Annals of hepatology最新文献_第3页

Reevaluating the clinical course of AMA-positive patients with normal liver enzymes: A large retrospective cohort study 重新评估肝酶正常的ama阳性患者的临床过程：一项大型回顾性队列研究。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-10-24 DOI: 10.1016/j.aohep.2025.102147

Ahmad Yahia , Fadi Abu Baker , Mifleh Tatour , Rawi Hazzan

Introduction and Objectives

The long-term clinical significance of anti-mitochondrial antibody (AMA)-positive patients with normal liver enzymes remains unclear. Despite increasing detection of AMA positivity in asymptomatic individuals, clinicians lack evidence-based protocols for long-term surveillance, and guidelines offer no clear recommendations. This study, the largest of its kind, investigates the natural history, prognostic implications, and risk factors for disease progression in this population.

Materials and Methods

We conducted a retrospective cohort study using a national healthcare database to identify adults (aged 18 years or older) with a positive AMA and normal alkaline phosphatase (ALP) levels between 2002 and 2023. Demographics, laboratory data, and liver-related outcomes were assessed. Multivariate logistic and Cox regression models were used to evaluate predictors of primary biliary cholangitis (PBC), cirrhosis, and hepatic complications.

Results

Among 1018 patients (median follow-up 6.3 years (IQR 2.5–11.5), 76 (7.5 %) developed PBC and 30 (2.9 %) progressed to cirrhosis. Liver-related complications were infrequent: esophageal varices (1.1 %), ascites (1.8 %), hepatocellular carcinoma (0.2 %), and liver transplantation (0.1 %). Higher AMA titers were strongly associated with increased risk of PBC, cirrhosis, and complications, showing a clear titer-dependent gradient. Longitudinal analysis also demonstrated titer-associated increases in ALP and bilirubin over time.

Conclusions

AMA-positive individuals with normal liver enzymes typically experience a benign clinical course. However, high AMA titers identify a subgroup at increased risk for progression to PBC and advanced liver disease. These findings underscore the importance of risk-stratified surveillance strategies in clinical practice, guiding healthcare professionals in the management of their patients.

简介和目的：抗线粒体抗体（AMA）阳性肝酶正常患者的长期临床意义尚不清楚。尽管在无症状个体中检测到的AMA阳性越来越多，但临床医生缺乏基于证据的长期监测方案，指南也没有提供明确的建议。这项研究是同类研究中规模最大的，调查了该人群的自然病史、预后影响和疾病进展的危险因素。材料和方法：我们使用国家卫生保健数据库进行了一项回顾性队列研究，以确定2002年至2023年间AMA阳性和碱性磷酸酶（ALP）水平正常的成年人（18岁或以上）。对人口统计学、实验室数据和肝脏相关结果进行评估。采用多变量logistic和Cox回归模型评估原发性胆管炎（PBC）、肝硬化和肝脏并发症的预测因素。结果：在1018例患者（中位随访6.3年（IQR 2.5-11.5））中，76例（7.5 %）发展为PBC， 30例（2.9 %）发展为肝硬化。肝脏相关并发症少见：食管静脉曲张（1.1 %）、腹水（1.8 %）、肝细胞癌（0.2 %）和肝移植（0.1 %）。较高的AMA滴度与PBC、肝硬化和并发症的风险增加密切相关，显示出明显的滴度依赖性梯度。纵向分析也表明，随着时间的推移，ALP和胆红素的增加与滴度相关。结论：肝酶正常的ama阳性个体通常经历一个良性的临床过程。然而，高AMA滴度确定了一个亚组在PBC和晚期肝病进展的风险增加。这些发现强调了风险分层监测策略在临床实践中的重要性，指导医护人员管理他们的病人。

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引用次数: 0

Prevalence of cirrhotic cardiomyopathy in liver transplant candidates: Impact on pre- and post-transplant mortality 肝移植受者肝硬化心肌病患病率：对移植前和移植后死亡率的影响

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-10-15 DOI: 10.1016/j.aohep.2025.102141

Ignacio Roca , Cecilia Morales , Mariela De Santos , Nicolas Dominguez , Luciana Meza , Manuel Barbero , Lucia Navarro , Omar Galdame , Mario Altieri , Hongqun Liu , Samuel S. Lee , Fernando Cairo , Graciela Reyes

Introduction and Objectives

Cirrhotic cardiomyopathy (CCM) is defined as the presence of cardiac dysfunction in patients with cirrhosis in the absence of pre-existing heart disease. Reported prevalence thus far has varied between 17.5% and 35%, depending on the studies. In 2020, diagnostic criteria were revised based on imaging advances. The aim of this study was to evaluate the prevalence of CCM and its impact on overall mortality on the waiting list and post-transplantation.

