Digestive and Liver Disease最新文献

Background: Frailty is a multidimensional syndrome associated with poor outcomes and increased vulnerability, yet its assessment in inflammatory bowel diseases (IBD) remains challenging due to the absence of disease-specific tools.

Aims: This study aimed to develop and validate the IBD Frailty Score, a tailored instrument for evaluating frailty in patients with Crohn disease (CD) and ulcerative colitis (UC).

Methods: In the development phase, 28 categorical items were included in the IBD Frailty Score. This tool was tested in an exploratory cohort of 121 IBD outpatients and later validated in a prospective multicenter cohort of 512 patients across four tertiary centers. Predictive factors of frailty were identified through univariate and multivariate analyses.

Results: The IBD Frailty Score was feasible, with an average administration time of ∼2 minutes. It correlated positively with the Fried Frailty Phenotype, IBD Disability Index, and Charlson Comorbidity Index and showed good reproducibility (rho = 0.78) and strong diagnostic accuracy (AUC = 0.79). A cut-off score of 4 reliably distinguished fit from frail patients. Increasing age, polypharmacy, history of extraintestinal manifestations, and higher disease activity were independent risk factors for frailty.

Conclusions: The IBD Frailty Score is the first validated, disease-specific tool for assessing frailty in IBD. It is practical, reproducible, and correlates well with established measures.

Background: Hepatoid adenocarcinoma of the stomach (HAS) and gastric adenocarcinoma with enteroblastic differentiation (GAED) are rare and highly aggressive subtypes of gastric cancer (GC).

Aims: This study aimed to investigate the clinicopathological characteristics and prognostic outcomes of patients with HAS and GAED.

Methods: This multicenter retrospective study compared 107 patients with HAS/GAED with 428 patients with conventional GC (cGC) after 4:1 propensity score matching (PSM). The primary outcomes included disease-free survival (DFS), gastric cancer-specific survival (GCSS), and overall survival (OS). Survival analyses were performed using Cox proportional hazards models and Kaplan-Meier curves.

Results: With a median follow-up of 33 months, patients in the HAS/GAED group, compared with those in the cGC group, exhibited larger tumor size, poorer histological differentiation, higher preoperative carcinoembryonic antigen (CEA) levels, and a higher rate of human epidermal growth factor receptor 2 (HER2) overexpression (all P<0.05). Multivariate analysis identified elevated CEA levels, perineural invasion (PNI), and pathological N (pN) category as independent risk factors for poor prognosis, whereas postoperative chemotherapy was identified as a protective factor. The HAS/GAED group demonstrated significantly worse DFS (P<0.001), GCSS (P=0.001), and OS (P=0.028) compared with the cGC group. No significant prognostic differences were observed between patients with HAS and those with GAED.

Conclusion: HAS and GAED are highly aggressive subtypes of GC, characterized by distinct clinicopathological features and an unfavorable prognosis.

Background & aims: A significant subset of patients with acute pancreatitis (AP) who do not present with organ failure (OF) at admission nonetheless progress to severe acute pancreatitis (SAP). We aimed to develop and validate a simple scoring system to predict progression to SAP specifically in AP patients without initial OF.

Methods: This study utilized a prospectively maintained AP database. Patients admitted without OF were included. Variable selection employed multivariable logistic regression, Boruta algorithm, and LASSO regression. A nomogram was developed, from which a simplified ACR score was derived.

Results: Of 3,813 eligible AP patients without OF at admission, 458 (12.0%) progressed to SAP. Six variables were independently associated with SAP progression. The resulting nomogram demonstrated strong discrimination, with AUCs of 0.834 (training), 0.833 (internal test), and 0.885 (external validation). The simplified ACR score (range 0-9) showed comparable performance (AUC 0.827, 95% CI: 0.807-0.846) and was significantly superior to APACHE II (AUC 0.655, p < 0.001), SIRS (AUC 0.732, p < 0.001) and BISAP (AUC 0.718, p < 0.001). Stratification into low- (0-3 points), intermediate- (4-6 points), and high-risk (7-9 points) groups revealed sharply increasing SAP incidence (2.9%, 16.5%, and 52.1%, respectively; p < 0.001) and worsening clinical outcomes.

Conclusions: The ACR score, comprising six readily available clinical parameters, effectively stratifies the risk of SAP progression in AP patients without organ failure at admission.

Background: Acute liver failure (ALF) is a rapidly progressive and life-threatening condition that requires accurate risk stratification. Existing prognostic tools have limited sensitivity and generalizability. This study aimed to develop and externally validate a machine learning-based modeling framework for early in-hospital dynamic prediction of in-hospital mortality in patients with acute liver failure.

Methods: Patients with ALF were identified from the MIMIC-IV database, with an independent external cohort from Guangxi Medical University Cancer Hospital for validation. Eleven predictors were selected using LASSO regression and the Boruta algorithm. Seven ML models were trained and optimized through cross-validation and grid search. Model performance was assessed using discrimination, calibration, and decision curve analysis, with interpretability evaluated by SHAP.

