World Journal of Hepatology最新文献

Background: Patients with decompensated cirrhosis frequently experience severe psychological distress, anxiety, and depression, yet psychological support is often fragmented in conventional care.

Aim: To investigate the effect of interdisciplinary team scheduling on psychological outcomes in decompensated cirrhosis.

Methods: A randomized, single-blind, single-center trial was conducted from January 2022 to December 2024 in Guangxi Zhuang Autonomous Region. A total of 110 patients with decompensated cirrhosis (Distress Thermometer ≥ 4) were randomized to interdisciplinary team scheduling (n = 55) or conventional scheduling (n = 55). Psychological distress, anxiety, depression, and quality of life were assessed using the Distress Thermometer, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and World Health Organization Quality of Life 100 questionnaire, respectively.

Results: Following the intervention, the interdisciplinary group achieved significantly lower psychological distress [3 (2-3) vs 3 (3-4)], anxiety (41.65 ± 4.29 vs 46.38 ± 4.18), and depression scores (45.79 ± 3.25 vs 50.14 ± 3.69) compared with the control group (all P < 0.05). Quality of life scores also improved significantly in the physical, psychological, and social domains (P < 0.05).

Conclusion: The interdisciplinary team scheduling model effectively alleviates psychological symptoms and enhances quality of life among patients with decompensated cirrhosis. This model addresses unmet psychosocial needs through early, continuous, and collaborative care, providing a practical framework for integrating psychological support into chronic liver disease management.

Background: This report describes the development of schizophrenia in a 63-year-old female patient approximately six months after undergoing liver transplantation. The patient exhibited no previous indications of psychiatric conditions and did not have any familial background of schizophrenia.

Case summary: This particular case serves as an illustration of the intricate interaction of various elements, such as the liver transplantation process, surgical trauma, intraoperative narcosis, and immunosuppression, which may potentially contribute to the onset of schizophrenia. This report examines the clinical trajectory, diagnostic assessment, and therapeutic strategies employed in this case.

Conclusion: This report emphasizes the significance of identifying and managing psychiatric issues during the post-transplant phase, highlighting potential underlying mechanisms that may link transplantation-related factors to the onset of schizophrenia.

Background: Lifestyle modifications aimed at weight loss are key to improving metabolic dysfunction-associated steatotic liver disease (MASLD); however, achieving substantial and sustained weight loss through non-surgical approaches may be difficult for some patients. Bariatric surgery should be considered as a therapeutic option in select patients with MASLD, but the national referral rate for eligible patients is low (< 1%).

Aim: To examine referral rates and one-year outcomes among adults with MASLD in a multidisciplinary clinic integrating hepatology and obesity medicine.

Methods: We performed a retrospective cohort study of 965 patients seen in a MASLD-specific clinic over a three-year period (2018-2022). Patients were categorized as bariatric surgery eligible or non-eligible based on standard referral criteria. We assessed bariatric surgery referral rates, weight, and liver-related outcomes, including change in nonalcoholic fatty liver disease fibrosis score. Categorical variables were compared with χ ² tests, and continuous variables were analyzed with two-tailed t-tests. P value < 0.05 was considered significant.

Results: Among 491 patients eligible for bariatric surgery, 127 patients (26%) were referred for surgical evaluation, with 31 patients (24%) ultimately undergoing bariatric surgery (21 sleeve gastrectomy and 10 Roux-en-Y gastric bypass). The remaining 96 patients continued with medication and/or lifestyle management. Individuals who underwent bariatric surgery achieved greater one-year total body weight loss than those who utilized medication and/or lifestyle management alone (20.6% vs 2.5%, P < 0.001). Average nonalcoholic fatty liver disease fibrosis score at one year was -0.91 in surgery patients vs -0.008 in non-surgery patients (P = 0.005).

Conclusion: Integration of weight management with hepatology care in patients with MASLD resulted in bariatric surgery referral rates that substantially exceed the national average, leading to improved weight and liver-related outcomes.

Background: Liver biopsy, once the gold standard for evaluating liver fibrosis and steatosis, has been largely replaced in routine clinical practice by non-invasive tools like Fibroscan^®, which evaluate liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). While Fibroscan^® is well-validated, cost and accessibility challenges limit its use for regular follow-up, especially in primary care.

Aim: To investigate the diagnostic accuracy and correlation of blood-based parameters fibrosis 4 (FIB-4) score, aspartate transaminase to platelet ratio index (APRI), neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil percentage-to-albumin ratio (NPAR) with LSM and CAP values in metabolic dysfunction-associated steatotic liver disease (MASLD) patients.