Materials and Methods

A prospectively recorded database was retrospectively analyzed. Consecutive adult patients who were evaluated and placed on the waiting list for liver transplantation (LT) from 2019 to 2023 were enrolled. Survival curves for patients with and without cirrhotic cardiomyopathy were constructed using the Kaplan-Meier method, and differences were compared by the Log-rank test. Multiple regression analysis was performed by the Cox proportional hazards model.

Results

A total of 451 patients were assessed, of whom 389 (86.3%) met inclusion criteria. The median age was 55 years (IQR 46–61) with 236 (60.7%) males. The most common etiology of cirrhosis was hepatitis C, 110/389 (28.3%). The prevalence of CCM was 16.2% (63/389). Thirty-seven patients (9.5%) met systolic criteria, and 27 (6.9%) met diastolic criteria for CCM. No mean differences were found in MELD-Na (15, IQR 11–19, vs 14, IQR 10–16.5, p00.1) or decompensations. The presence of hepatocellular carcinoma was higher in the CCM group (44.4% vs. 22.1% p < 0.01).The median overall survival time on the waitlist was longer in the group without CCM compared to that in the CCM group (32 vs 22 months, p = 0.04). In Cox regression analysis, the presence of CCM (HR 1.71 CI95% 1.09–2.68 p00.02), HCC (HR 2.37, CI95% 1.47–3.82 p < 0.001) and higher MELD-Na (HR 1.14 CI95% 1.10–1.18, p < 0.001) were predictors of mortality on the waiting list. There were no significant differences in survival between the groups post-transplantation.

Conclusions

Our study revealed a lower prevalence of CCM in liver transplant candidates compared with previous reports. Moreover, it underscores that CCM was an independent predictor of mortality on a liver transplantation waitlist, highlighting its significant clinical implications. Further research is imperative to elucidate its precise impact on post-transplant survival.

简介和目的：肝硬化心肌病（CCM）被定义为肝硬化患者在没有既往心脏病的情况下存在心功能障碍。到目前为止，根据不同的研究，报告的患病率在17.5%到35%之间。2020年，诊断标准根据影像学进展进行了修订。本研究的目的是评估CCM的患病率及其对等待名单和移植后总死亡率的影响。材料和方法：回顾性分析前瞻性记录的数据库。纳入了2019年至2023年连续评估并列入肝移植（LT）等待名单的成年患者。采用Kaplan-Meier法构建肝硬化和非肝硬化心肌病患者的生存曲线，并通过Log-rank检验比较差异。采用Cox比例风险模型进行多元回归分析。结果：共纳入451例患者，其中389例（86.3%）符合纳入标准。中位年龄55岁（IQR 46-61），男性236例（60.7%）。肝硬化最常见的病因是丙型肝炎，110/389（28.3%）。CCM患病率为16.2%（63/389）。37例（9.5%）患者符合CCM的收缩期标准，27例（6.9%）患者符合舒张期标准。MELD-Na无平均差异（15,IQR 11-19, vs 14, IQR 10-16.5, p0.1）或代偿。CCM组肝细胞癌的发生率更高（44.4% vs 22.1%）。结论：我们的研究显示，与之前的报道相比，CCM在肝移植候选者中的患病率较低。此外，它强调了CCM是肝移植等待名单上死亡率的独立预测因子，强调了其重要的临床意义。进一步的研究阐明其对移植后生存的确切影响是必要的。

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引用次数: 0

Real-world BCLC adherence and survival in hepatocellular carcinoma: first prospective study from Central America 真实世界肝细胞癌BCLC依从性和生存率：来自中美洲的第一项前瞻性研究。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-10-30 DOI: 10.1016/j.aohep.2025.102154

Pablo Coste Murillo , María Fernanda Lynch-Mejía , Wagner Ramírez Quesada , Francisco Vargas Navarro , Vanessa López Jara , Silvia Alfaro Cartín , Ariela Gómez Pérez , Sheila Araya Chavarría , Fabián Araya Madriz , Esteban González González , Irene Mora Quesada , Alejandra Ochoa Palominos , Karen Melissa Rodríguez Masís

Introduction and Objectives

Hepatocellular carcinoma (HCC) is a major global health concern. The Barcelona Clinic Liver Cancer (BCLC) staging system provides evidence-based therapeutic guidance, yet real-world adherence remains suboptimal, particularly in underrepresented regions. This study aimed to evaluate adherence to 2022 BCLC first-line treatment recommendations and associated survival outcomes in a prospective cohort from Costa Rica, the first such study in Central America.

