Annals of hepatology最新文献

Introduction and objectives: Timely identification and discontinuation of culprit-drug is the cornerstone in managing drug-induced liver injury (DILI), and this study aims to thoroughly investigate the potential hepatotoxic drugs by using the FDA Adverse Event Reporting System (FAERS) database.

Materials and methods: DILI-related reports in the FAERS database between 2004 and 2024 were used to compile a reported culprit-drug list, and the single drug and drug class with the highest reporting frequency were counted accordingly. The disproportionality analysis was used to assess the DILI risk of each reported culprit-drug.

Results: 236,918 DILI-related reports were submitted to the FAERS database between 2004 and 2024, in which 1459 drugs were reported as culprit-drug. Paracetamol is the most frequently reported single drug, while antineoplastic agents are the most frequently reported drug class. 806 of 1459 drugs showed positive signals in disproportionality analysis, among which vorasidenib is the drug with the highest signal strength, followed by floxuridine, pyrazinamide, delandistrogene moxeparvovec, and isoniazid. In the distribution analysis of positive signal drugs, antineoplastic agents have the largest number of positive drugs and occupy a dominant position among high-risk level drugs.

Conclusions: Our study summarized a reported culprit-drug list of DILI by comprehensively reviewing the liver injury-related reports in the FAERS database, and highlighted the prominent position of antineoplastic agents in reporting frequency, risk signal strength ranking, number of positive signal drugs, and high-risk drug distribution, suggesting that we may need to pay more attention to the liver injury risk of antineoplastic agents in clinical practice.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has emerged as a major comorbidity among patients with severe mental illness (SMI), particularly those treated with second-generation antipsychotics (SGAs). These agents induce systemic metabolic disturbances through mechanisms involving adipose tissue dysfunction, mitochondrial injury, and dysregulation of hepatic lipid metabolism. Increasing evidence identifies SGAs as significant contributors to hepatic dysfunction, acting through activation of sterol regulatory element-binding proteins (SREBPs), impairment of mitochondrial respiratory function, low-grade inflammation, alterations in the AMPK signaling pathway, and gut microbiota dysbiosis. Collectively, these processes promote hepatic lipid accumulation, insulin resistance, and progression toward non-alcoholic steatohepatitis (NASH). Furthermore, non-invasive biomarkers such as the Fatty Liver Index (FLI) and FIB-4 score have demonstrated potential utility for early screening and risk stratification in psychiatric populations. Overall, SGAs play a central role in the pathogenesis of MASLD by disrupting mitochondrial homeostasis, lipid metabolism, and gut-liver axis communication. Routine liver monitoring should be integrated into psychiatric care, and future research must focus on preventive and therapeutic strategies that protect hepatic function without compromising mental stability.

Introduction and objectives: Unhealthy sleep patterns have been associated with an increased risk of liver-related events, including the development of advanced liver disease. While prior studies linked sleep patterns to cirrhosis and mortality, the relationship between sleep behaviors and overall liver-related events (LRE) remains underexplored. This study examines the association between healthy sleep patterns (HSP) and the incidence of LRE, including cirrhosis and liver cancer.

Patients and methods: This prospective cohort study included 356,501 European participants from the UK Biobank. A healthy sleep pattern was assessed using five key parameters: sleep duration, chronotype, insomnia, daytime sleepiness, and snoring. Associations between the healthy sleep score (HSS) and the risk of LRE, cirrhosis, and liver cancer were evaluated using Cox proportional hazards models.

Results: Over a median follow-up of 12.8 years, 2441 incident liver-related events (LRE), 2197 cirrhosis cases, and 661 liver cancer cases were documented. After multivariable adjustment, a healthy sleep score (HSS) of 5 was significantly associated with a 44% reduction in LRE risk (HR=0.56; 95% CI: 0.46-0.70), a 46% reduction in cirrhosis risk (HR=0.54; 95% CI: 0.43-0.67), and a 45% reduction in liver cancer risk (HR=0.55; 95% CI: 0.37-0.80), compared to HSS 0-1. The inverse association between HSS and LRE was more pronounced among younger participants, individuals with prolonged sedentary behavior, and those with diabetes mellitus (P < 0.05).

Conclusions: Adherence to a healthy sleep pattern is independently associated with a reduced risk of liver-related events, cirrhosis, and liver cancer. This association is especially pronounced in younger adults, individuals with prolonged sedentary behavior (>4 h/day), and patients with diabetes.