M. Liu, X. Zhang, X. Cheng, Q. He, T. Zhou, H. Wang, B. Li, W. Luo, J. Li, H. Li, Z. Lin, J. Song, W. Wang, J. Huang, Y. Ji, D. Zhou, W. Xie, Q. Yang, M. Tu, X. Luo, X. Zhang, H. Yan, J. Chen, “Indocyanine Green Clearance Test via Pulse Dye Densitometry for Portal Hypertension Diagnosis in cACLD,” Liver International 45, no. 12 (2025): e70425, 10.1111/liv.70425.
We noticed an error in the co-first author contribution statement, which incorrectly listed Xiao Cheng twice and omitted Qinjun He.
The correct co-first contribution statement should read: Miaoxia Liu, Xiaofeng Zhang, Xiao Cheng, Qinjun He and Tiantian Zhou contributed equally to this study.
We apologise for this error.
刘敏，张晓霞，程晓霞，何其清，周涛，王红红，李斌，罗伟，李静，李宏，林志杰，宋建军，王伟，黄军，季勇，周德华，谢伟，杨琴，涂敏，罗晓霞，张晓霞，严宏，陈俊，“脉冲染料密度法检测门静脉高压症诊断中的Indocyanine Green Clearance Test”，《国际肝病》第45期，第1期。12 (2025): e70425, 10.1111/ live .70425。我们注意到共同第一作者贡献声明中有一个错误，错误地两次列出了肖成，并省略了何勤军。正确的共同第一贡献声明应为：Miaoxia Liu、Xiaofeng Zhang、Xiao Cheng、qjun He和Tiantian Zhou对本研究的贡献相同。我们为这个错误道歉。
{"title":"Correction to ‘Indocyanine Green Clearance Test via Pulse Dye Densitometry for Portal Hypertension Diagnosis in cACLD’","authors":"","doi":"10.1111/liv.70496","DOIUrl":"10.1111/liv.70496","url":null,"abstract":"<p>M. Liu, X. Zhang, X. Cheng, Q. He, T. Zhou, H. Wang, B. Li, W. Luo, J. Li, H. Li, Z. Lin, J. Song, W. Wang, J. Huang, Y. Ji, D. Zhou, W. Xie, Q. Yang, M. Tu, X. Luo, X. Zhang, H. Yan, J. Chen, “Indocyanine Green Clearance Test via Pulse Dye Densitometry for Portal Hypertension Diagnosis in cACLD,” <i>Liver International</i> 45, no. 12 (2025): e70425, 10.1111/liv.70425.</p><p>We noticed an error in the co-first author contribution statement, which incorrectly listed Xiao Cheng twice and omitted Qinjun He.</p><p>The correct co-first contribution statement should read: Miaoxia Liu, Xiaofeng Zhang, <b>Xiao Cheng, Qinjun He</b> and Tiantian Zhou contributed equally to this study.</p><p>We apologise for this error.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 2","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70496","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145856931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qi Feng, Pinelopi Manousou, Chioma N. Izzi-Engbeaya, Rohit Loomba, Mark Thursz, Mark Woodward
Background and Aims
We investigated the associations between SLD, fibrosis stage, and all-cause and cause-specific mortality, with a focus on SLD subtypes.
Methods
We analysed 486 156 UK Biobank participants. SLD cases were identified using fatty liver index ≥ 60. Causes of death were confirmed via death registries. Multivariable Cox models estimated associations between SLD, SLD subtypes, FIB4 score and mortality outcomes, including all-cause mortality, mortality from liver-related diseases, cardiovascular disease (CVD) and extrahepatic cancers.
Results
SLD was identified in 178 336 participants (36.7%): 73.5% with MASLD, 19.0% with MetALD and 6.4% with ALD. Over a median follow-up of 13.8 years, 20 766 (11.6%) deaths occurred among people with SLD and 21 754 among those without (307 820; 7.1%), suggesting a higher mortality rate in SLD than in non-SLD (8.78 vs. 5.25/1000 person-years). All SLD subtypes were associated with higher all-cause mortality: MASLD (HR (95% CI): 1.32 (1.29–1.35)), MetALD (1.16 (1.12–1.20)) and ALD (1.36 (1.29–1.44)). Excess mortality was primarily driven by extrahepatic cancer (42.5%) and cardiovascular disease (24.2%), while liver-related deaths were concentrated among those with ALD and fibrosis. A strong dose–response relationship was observed between FIB4 stratification and mortality, particularly for liver-related deaths. These associations were independent of socioeconomic status, lifestyle and cardiometabolic risk factors.