Patients and Methods

A total of 260 patients diagnosed with HCC between September 2018, and June 2024 were prospectively enrolled at a national liver transplant center. Clinical, tumor, and treatment characteristics were recorded. Adherence was defined as concordance with BCLC stage-specific first-line recommendations. Survival and predictors of adherence were analyzed using Kaplan–Meier curves and multivariate logistic regression.

Results

Overall adherence to BCLC first-line recommendations was 47.8 %, varying by stage: 44.9 % (BCLC 0/A), 53.7 % (B), 23.1 % (C), and 93.5 % (D) (p < 0.001). Adherent patients had significantly longer median survival (722 vs. 535 days; p = 0.001). Adherence conferred survival benefit in BCLC 0/A (1404 vs. 807 days; p = 0.005) and C (492 vs. 168 days; p = 0.029). Child-Pugh B/C (aOR: 3.82; p < 0.001) and ECOG > 0 (aOR: 5.04; p = 0.022) were associated with adherence, while stages B, C, and D were inversely associated.

Conclusions

Adherence to BCLC guidelines significantly improves survival in HCC, especially in early and advanced stages. Functional status and liver disease severity were key adherence predictors. Targeted strategies are needed to improve guideline implementation in Central America and other resource-limited settings.

简介和目的：肝细胞癌（HCC）是一个主要的全球健康问题。巴塞罗那诊所肝癌（BCLC）分期系统提供了基于证据的治疗指导，但现实世界的依从性仍然不是最佳的，特别是在代表性不足的地区。该研究旨在评估来自哥斯达黎加的前瞻性队列对2022年BCLC一线治疗建议的依从性和相关的生存结果，这是中美洲的第一个此类研究。患者和方法：在2018年9月至2024年6月期间，共有260名被诊断为HCC的患者被纳入国家肝移植中心。记录临床、肿瘤及治疗特点。依从性被定义为符合BCLC特定阶段的一线建议。使用Kaplan-Meier曲线和多变量logistic回归分析生存率和依从性预测因子。结果：BCLC一线建议的总体依从率为47.8%，不同分期的依从率分别为44.9% （BCLC 0/A）、53.7% (B)、23.1% (C)和93.5% (D) （p < 0.001）。粘附患者的中位生存期明显延长（722天vs. 535天；p = 0.001）。依从性赋予BCLC 0/A患者生存获益（1404天vs. 807天；p = 0.005）和C患者（492天vs. 168天；p = 0.029）。Child-Pugh B/C （aOR: 3.82; p < 0.001）和ECOG > （aOR: 5.04; p = 0.022）与依从性相关，而B、C、D期呈负相关。结论：坚持BCLC指南可显著提高HCC患者的生存率，尤其是在早期和晚期。功能状态和肝脏疾病严重程度是关键的依从性预测指标。需要有针对性的战略来改善指南在中美洲和其他资源有限地区的实施。

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引用次数: 0

Serum IL-6 is a prognostic biomarker for advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab 血清IL-6是阿特唑单抗和贝伐单抗治疗晚期肝细胞癌的预后生物标志物。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-10-11 DOI: 10.1016/j.aohep.2025.102138

Lorenz Kocheise , Jan Kempski , Yunhe Tang , Lorenz Balcar , Victoria Berger , Miriam Tomczak , Joao Gorgulho , Ramsha Masood , Franziska Giehren , Constantin Schmidt , Jan P. Sutter , Thorben W. Fruendt , Francesca Pagani , Sophie Wulf , Julian Kött , Saskia Domanig , Anastasios Giannou , Tanja Bedke , Jöran Lücke , Tao Zhang , Kornelius Schulze

Introduction and Objectives

Immunotherapy with atezolizumab/bevacizumab (atezo/bev) is an established first-line treatment for patients with non-resectable hepatocellular carcinoma (HCC). Despite notable successes, only a subset of patients shows treatment response, highlighting the need for biomarkers to identify those likely to benefit from this therapy.