Methods: In a cross-sectional study of 300 MASLD patients we compared FIB-4, APRI, NLR, PLR, and NPAR with LSM and CAP values. Patients were categorized based on LSM into less fibro-progressed (F0-F2) and advanced fibro-progressed (F3-F4) groups, and by CAP into S1, S2 and S3 categories. Sensitivity, specificity, positive predictive value, and negative predictive value of the markers were analyzed, and receiver operating characteristic curves were plotted.

Results: FIB-4 [r = 0.537, P < 0.001; area under curve (AUC) = 0.806; diagnostic accuracy = 75.63%] and APRI (r = 0.513, P < 0.001; AUC = 0.772) showed strong correlations with LSM, confirming their reliability for LSM. APRI and FIB-4 are validated against fibrosis in liver biopsy, our results demonstrate comparable performance between these scores and LSM by Fibroscan^®. PLR exhibited high specificity (98.0%) but showed negative correlation with LSM (r = -0.317, P < 0.01). For CAP, NPAR demonstrated the highest specificity (97.67%) and positive predictive value (91.31%), followed by NLR (specificity 92.77%, positive predictive value 91.58%), though AUC values were modest (0.562 and 0.540, respectively).

Conclusion: FIB-4 and APRI which are robust non-invasive markers for fibrosis, correlates well with LSM as well. NPAR shows potential for steatosis assessment using CAP, warranting further validation. Negative correlation of PLR might suggest its role in liver stiffness evaluation. These markers both conventional and novel, can be used for repeated measurements during follow-up in primary care settings.

Background: The health challenges of partial hepatectomy in patients with clinically significant portal hypertension (CSPH) have been a subject of study for decades. No meta-analysis has systematically evaluated the relationship between CSPH and posthepatectomy liver failure (PHLF), despite its potential role as a critical factor in surgical decision-making. This systematic review and meta-analysis investigated the incidence of PHLF in patients with and without CSPH.

Aim: To include more recent studies and focus on short-term postoperative outcomes, particularly the association between CSPH and PHLF. Additionally, stratified analyses were also performed according to CSPH and PHLF assessment methods, study design, study period, surgical technique, and underlying liver diseases.

Methods: A comprehensive literature search was conducted in EMBASE, PubMed, MEDLINE, ScienceDirect, Elsevier, and Cochrane databases using combinations of the following terms: ("portal hypertension" OR "hypertension, portal" OR "portal hypertensions") AND ("hepatectomy" OR "hepatectomies" OR "liver resection") AND ("liver failure" OR "hepatic failure" OR "liver decompensation"). Studies published from January 1996 to April 2025, 21 published studies were finally included in the systematic review and meta-analysis. The quality assessment was performed independently by using the Newcastle-Ottawa Scale. Odds ratios (OR) and 95% confidence intervals (CI) were calculated and compared using a random-effects model. Heterogeneity was assessed with the χ ² test, and the degree of inconsistency was measured using I ². A P value < 0.05 or I ² > 50% indicated substantial heterogeneity. Sensitivity analysis was conducted to test the robustness of the findings and to identify potential sources of bias.

Results: A total of 6981 patients (1453 patients with CSPH and 5529 patients without CSPH) were finally included in this study. Compared with patients without CSPH, the incidences of PHLF increased in patients with CSPH (OR = 3.14; 95%CI: 2.45-4.02; P < 0.001). Subsequent subgroup analysis suggested that the diagnostic methods for CSPH is a potential interfering factor in PHLF, the OR was maximal in hepatic venous pressure gradient measurement groups (OR = 15.61; 95%CI: 2.11-115.35; P = 0.007).

Conclusion: The presence of CSPH should be considered as a significant risk factor, it still should be taken into account seriously prior to surgery and needs strict perioperative management. Meanwhile, different methods of diagnosing CSPH could influence PHLF.

The global rise in childhood obesity has made metabolic dysfunction-associated steatotic liver disease (MASLD) the leading cause of pediatric liver disease. Studies have consistently reported alarmingly high rates of advanced fibrosis in up to 20% of adolescents with MASLD. There is evidence that pediatric MASLD may run a more severe clinical course compared to adults, as well as pose an independent risk factor for mortality than pediatric obesity or type 2 diabetes mellitus alone. This underscores the necessity for timely recognition, accurate diagnosis and early institution of therapeutic interventions for pediatric MASLD. In this minireview, we discuss the various non-invasive diagnostic modalities used for the evaluation of MASLD, and propose an updated diagnostic and monitoring algorithm incorporating recent multi-societal statements. The advent of non-invasive diagnostics such as vibration-controlled transient elastography in children allows for earlier recognition of liver fibrosis, and may prioritize the need for early pharmacological therapy. We also discuss the importance of early pharmacological intervention in pediatric MASLD, in particular the use of glucagon-like peptide 1 receptor agonists which may have potential to halt MASLD progression if instituted early, and the potential role for novel anti-fibrotic therapy in this population.