Conclusion
SLD is independently associated with increased all-cause and cause-specific mortality, with substantial variation across subtypes and fibrosis severity. Extrahepatic cancer and cardiovascular disease are the leading contributors to excess mortality. These findings underscore the need for integrated care strategies targeting metabolic risk, fibrosis progression and cancer prevention in the SLD population.
背景和目的：我们研究了SLD、纤维化分期、全因死亡率和病因特异性死亡率之间的关系，重点研究了SLD亚型。方法：我们分析了486 156名英国生物银行参与者。以脂肪肝指数≥60诊断SLD。死亡原因通过死亡登记得到确认。多变量Cox模型估计了SLD、SLD亚型、FIB4评分和死亡率结局之间的关联，包括全因死亡率、肝脏相关疾病、心血管疾病（CVD）和肝外癌的死亡率。结果：178336名参与者（36.7%）被确诊为SLD，其中MASLD为73.5%，MetALD为19.0%，ALD为6.4%。在中位13.8年的随访中，SLD患者中有20766例（11.6%）死亡，无SLD患者中有21754例（307820例；7.1%），表明SLD患者的死亡率高于非SLD患者（8.78 vs 5.25/1000人年）。所有SLD亚型均与较高的全因死亡率相关：MASLD (HR （95% CI): 1.32(1.29-1.35)）、MetALD（1.16(1.12-1.20)）和ALD（1.36(1.29-1.44)）。过高的死亡率主要由肝外癌（42.5%）和心血管疾病（24.2%）引起，而肝脏相关死亡主要集中在ALD和纤维化患者中。观察到FIB4分层与死亡率之间存在很强的剂量-反应关系，特别是与肝脏相关的死亡。这些关联与社会经济地位、生活方式和心脏代谢危险因素无关。结论：SLD与全因死亡率和病因特异性死亡率增加独立相关，在不同亚型和纤维化严重程度之间存在显著差异。肝外癌和心血管疾病是导致死亡率过高的主要原因。这些发现强调了针对SLD人群代谢风险、纤维化进展和癌症预防的综合护理策略的必要性。
{"title":"Unveiling the Burden of Steatotic Liver Disease: Mortality Risks by Subtype and Fibrosis Stage in a Nationwide Cohort","authors":"Qi Feng, Pinelopi Manousou, Chioma N. Izzi-Engbeaya, Rohit Loomba, Mark Thursz, Mark Woodward","doi":"10.1111/liv.70485","DOIUrl":"10.1111/liv.70485","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>We investigated the associations between SLD, fibrosis stage, and all-cause and cause-specific mortality, with a focus on SLD subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed 486 156 UK Biobank participants. SLD cases were identified using fatty liver index ≥ 60. Causes of death were confirmed via death registries. Multivariable Cox models estimated associations between SLD, SLD subtypes, FIB4 score and mortality outcomes, including all-cause mortality, mortality from liver-related diseases, cardiovascular disease (CVD) and extrahepatic cancers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SLD was identified in 178 336 participants (36.7%): 73.5% with MASLD, 19.0% with MetALD and 6.4% with ALD. Over a median follow-up of 13.8 years, 20 766 (11.6%) deaths occurred among people with SLD and 21 754 among those without (307 820; 7.1%), suggesting a higher mortality rate in SLD than in non-SLD (8.78 vs. 5.25/1000 person-years). All SLD subtypes were associated with higher all-cause mortality: MASLD (HR (95% CI): 1.32 (1.29–1.35)), MetALD (1.16 (1.12–1.20)) and ALD (1.36 (1.29–1.44)). Excess mortality was primarily driven by extrahepatic cancer (42.5%) and cardiovascular disease (24.2%), while liver-related deaths were concentrated among those with ALD and fibrosis. A strong dose–response relationship was observed between FIB4 stratification and mortality, particularly for liver-related deaths. These associations were independent of socioeconomic status, lifestyle and cardiometabolic risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SLD is independently associated with increased all-cause and cause-specific mortality, with substantial variation across subtypes and fibrosis severity. Extrahepatic cancer and cardiovascular disease are the leading contributors to excess mortality. These findings underscore the need for integrated care strategies targeting metabolic risk, fibrosis progression and cancer prevention in the SLD population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 2","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Do Han Kim, Donghyun Ko, Vincent L. Chen, Jose A. Porres, Carlos Elizondo Alatorre, Luis M. Nieto, Pedro Palacios Argueta, Paul T. Kröner, Frank J. Lukens, Donghee Kim, Raffi Karagozian, Meena B. Bansal, Karn Wijarnpreecha
Introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) represent a spectrum of liver conditions that can gradually progress to cirrhosis. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have shown benefits in reducing hepatic steatosis and liver-related events in MASLD. This study aims to assess whether SGLT-2 inhibitors are associated with a reduced risk of all-cause mortality and disease-specific outcomes in patients with MASH cirrhosis and type 2 diabetes (T2D).