Materials and Methods

In this biomarker study, 143 patients with atezo/bev-treated HCC were enrolled across three European centers. Baseline cytokine levels were measured using a flow cytometric multiplex bead assay. Overall survival (OS) analysis, reported as hazard ratios (HR), was conducted in an unbiased manner, with patients divided into a discovery cohort (one center, 63 patients) and a validation cohort (two centers, 80 patients).

Results

Our cohorts show typical baseline characteristics of Western HCC patients, with alcohol-related liver disease (35.0 %) and hepatitis C (21.7 %) as the main HCC etiologies. Elevated serum IL-6 (cut-off 18.22 pg/ml) was associated with poor OS in both the discovery (HR 2.6, 95 % CI 1.2–5.6, p = 0.013) and validation cohorts (HR 2.4, 95 % CI 1.3–4.4, p = 0.005). Multivariate analysis confirmed elevated IL-6 to be a significant prognostic biomarker of poor OS (HR 2.1, 95 % CI 1.1–3.9, p = 0.021) after adjusting for established risk factors.

Conclusions

We identify elevated serum IL-6 levels as prognostic biomarker in patients with advanced HCC in Western countries. Importantly, this association was independent of infection with viral hepatitis, thus extending the previously reported associations between IL-6 and treatment response in East Asian cohorts.

简介和目的：atezolizumab/bevacizumab （atezo/bev）免疫治疗是不可切除肝细胞癌（HCC）患者的一线治疗方法。尽管取得了显著的成功，但只有一小部分患者显示出治疗反应，这突出表明需要生物标志物来识别可能从这种治疗中受益的患者。材料和方法：在这项生物标志物研究中，来自三个欧洲中心的143例atezo/bev治疗的HCC患者入组。基线细胞因子水平用流式细胞术测定。以风险比（HR）报告的总生存期（OS）分析以无偏方式进行，将患者分为发现队列（1个中心，63例患者）和验证队列（2个中心，80例患者）。结果：我们的队列显示了典型的西方HCC患者的基线特征，酒精相关性肝病（35.0%）和丙型肝炎（21.7%）是主要的HCC病因。在发现组（HR 2.6, 95% CI 1.2-5.6, p = 0.013）和验证组（HR 2.4, 95% CI 1.3-4.4, p = 0.005）中，血清IL-6升高（截止值18.22 pg/ml）与不良OS相关。多因素分析证实，在调整已确定的危险因素后，IL-6升高是不良OS的重要预后生物标志物（HR 2.1, 95% CI 1.1-3.9, p = 0.021）。结论：我们发现血清IL-6水平升高是西方国家晚期HCC患者的预后生物标志物。重要的是，这种关联与病毒性肝炎感染无关，从而扩展了之前报道的东亚队列中IL-6与治疗反应之间的关联。

{"title":"Serum IL-6 is a prognostic biomarker for advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab","authors":"Lorenz Kocheise , Jan Kempski , Yunhe Tang , Lorenz Balcar , Victoria Berger , Miriam Tomczak , Joao Gorgulho , Ramsha Masood , Franziska Giehren , Constantin Schmidt , Jan P. Sutter , Thorben W. Fruendt , Francesca Pagani , Sophie Wulf , Julian Kött , Saskia Domanig , Anastasios Giannou , Tanja Bedke , Jöran Lücke , Tao Zhang , Kornelius Schulze","doi":"10.1016/j.aohep.2025.102138","DOIUrl":"10.1016/j.aohep.2025.102138","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Immunotherapy with atezolizumab/bevacizumab (atezo/bev) is an established first-line treatment for patients with non-resectable hepatocellular carcinoma (HCC). Despite notable successes, only a subset of patients shows treatment response, highlighting the need for biomarkers to identify those likely to benefit from this therapy.</div></div><div><h3>Materials and Methods</h3><div>In this biomarker study, 143 patients with atezo/bev-treated HCC were enrolled across three European centers. Baseline cytokine levels were measured using a flow cytometric multiplex bead assay. Overall survival (OS) analysis, reported as hazard ratios (HR), was conducted in an unbiased manner, with patients divided into a discovery cohort (one center, 63 patients) and a validation cohort (two centers, 80 patients).</div></div><div><h3>Results</h3><div>Our cohorts show typical baseline characteristics of Western HCC patients, with alcohol-related liver disease (35.0 %) and hepatitis C (21.7 %) as the main HCC etiologies. Elevated serum IL-6 (cut-off 18.22 pg/ml) was associated with poor OS in both the discovery (HR 2.6, 95 % CI 1.2–5.6, p = 0.013) and validation cohorts (HR 2.4, 95 % CI 1.3–4.4, p = 0.005). Multivariate analysis confirmed elevated IL-6 to be a significant prognostic biomarker of poor OS (HR 2.1, 95 % CI 1.1–3.9, p = 0.021) after adjusting for established risk factors.</div></div><div><h3>Conclusions</h3><div>We identify elevated serum IL-6 levels as prognostic biomarker in patients with advanced HCC in Western countries. Importantly, this association was independent of infection with viral hepatitis, thus extending the previously reported associations between IL-6 and treatment response in East Asian cohorts.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102138"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Beyond the association: towards an integrated hepato–renal approach 超越关联：走向肝肾一体化方法。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-11-12 DOI: 10.1016/j.aohep.2025.102155

