirms effectiveness of durvalumab, aligning with clinical trial results. However, the substantial economic burden underscores the importance of optimizing dosing strategies. The recent approval of pembrolizumab further highlights the need for prospective cost-benefit comparisons studies incorporating predictive biomarkers.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 10","pages":"Article 102733"},"PeriodicalIF":2.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1016/j.clinre.2025.102732
Oscar Corsi , Constanza Jara , Magdalena Fernandez , Antonia Pastore , Diego Pérez , Alonso Valdes , Álvaro Huete , Eduardo Briceño , Juan Pablo Arab , Francisco Barrera , Marco Arrese , Roberto Candia
Background
: Cholecystectomy due to gallstones is one of the most frequent surgeries worldwide. Observational studies suggest that cholecystectomy may be a risk factor for metabolic dysfunction associated with steatotic liver disease (MASLD). However, gallstone disease and MASLD share common risk factors, which could make cholecystectomy a confounder.
Aim
To assess the relationship among cholecystectomy, gallstones, and MASLD in a longitudinal cohort study from a population at high risk of gallbladder diseases.
Methods
A longitudinal retrospective cohort study compared consecutive patients undergoing cholecystectomy with a control group composed of patients with their gallbladder intact. All participants had normal liver imaging and biochemistry at baseline. Participants with incomplete clinical records or significant alcohol consumption were excluded. The primary outcome was the development of MASLD after a follow-up of at least 3 years. Cox regression models were used to conduct multivariable analyses.
Results
We included 427 participants 132 in the cholecystectomy group and 295 controls. The mean age was 47.2 years, with 71.7% being female, and 43.6% having gallstone disease. The median follow-up was 9.7 years. In the Cox multivariate analysis, male gender (aHR: 1.56 [1.09-2.24]), gallstone disease (aHR: 2.18 [1.42-3.36]), prediabetes (aHR: 1.56 [1.06-2.3]), diabetes (aHR: 2.39 [1.38-4.13]), and overweight/obesity (aHR: 5.7 [3.19-10.21]) were independent risk factors for MASLD. After adjustment, cholecystectomy was not associated with MASLD incidence (aHR: 0.68 [0.44-1.03]). Sensitivity analyses supported these findings.
Conclusion
Cholecystectomy was not found to significantly influence the incidence of MASLD after adjusting for metabolic risk factors. The risk of developing MASLD is likely driven by metabolic factors and previous gallstone disease.
{"title":"Is cholecystectomy a real risk factor for Metabolic dysfunction-associated steatotic liver disease (MASLD)? A longitudinal cohort study from a population with a high burden of gallbladder diseases","authors":"Oscar Corsi , Constanza Jara , Magdalena Fernandez , Antonia Pastore , Diego Pérez , Alonso Valdes , Álvaro Huete , Eduardo Briceño , Juan Pablo Arab , Francisco Barrera , Marco Arrese , Roberto Candia","doi":"10.1016/j.clinre.2025.102732","DOIUrl":"10.1016/j.clinre.2025.102732","url":null,"abstract":"<div><h3>Background</h3><div><strong>:</strong> Cholecystectomy due to gallstones is one of the most frequent surgeries worldwide. Observational studies suggest that cholecystectomy may be a risk factor for metabolic dysfunction associated with steatotic liver disease (MASLD). However, gallstone disease and MASLD share common risk factors, which could make cholecystectomy a confounder.</div></div><div><h3>Aim</h3><div>To assess the relationship among cholecystectomy, gallstones, and MASLD in a longitudinal cohort study from a population at high risk of gallbladder diseases.</div></div><div><h3>Methods</h3><div>A longitudinal retrospective cohort study compared consecutive patients undergoing cholecystectomy with a control group composed of patients with their gallbladder intact. All participants had normal liver imaging and biochemistry at baseline. Participants with incomplete clinical records or significant alcohol consumption were excluded. The primary outcome was the development of MASLD after a follow-up of at least 3 years. Cox regression models were used to conduct multivariable analyses.</div></div><div><h3>Results</h3><div>We included 427 participants 132 in the cholecystectomy group and 295 controls. The mean age was 47.2 years, with 71.7% being female, and 43.6% having gallstone disease. The median follow-up was 9.7 years. In the Cox multivariate analysis, male gender (aHR: 1.56 [1.09-2.24]), gallstone disease (aHR: 2.18 [1.42-3.36]), prediabetes (aHR: 1.56 [1.06-2.3]), diabetes (aHR: 2.39 [1.38-4.13]), and overweight/obesity (aHR: 5.7 [3.19-10.21]) were independent risk factors for MASLD. After adjustment, cholecystectomy was not associated with MASLD incidence (aHR: 0.68 [0.44-1.03]). Sensitivity analyses supported these findings.</div></div><div><h3>Conclusion</h3><div>Cholecystectomy was not found to significantly influence the incidence of MASLD after adjusting for metabolic risk factors. The risk of developing MASLD is likely driven by metabolic factors and previous gallstone disease.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 10","pages":"Article 102732"},"PeriodicalIF":2.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Expert opinion on hot topics in the field of IBD","authors":"Lucine Vuitton , Marianne Hupé , Lucien Grados , Aurélien Amiot , Laurent Peyrin-Biroulet , Mathurin Fumery","doi":"10.1016/j.clinre.2025.102724","DOIUrl":"10.1016/j.clinre.2025.102724","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"50 1","pages":"Article 102724"},"PeriodicalIF":2.4,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.clinre.2025.102731
Kunlin Hu , Shulin Xiang , Jing Pang , Baoyue Huang , Bin Xiong
Background
Accurate assessment of enteral feeding intolerance (ENFI) in septic patients remains challenging, as existing clinical tools show limited predictive value.