Methods
A retrospective cohort study was performed using TriNetX. Patients with T2D and MASH cirrhosis on SGLT-2 inhibitors were matched 1:1 with other glucose-lowering drugs (oGLDs) based on demographics, comorbidities and medications. Primary outcomes included all-cause mortality, hepatic decompensation and major adverse liver outcomes (MALO). Cox-proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence interval (CI).
Results
A total of 51 427 patients with MASH cirrhosis and T2D were identified, of which 6833 (13.28%) were on SGLT-2 inhibitors. Patients on SGLT-2 inhibitors (n = 6449, mean age 63.7 years, 52.9% female) were matched with 6449 individuals (mean age 63.9 years, 53.5% female) on oGLDs. The SGLT-2 inhibitors cohort had statistically significantly lower risk of all-cause mortality (HR: 0.58, 95% CI: 0.53–0.63), hepatic decompensation (HR: 0.85, 95% CI: 0.81–0.90) and MALO (HR: 0.88, 95% CI: 0.83–0.93).
Conclusion
SGLT-2 inhibitors are associated with a reduced risk of all-cause mortality in patients with MASH cirrhosis and T2DM, which may be partly attributable to a lower risk of hepatic decompensation and subsequent events. Further studies are warranted as SGLT-2 inhibitors may serve as an adjunctive therapy for patients with MASH cirrhosis.
{"title":"SGLT-2 Inhibitors Are Associated With Lower Mortality and Decompensation in Patients With MASH Cirrhosis and Type 2 Diabetes","authors":"Do Han Kim, Donghyun Ko, Vincent L. Chen, Jose A. Porres, Carlos Elizondo Alatorre, Luis M. Nieto, Pedro Palacios Argueta, Paul T. Kröner, Frank J. Lukens, Donghee Kim, Raffi Karagozian, Meena B. Bansal, Karn Wijarnpreecha","doi":"10.1111/liv.70490","DOIUrl":"10.1111/liv.70490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH) represent a spectrum of liver conditions that can gradually progress to cirrhosis. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have shown benefits in reducing hepatic steatosis and liver-related events in MASLD. This study aims to assess whether SGLT-2 inhibitors are associated with a reduced risk of all-cause mortality and disease-specific outcomes in patients with MASH cirrhosis and type 2 diabetes (T2D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was performed using TriNetX. Patients with T2D and MASH cirrhosis on SGLT-2 inhibitors were matched 1:1 with other glucose-lowering drugs (oGLDs) based on demographics, comorbidities and medications. Primary outcomes included all-cause mortality, hepatic decompensation and major adverse liver outcomes (MALO). Cox-proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence interval (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 51 427 patients with MASH cirrhosis and T2D were identified, of which 6833 (13.28%) were on SGLT-2 inhibitors. Patients on SGLT-2 inhibitors (<i>n</i> = 6449, mean age 63.7 years, 52.9% female) were matched with 6449 individuals (mean age 63.9 years, 53.5% female) on oGLDs. The SGLT-2 inhibitors cohort had statistically significantly lower risk of all-cause mortality (HR: 0.58, 95% CI: 0.53–0.63), hepatic decompensation (HR: 0.85, 95% CI: 0.81–0.90) and MALO (HR: 0.88, 95% CI: 0.83–0.93).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SGLT-2 inhibitors are associated with a reduced risk of all-cause mortality in patients with MASH cirrhosis and T2DM, which may be partly attributable to a lower risk of hepatic decompensation and subsequent events. Further studies are warranted as SGLT-2 inhibitors may serve as an adjunctive therapy for patients with MASH cirrhosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 2","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jung Sun Kim, Jeffrey Wong, San-Chi Chen, David Tai, Hannah Yang, Youngun Kim, Beodeul Kang, Ilhwan Kim, Hyeyeong Kim, Chansik An, Su Jin Jang, Masatoshi Kudo, Ho Yeong Lim, Chan Kim, Thomas Yau, Hong Jae Chon
Background/Aims
Immune checkpoint inhibitors (ICIs) have transformed advanced HCC treatment. The benefit of sequential immunotherapy after prior ICI failure remains unclear. Given the expanded use of atezolizumab plus bevacizumab (Ate/Bev) over the past 5 years, we explored the real-world outcomes of nivolumab plus ipilimumab (Nivo/Ipi) in patients with advanced HCC, with more focus on those previously exposed to Ate/Bev.