Juanita Pérez-Escobar , Ricardo Ivan Velazquez-Silva , Paulina Carpinteyro-Espin , José Carlos Gasca-Aldama

引用次数: 0

Trends and health inequalities of hepatitis virus-associated liver cancer mortality during 1990–2050 1990-2050年期间肝炎病毒相关肝癌死亡率的趋势和保健不平等。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-10-24 DOI: 10.1016/j.aohep.2025.102144

Yujiao Deng , Jingyue Tan , Jian Zu , Zixuan Xing , Zhanpeng Yang , Yue Zhang , Yajing Bo , Xu Gao , Enrui Xie , Yuan Wang , Meijuan Han , Fanpu Ji , Yang Yang

Introduction and Objectives

Liver cancer (LC) is a leading cause of cancer-related deaths worldwide. Hepatitis B/C virus -associated LC (HBC/HCC) remains the primary cause of liver cancer, and it imposes a heavy burden on public health. This study aimed to estimate the mortality and health inequalities of hepatitis B/C virus (HBV/HCV)-associated LC at the global, regional and national levels to provide guidance to reduce the mortality burden of LC.

Materials and Methods

We extracted the HBV/HCV-associated LC mortality data from the GBD 2021 study during 1990–2021 and analyzed its temporal and spatial trends and forecasted to 2050. Average annual percent change (AAPC) was calculated by joinpoint regression to evaluate the variation of ASMRs, and factors impacting mortality were evaluated through decomposition analysis. The Bayesian spatiotemporal model was used to fit the relationship between age-standardized mortality rate (ASMR) of 204 countries/territories and spatial effects, temporal effects, and spatio-temporal interaction effects. Frontier analysis was conducted to evaluate the minimum achievable ASMR in each country or territory by 2050 and its potential space for ASMR improvement in 2050.

Results

Globally, LC deaths doubled from 238,969 in 1990 to 483,875 in 2021. Compared with 1990, the proportions of HBV and HCV in the mortality rate of LC in 2021 were 37.45 % and 30.28 %, corresponding to a decrease of 7.13 % and an increase of 3.44 %, respectively. From 1990 to 2021, the global ASMR of LC (AAPC:0.11, 95 % CI:0.35 to 0.12) and LCC (AAPC: 0.05, 95 % CI:0.26 to 0.36) remained stable, while LCB decreased (AAPC:0.54, 95 % CI:0.81 to -0.27). ASMRs for LC and LCB was the highest in the Western Pacific Region (WPR), but significant declines were observed. The highest ASMR of LCB and LCC shifted from WPR to the Eastern Mediterranean Region (EMR). It is expected that the global ASMR of LC will decrease by 2050. From 1990 to 2021, population growth and age structure were the primary drivers for the increase of LC mortality globally and in Southeast Asia, and age structure is projected to remain a key factor until 2050.

Conclusions

Hepatitis virus-related LC remains a serious health issue worldwide, with regional variations. Asia contributes the most LC-related deaths. The WPR had the highest ASMR for LC and LCB. ASMR for LC showed the fastest decrease in WPR. For women, Africa had the highest ASMR for LC and LCB, while the Americas had the lowest ASMR for LC. The highest ASMR for LCC shifted from the WPR to the EMR during 1990–2021.