Methods
A prospectively cohort of 60 patients with sepsis (30 ENFI, 30 with feeding tolerance) and 20 healthy controls was enrolled. Serum samples were drawn for metabolomic profiling on the 1st day following sepsis. LC/MS was used to profile serum metabolites. The feeding intolerance outcome was collected at 14 days after ICU admission. Using a deep learning algorithm, we developed three ENFI prediction models: a metabolite-based model, a clinical risk model, and a new combined model integrating both feature types.
Results
The metabolite-based model included four key biomarkers—palmitic acid, histidine-threonine, glutamate-histidine, and dehydrobilirubin—and achieved an area under the receiver operating characteristic curve (AUC) of 0.85. The clinical model, based on variables such as APACHE II score, intra-abdominal pressure, and albumin, achieved an AUC of 0.88. The combined model demonstrated the best performance, with an AUC of 0.94. It also showed higher accuracy, precision, F1-score, and net benefit in decision curve analysis, particularly when the risk threshold exceeded 4%. Statistical comparisons confirmed its superiority (Net Reclassification Index = 0.33, Integrated Discrimination Improvement = 0.31, P < 0.05).
Conclusions
Integrating metabolomics with clinical data significantly improves ENFI risk prediction in septic patients. External validation is warranted before clinical application.
{"title":"Metabolomic biomarkers enhance prediction of feeding intolerance in ICU septic patients","authors":"Kunlin Hu , Shulin Xiang , Jing Pang , Baoyue Huang , Bin Xiong","doi":"10.1016/j.clinre.2025.102731","DOIUrl":"10.1016/j.clinre.2025.102731","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of enteral feeding intolerance (ENFI) in septic patients remains challenging, as existing clinical tools show limited predictive value.</div></div><div><h3>Methods</h3><div>A prospectively cohort of 60 patients with sepsis (30 ENFI, 30 with feeding tolerance) and 20 healthy controls was enrolled. Serum samples were drawn for metabolomic profiling on the 1st day following sepsis. LC/MS was used to profile serum metabolites. The feeding intolerance outcome was collected at 14 days after ICU admission. Using a deep learning algorithm, we developed three ENFI prediction models: a metabolite-based model, a clinical risk model, and a new combined model integrating both feature types.</div></div><div><h3>Results</h3><div>The metabolite-based model included four key biomarkers—palmitic acid, histidine-threonine, glutamate-histidine, and dehydrobilirubin—and achieved an area under the receiver operating characteristic curve (AUC) of 0.85. The clinical model, based on variables such as APACHE II score, intra-abdominal pressure, and albumin, achieved an AUC of 0.88. The combined model demonstrated the best performance, with an AUC of 0.94. It also showed higher accuracy, precision, F1-score, and net benefit in decision curve analysis, particularly when the risk threshold exceeded 4%. Statistical comparisons confirmed its superiority (Net Reclassification Index = 0.33, Integrated Discrimination Improvement = 0.31, <em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Integrating metabolomics with clinical data significantly improves ENFI risk prediction in septic patients. External validation is warranted before clinical application.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 10","pages":"Article 102731"},"PeriodicalIF":2.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.clinre.2025.102729
Vincent Zimmer , Roland Heyny-von Haußen
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