Methods
Patients treated with Nivo/Ipi for advanced HCC from six referral hospitals in Korea, Hong Kong, Taiwan and Singapore were included. Patients with prior non–Ate/Bev ICI or Child–Pugh B–C were excluded. Outcomes were compared between the ICI-naïve and Ate/Bev-experienced groups.
Results
Among 116 patients with advanced HCC treated with Nivo/Ipi, 57 were ICI-naïve and 59 had prior Ate/Bev exposure. Overall objective response rate was 31.2%, higher in the ICI-naïve group (42.6% vs. 20.0%, p = 0.01). However, the median duration of response was comparable between groups (24.8 vs. 23.7 months; p = 0.71), suggesting durable benefits regardless of prior Ate/Bev therapy. Median progression-free survival (PFS) and overall survival (OS) were 2.5 and 11.3 months, respectively, with longer PFS (5.3 vs. 1.6 months; p < 0.01) and OS (16.2 vs. 7.8 months; p = 0.06) in the ICI-naïve. Immune-related adverse events (irAEs), especially thyroid dysfunction, were associated with longer PFS and OS. Notably, most Nivo/Ipi responders post-Ate/Bev (8/11) had irAEs during Nivo/Ipi treatment, whereas no irAEs occurred during prior Ate/Bev. Nivo/Ipi responders post-Ate/Bev revealed a high tumour mutational burden (5.71–12.75 mutations/Mb).
Conclusion
Nivo/Ipi demonstrated meaningful clinical activity in patients with advanced HCC, even after Ate/Bev failure.
背景/目的：免疫检查点抑制剂（ICIs）已经改变了晚期HCC的治疗。既往ICI失败后序贯免疫治疗的益处尚不清楚。鉴于过去5年来阿特唑单抗加贝伐单抗（Ate/Bev）的使用范围扩大，我们探索了纳武单抗加伊匹单抗（Nivo/Ipi）在晚期HCC患者中的实际结果，更多地关注那些先前暴露于Ate/Bev的患者。方法：选取韩国、香港、台湾和新加坡6家转诊医院接受Nivo/Ipi治疗的晚期HCC患者。排除既往非ate /Bev ICI或Child-Pugh B-C患者。比较ICI-naïve组和Ate/ bev组的结果。结果：116例接受Nivo/Ipi治疗的晚期HCC患者中，57例ICI-naïve， 59例既往有Ate/Bev暴露。总体客观有效率为31.2%，ICI-naïve组较高（42.6% vs. 20.0%, p = 0.01）。然而，两组间的中位反应持续时间具有可比性（24.8个月vs. 23.7个月；p = 0.71），表明无论先前的Ate/Bev治疗如何，均可获得持久的益处。中位无进展生存期（PFS）和总生存期（OS）分别为2.5个月和11.3个月，PFS较长（5.3个月对1.6个月）。结论：Nivo/Ipi在晚期HCC患者中显示出有意义的临床活性，即使在Ate/Bev失败后也是如此。
{"title":"Outcomes of Nivolumab Plus Ipilimumab After Atezolizumab Plus Bevacizumab in Advanced HCC: An International Multicentre Study","authors":"Jung Sun Kim, Jeffrey Wong, San-Chi Chen, David Tai, Hannah Yang, Youngun Kim, Beodeul Kang, Ilhwan Kim, Hyeyeong Kim, Chansik An, Su Jin Jang, Masatoshi Kudo, Ho Yeong Lim, Chan Kim, Thomas Yau, Hong Jae Chon","doi":"10.1111/liv.70493","DOIUrl":"10.1111/liv.70493","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aims</h3>\u0000 \u0000 <p>Immune checkpoint inhibitors (ICIs) have transformed advanced HCC treatment. The benefit of sequential immunotherapy after prior ICI failure remains unclear. Given the expanded use of atezolizumab plus bevacizumab (Ate/Bev) over the past 5 years, we explored the real-world outcomes of nivolumab plus ipilimumab (Nivo/Ipi) in patients with advanced HCC, with more focus on those previously exposed to Ate/Bev.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients treated with Nivo/Ipi for advanced HCC from six referral hospitals in Korea, Hong Kong, Taiwan and Singapore were included. Patients with prior non–Ate/Bev ICI or Child–Pugh B–C were excluded. Outcomes were compared between the ICI-naïve and Ate/Bev-experienced groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 116 patients with advanced HCC treated with Nivo/Ipi, 57 were ICI-naïve and 59 had prior Ate/Bev exposure. Overall objective response rate was 31.2%, higher in the ICI-naïve group (42.6% vs. 20.0%, <i>p</i> = 