This letter reviews Loschi et al's study evaluating structured telerehabilitation for frail cirrhotic liver transplant candidates, which fills a critical pre-transplant care gap. The video-based program, using low-cost tools and asynchronous sessions, improved liver frailty index reduction and function in adherent patients (29.8%) although a high attrition rate (70%) highlighted engagement challenges. Limitations include a small, non-randomized sample, mixed frailty subgroups, and unexplored long-term effects. Future directions emphasize hybrid models, patient-centered barrier analysis, and policy-driven frailty screening. This work advances digital health for cirrhosis; however, larger trials are needed to optimize outcomes.

Sarcopenia and frailty are pervasive, interrelated syndromes in cirrhosis that worsen morbidity, quality of life, transplantation waitlist outcomes, and post-transplant survival. This review synthesized contemporary evidence on definitions, epidemiology, mechanisms, diagnosis, prognostic impact, and management with an emphasis on implementable strategies in hepatology practice. Sarcopenia affects 40%-70% of patients with cirrhosis, and frailty affects 20%-50% of patients with cirrhosis with variations across populations and definitions. Mechanistic drivers include hyperammonemia, systemic inflammation, endocrine disturbances, malnutrition and accelerated starvation, gut-liver-muscle axis alterations, mammalian target of rapamycin inhibition, and inactivity. Diagnosis spans simple bedside tests such as handgrip strength, chair stands, gait speed, and the Liver Frailty Index as well as imaging modalities including computed tomography-based skeletal muscle index, dual energy X-ray absorptiometry, magnetic resonance imaging, and bioimpedance. Both sarcopenia and frailty independently predict hepatic decompensation, hospitalizations, waitlist dropout, and mortality, providing additive prognostic value beyond model for end-stage liver disease (MELD)/MELD-Na, and they are associated with longer intensive care unit and hospital stays and worse post-transplant outcomes. Management requires a multimodal approach: Optimization of cirrhosis complications and ammonia-lowering therapy; adequate nutrition with 1.2-1.5 g/kg/day protein and a late-evening snack; structured aerobic and resistance exercise programs; cautious use of testosterone in hypogonadal males; and emerging therapies such as beta-hydroxy-beta-methylbutyrate, vitamin D, L-carnitine, microbiome modulation, and myostatin inhibitors. Routine screening and multidisciplinary prehabilitation should be embedded in standard care pathways, and incorporation of sarcopenia and frailty metrics alongside MELD may refine risk stratification, enhance transplant allocation, and improve long-term outcomes.

Bacterial infections are a key precipitant of acute decompensation and acute-on-chronic liver failure in cirrhotic patients. The rising prevalence of multidrug-resistant organisms complicates intensive care unit management, making colonization screening increasingly important. In this issue, Kosuta et al report that one-third of cirrhotic intensive care unit patients were colonized with multidrug-resistant organisms, with an 82% concordance between colonizing and infecting strains. Yet colonization did not independently predict infection or short-term mortality, which were instead driven by the severity of organ dysfunction. These findings highlight host vulnerability as the main determinant of mortality, while reinforcing colonization's role in guiding empiric therapy and regional stewardship strategies.

Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease worldwide, with global prevalence estimated at about 32%. The main predictor of clinical outcome is liver fibrosis severity, making an accurate diagnosis essential. This study evaluated the role and accuracy of noninvasive methods (NIMs) for assessing liver fibrosis in MASLD. A systematic literature search was conducted in the PubMed, Cochrane, SciELO, and LILACS databases using the keywords "metabolic steatotic liver disease", "noninvasive markers", "liver fibrosis", and related terms. A total of 76 articles were selected for review. NIMs offer advantages over liver biopsy due to their simplicity, accessibility, and reproducibility, enabling effective risk stratification at lower costs. Despite some limitations in defining intermediate fibrosis stages, a stepwise approach enhances diagnostic accuracy. Although liver biopsy remains the gold standard, NIMs are increasingly recognized for reliably excluding advanced fibrosis in patients with MASLD, reducing the need for invasive procedures.