Results: A total of 1,228 patients from MIMIC-IV and 108 external patients were included. Among all evaluated models, logistic regression demonstrated the most robust and stable performance, with AUCs of 0.802 in internal validation and 0.774 in external validation. Calibration and decision curve analyses demonstrated good clinical utility. SHAP identified temperature, vasopressor use, age, CRRT, and sedative/analgesic use as key predictors. A nomogram and online tool were developed for individualized risk prediction.

Conclusion: This study presents an interpretable and externally validated ML model for predicting in-hospital mortality in ALF, providing a practical tool for early in-hospital dynamic risk stratification and clinical decision support.

Background and aim: The benefit of combining linaclotide with polyethylene glycol (PEG) for improving bowel preparation quality and adenoma detection in patients at risk for inadequate bowel preparation remains uncertain. This study aimed to evaluate its efficacy and safety.

Methods: From August 2022 to July 2023, a multicenter, randomized trial assigned participants to a 2-day linaclotide or placebo plus PEG regimen. The primary endpoints included adequate bowel preparation rate and mean number of adenomas detected per colonoscopy.

Results: The modified intention-to-treat (mITT) (n=672) and per-protocol (n=574) analyses showed no significant differences in adequate bowel preparation rates (mITT: OR 1.26, 95% CI 0.73-2.16, P=0.406; per-protocol: OR 1.46, 95% CI 0.80-2.66, P=0.222) or the mean number of adenomas (mITT: mean difference -0.02, 95% CI -0.19-0.15, P=0.832; per-protocol: mean difference -0.06, 95% CI -0.25-0.13, P=0.530) between groups. However, linaclotide and PEG increased the mean number of polyps in the right colon (0.54 ± 1.9 vs. 0.27 ± 0.8; mean difference -0.27, 95% CI -0.49- -0.05, P=0.016), particularly in patients aged ≥70 years (mean difference -1.30, 95% CI -2.48- -0.13, P=0.033).

Conclusions: A 2-day linaclotide regimen failed to improve the primary endpoints of bowel preparation adequacy or adenoma detection in high-risk patients.

Background and aims: Cirrhosis progression from compensated to decompensated stage signals a deterioration in prognosis, with episodes of acute decompensation (AD) carrying a high risk of short-term mortality. Recently, the concept of non-acute decompensation (NAD) has emerged, representing a more insidious form of decompensation that is nonetheless associated with increased mortality. We aimed to evaluate the clinical impact of NAD in a hospital-referred hepatology population.

Methods: Single-center, retrospective, longitudinal observational study which included adult patients with compensated cirrhosis followed between 2013-2025.

Results: Data from 391 patients were analyzed, 72.1% male with a mean age of 59.9±11 years. Of those, 215 did not decompensate (ND), 121 developed NAD and 55 developed AD. The baseline independent predictors of NAD included a higher MELD score, lower serum albumin and non-compliance with the effective etiological treatment. AD was predicted by lower serum albumin, lower platelet count and non-compliance with the effective etiological treatment. Mortality was significantly higher in NAD (HR 10.82; p<0.001) and AD (HR 21.47; p<0.001) when compared with ND.

Conclusions: Our data shows that both AD and NAD are independent predictors of mortality in cirrhosis, with the former associating more significantly than the latter. However, the occurrence of NAD, despite clinically silent, should be recognized as marker of poor prognosis.

Background: Depression and anxiety were not only common but also with serious consequence in inflammatory bowel diseases (IBD) patients. The current study endeavors to define distinct depression and anxiety profiles of IBD patients and identify central symptoms within different profiles to facilitate targeted interventions.

Methods: The research employed K-means Clustering to delineate the depression and anxiety profiles, followed by a repetition of the analysis using Latent Profile Analysis (LPA). Furthermore, network analysis was utilized to identify central symptoms within the various profiles.

Results: K‑means Clustering identified Cluster 1 (38.89%), Cluster 2 (45.33%) and Cluster 3 (15.78%), while LPA yielded the low-risk group (39.56%), the mild-risk group (44.22%) and the high-risk group (16.22%). A majority of patients in the three clusters were predominantly in a single LPA-derived patient class (96.1-99.0%). Network analysis revealed that connections within each symptom in PHQ-9 and GAD-7 were stronger than those between symptoms. Furthermore, PHQ 6 ("guilt"), PHQ2 ("sad mood")and GAD 7 ("feeling afraid") were identified as the central symptoms in Cluster 1. PHQ2 ("sad mood"), GAD 3("excessive worry") and GAD 1 ("nervousness") emerged as the central symptoms in Cluster 2. Additionally, GAD3 ("excessive worry"), GAD 4 ("trouble relaxing") and GAD 6("irritability") were identified as the central symptoms in Cluster 3.

Conclusion: We defined three distinct depression and anxiety profiles among IBD patients and pinpointed central symptoms within each profile. These findings underscore the importance of directing research towards those central symptoms within each profile in order to develop targeted intervention strategies.