0.01). However, the median duration of response was comparable between groups (24.8 vs. 23.7 months; <i>p</i> = 0.71), suggesting durable benefits regardless of prior Ate/Bev therapy. Median progression-free survival (PFS) and overall survival (OS) were 2.5 and 11.3 months, respectively, with longer PFS (5.3 vs. 1.6 months; <i>p</i> < 0.01) and OS (16.2 vs. 7.8 months; <i>p</i> = 0.06) in the ICI-naïve. Immune-related adverse events (irAEs), especially thyroid dysfunction, were associated with longer PFS and OS. Notably, most Nivo/Ipi responders post-Ate/Bev (8/11) had irAEs during Nivo/Ipi treatment, whereas no irAEs occurred during prior Ate/Bev. Nivo/Ipi responders post-Ate/Bev revealed a high tumour mutational burden (5.71–12.75 mutations/Mb).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Nivo/Ipi demonstrated meaningful clinical activity in patients with advanced HCC, even after Ate/Bev failure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 2","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12742031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tiantian Zhang, Taiji Pan, Liyin Zheng, Meiyu Yang
{"title":"Beyond Prediction: Unravelling the Interplay of Inflammation and Matrix Remodelling in HBV-ACLF","authors":"Tiantian Zhang, Taiji Pan, Liyin Zheng, Meiyu Yang","doi":"10.1111/liv.70501","DOIUrl":"10.1111/liv.70501","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 2","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ying Shang, Linnea Widman, Xiao Zhang, Gail Fernandes, Matthew G. Melaragno, Samuel S. Engel, Johan Vessby, Mattias Ekstedt, Hannes Hagström
Background and Aims
There is limited real-world data on the prognosis of patients with cirrhosis due to metabolic dysfunction-associated steatotic liver disease (MASLD). We sought to describe the characteristics and assess the clinical course of MASLD-cirrhosis.
Methods
A Swedish register-based cohort including 2318 patients with compensated and 1339 with decompensated cirrhosis due to MASLD from 2001 to 2020 was analysed. Incidence rates of severe clinical events including decompensated cirrhosis, liver transplantation or overall mortality were estimated. We further compared the results using a clinical cohort of 293 patients with MASLD- cirrhosis from three University Hospitals.
Results
Overall, 55.7% patients with compensated cirrhosis (median age 70, 43.6% female, 88.7% type 2 diabetes [T2D]) developed severe clinical events during a median follow-up of 1.1 years. The incidence rate was 78.5/1000 person-year (PY), 6.8/1000 PY and 182.0/1000 PY for decompensation, liver transplantation and death, respectively. Among 1399 patients with decompensated cirrhosis (median age 72, 41.1% female, 86% T2D), ascites (74.6%) was the most frequent initial events. 59.7% experienced death or transplantation with a median follow-up of 0.58 years. The incidence rate was 14.0/1000 PY for liver transplantation and 353.2/1000 PY for overall death. Estimates were similar in the clinical cohort but lower overall mortality were observed (IR = 63.1/1000 PY in compensated cirrhosis and 188.2/1000 PY in decompensated events).
Conclusions
This study describes the clinical characteristics and the natural history of patients with MASLD-cirrhosis by compensation status in Sweden, providing estimates for important outcomes that may be useful for patient prognostication and clinical trial design.
{"title":"Characteristics and Clinical Outcomes in Patients With Cirrhosis due to MASLD in Sweden","authors":"Ying Shang, Linnea Widman, Xiao Zhang, Gail Fernandes, Matthew G. Melaragno, Samuel S. Engel, Johan Vessby, Mattias Ekstedt, Hannes Hagström","doi":"10.1111/liv.70487","DOIUrl":"10.1111/liv.70487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>There is limited real-world data on the prognosis of patients with cirrhosis due to metabolic dysfunction-associated steatotic liver disease (MASLD). We sought to describe the characteristics and assess the clinical course of MASLD-cirrhosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A Swedish register-based cohort including 2318 patients with compensated and 1339 with decompensated cirrhosis due to MASLD from 2001 to 2020 was analysed. Incidence rates of severe clinical events including decompensated cirrhosis, liver transplantation or overall mortality were estimated. We further compared the results using a clinical cohort of 293 patients with MASLD- cirrhosis from three University Hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 55.7% patients with compensated cirrhosis (median age 70, 43.6% female, 88.7% type 2 diabetes [T2D]) developed severe clinical events during a median follow-up of 1.1 years. The incidence rate was 78.5/1000 person-year (PY), 6.8/1000 PY and 182.0/1000 PY for decompensation, liver transplantation and death, respectively. Among 1399 patients with decompensated cirrhosis (median age 72, 41.1% female, 86% T2D), ascites (74.6%) was the most frequent initial events. 59.7% experienced death or transplantation with a median follow-up of 0.58 years. The incidence rate was 14.0/1000 PY for liver transplantation and 353.2/1000 PY for overall death. Estimates were similar in the clinical cohort but lower overall mortality were observed (IR = 63.1/1000 PY in compensated cirrhosis and 188.2/1000 PY in decompensated events).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study describes the clinical characteristics and the natural history of patients with MASLD-cirrhosis by compensation status in Sweden, providing estimates for important outcomes that may be useful for patient prognostication and clinical trial design.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 2","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12741901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent. Existing non-invasive models for detecting fibrotic metabolic dysfunction-associated steatohepatitis (MASH) perform poorly, partly due to discordant fibrosis-inflammation relationships. We aimed to develop and validate a machine learning-based stepwise strategy to improve identification of high-risk MASLD (F ≥ 2 + NAS ≥ 5).
Methods
A multicenter retrospective cohort study analysed 840 biopsy-proven MASLD patients (after quality control from 934) across eight centres. Logistic regression and multi-omics detection identified predictors for significant fibrosis (F ≥ 2) and definite MASH (NAS ≥ 5). Patients were divided into a training cohort and a validation cohort based on the centre. Eight machine learning algorithms were trained to diagnose five endpoints. Four diagnostic strategies were compared: fibrosis-first (F ≥ 2 then NAS ≥ 5), MASH-first (NAS ≥ 5 then F ≥ 2), parallel (simultaneous F ≥ 2 and NAS ≥ 5), and single-model (direct F ≥ 2 and NAS ≥ 5).
Results
Both logistic regression and mass spectrometry data from this study demonstrated differences in fibrosis and NAS scores. Optimal models were: random forest (RF) for F ≥ 2, lightGBM for NAS ≥ 5, multilayer perceptron (MLP) for F ≥ 2 & NAS ≥ 5 and NAS ≥ 5|F ≥ 2, and elastic net for F ≥ 2|NAS ≥ 5. Internal validation showed the fibrosis-first strategy achieved superior performance (accuracy 84.7%, specificity 87.0%, NPV 92.3%). External validation confirmed stepwise approaches outperformed the single-model strategy. The sequential RF (F ≥ 2) followed by MLP (NAS ≥ 5) approach demonstrated the highest clinical utility.
Conclusions
A machine learning-based stepwise diagnostic strategy, prioritising fibrosis assessment first, significantly improves identification of high-risk MASLD (F ≥ 2 + NAS ≥ 5). This validated approach enhances risk stratification accuracy, reduces reliance on biopsy, and offers strong clinical applicability for optimising management. Findings support integrating sequential AI diagnostics into clinical practice and future guidelines.
{"title":"Two-Step Machine Learning Model Enhances Identification of High-Risk Metabolic Dysfunction-Associated Steatotic Liver Disease","authors":"Zheng'ao Xu, Yongfen Zhu, Fengjuan Chen, Qiongyue Fan, Ruiqi Wang, Yilong Fu, Xunxun Wu, Li Zhu, Fushuang Ha, Qing Ye, Chunyan Ye, Xiaoming Chen, Meijie Chen, Jiale Niu, Yangyang Xie, Kaixin Chang, Jiakun Miao, Weili Liu, Junping Shi, Zhongjie Hu, Minghua Zheng, Qingxian Cai, Xiao Liang","doi":"10.1111/liv.70491","DOIUrl":"10.1111/liv.70491","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent. Existing non-invasive models for detecting fibrotic metabolic dysfunction-associated steatohepatitis (MASH) perform poorly, partly due to discordant fibrosis-inflammation relationships. We aimed to develop and validate a machine learning-based stepwise strategy to improve identification of high-risk MASLD (<i>F</i> ≥ 2 + NAS ≥ 5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multicenter retrospective cohort study analysed 840 biopsy-proven MASLD patients (after quality control from 934) across eight centres. Logistic regression and multi-omics detection identified predictors for significant fibrosis (<i>F</i> ≥ 2) and definite MASH (NAS ≥ 5). Patients were divided into a training cohort and a validation cohort based on the centre. Eight machine learning algorithms were trained to diagnose five endpoints. Four diagnostic strategies were compared: fibrosis-first (<i>F</i> ≥ 2 then NAS ≥ 5), MASH-first (NAS ≥ 5 then <i>F</i> ≥ 2), parallel (simultaneous <i>F</i> ≥ 2 and NAS ≥ 5), and single-model (direct <i>F</i> ≥ 2 and NAS ≥ 5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both logistic regression and mass spectrometry data from this study demonstrated differences in fibrosis and NAS scores. Optimal models were: random forest (RF) for <i>F</i> ≥ 2, lightGBM for NAS ≥ 5, multilayer perceptron (MLP) for <i>F</i> ≥ 2 & NAS ≥ 5 and NAS ≥ 5|<i>F</i> ≥ 2, and elastic net for <i>F</i> ≥ 2|NAS ≥ 5. Internal validation showed the fibrosis-first strategy achieved superior performance (accuracy 84.7%, specificity 87.0%, NPV 92.3%). External validation confirmed stepwise approaches outperformed the single-model strategy. The sequential RF (<i>F</i> ≥ 2) followed by MLP (NAS ≥ 5) approach demonstrated the highest clinical utility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A machine learning-based stepwise diagnostic strategy, prioritising fibrosis assessment first, significantly improves identification of high-risk MASLD (<i>F</i> ≥ 2 + NAS ≥ 5). This validated approach enhances risk stratification accuracy, reduces reliance on biopsy, and offers strong clinical applicability for optimising management. Findings support integrating sequential AI diagnostics into clinical practice and future guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A subset of autoimmune hepatitis (AIH) patients fail to respond to standard treatments or experience frequent relapses. This study evaluates the efficacy and safety of telitacicept, a BAFF/APRIL dual inhibitor, as a rescue therapy. Two AIH patients treated with telitacicept were included. The first, steroid-dependent and refractory to multiple immunosuppressants, showed significant reductions in transaminases and immunoglobulin G, enabling steroid tapering. The second, with comorbid systemic lupus erythematosus, maintained remission and reduced steroid and mycophenolate mofetil doses. No severe adverse events were reported. Telitacicept shows promise as a safe therapy for refractory AIH.
{"title":"A Novel BAFF/APRIL Dual Inhibitor in Treating Refractory Autoimmune Hepatitis","authors":"Tianyu Mao, Xiong Ma, Xiao Xiao","doi":"10.1111/liv.70488","DOIUrl":"10.1111/liv.70488","url":null,"abstract":"<div>\u0000 \u0000 <p>A subset of autoimmune hepatitis (AIH) patients fail to respond to standard treatments or experience frequent relapses. This study evaluates the efficacy and safety of telitacicept, a BAFF/APRIL dual inhibitor, as a rescue therapy. Two AIH patients treated with telitacicept were included. The first, steroid-dependent and refractory to multiple immunosuppressants, showed significant reductions in transaminases and immunoglobulin G, enabling steroid tapering. The second, with comorbid systemic lupus erythematosus, maintained remission and reduced steroid and mycophenolate mofetil doses. No severe adverse events were reported. Telitacicept shows promise as a safe therapy for refractory AIH.</p>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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