简介和目的：肝癌（LC）是世界范围内癌症相关死亡的主要原因。乙型/丙型肝炎病毒相关LC （HBC/HCC）仍然是肝癌的主要病因，对公共卫生造成沉重负担。本研究旨在估计乙型/丙型肝炎病毒（HBV/HCV）相关的LC在全球、区域和国家层面的死亡率和健康不平等，为减轻LC的死亡率负担提供指导。材料和方法：从GBD 2021研究中提取1990-2021年HBV/ hcv相关的LC死亡率数据，分析其时空趋势并预测到2050年。采用连接点回归计算平均年变化百分率（AAPC）评价ASMRs的变化，采用分解分析评价影响死亡率的因素。采用贝叶斯时空模型拟合204个国家/地区的年龄标准化死亡率（ASMR）与空间效应、时间效应和时空交互效应的关系。通过前沿分析，评估各国或地区到2050年可达到的最低ASMR，以及2050年ASMR的潜在提升空间。结果：全球范围内，LC死亡人数从1990年的238,969人增加到2021年的483,875人，翻了一番。与1990年相比，2021年HBV和HCV在LC死亡率中的比例分别为37.45%和30.28%，分别下降了7.13%和3.44%。从1990年到2021年，LC （AAPC: -0.11, 95% CI: -0.35 ~ 0.12）和LCC （AAPC: 0.05, 95% CI: -0.26 ~ 0.36）的全球ASMR保持稳定，而LCB下降（AAPC: -0.54, 95% CI: -0.81 ~ -0.27）。在西太平洋区域（WPR）， LC和LCB的asmr最高，但也有显著下降。LCB和LCC的最高ASMR由WPR向东地中海地区（EMR）转移。预计到2050年，全球LC的ASMR将下降。从1990年到2021年，人口增长和年龄结构是全球和东南亚LC死亡率上升的主要驱动因素，预计到2050年，年龄结构仍将是一个关键因素。结论：肝炎病毒相关的LC在世界范围内仍然是一个严重的健康问题，但存在地区差异。亚洲是死亡人数最多的地区。WPR对LC和LCB的ASMR最高。LC的ASMR显示WPR下降最快。对于女性来说，非洲的男性男性和女性男性男性的男性男性比例最高，而美洲的女性男性男性比例最低。在1990-2021年期间，LCC的最高ASMR从WPR转移到EMR。

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引用次数: 0

Serum bilirubin concentrations and their association with clinical and radiological outcomes in multiple sclerosis: A large cohort study 血清胆红素浓度及其与多发性硬化症临床和放射预后的关系：一项大型队列研究。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-09-22 DOI: 10.1016/j.aohep.2025.102117

Tomáš Uher , Pavlína Kleinová , Jana Woronyczová , Lubomír Štěpánek , Manuela Vaněčková , Jan Krásenský , Renata Cífková , Dana Horáková , Eva Havrdová , David Hoskovec , Martin Leníček , Libor Vítek

Introduction and Objectives

Bilirubin is negatively associated with neurodegenerative diseases, including multiple sclerosis (MS). Since previous studies were small or did not evaluate all diagnostic aspects, the objective of the present study was to assess a large cohort of MS patients with multiple determinations of serum bilirubin.

Patients and Methods

The study was carried out in 2,696 consecutive MS patients (median age=37.1 years, disease duration=6.8 years, follow-up duration=7.2 years, and Expanded Disability Status Scale (EDSS)=2.5) with 28,501 visits. Individuals from the Czech post-MONICA study representing the general Czech population (n=2,621) were used as controls. Serum bilirubin concentrations in study subjects were compared with multiple diagnostic and clinical parameters.

Results

Serum bilirubin concentrations in MS patients were significantly lower compared to the general population (8.3 vs. 9.6 μmol/L, P<0.001). Hyperbilirubinemia >17 µmol/L in MS patients was much less frequent compared to the general population (8.2 vs. 12.5%, P<0.001). An increase in disease duration by 10 years was associated with an 8% decrease in bilirubin concentration (p<0.0001). Ten percent higher serum bilirubin concentration was associated with a 9% decrease in EDSS (p=0.001) and a 2.1% increase in normalized brain volume (p<0.0001). The frequencies of individual UGT1A1 (TA)n/n genotypes did not differ between MS patients and the control population.

Conclusions

MS patients have markedly lower serum bilirubin concentrations, most likely due to consumption during the increased oxidative stress since the frequencies of UGT1A1 were comparable in the MS and control populations. Higher serum bilirubin is associated with lower disability and lower brain atrophy.

简介和目的：胆红素与神经退行性疾病，包括多发性硬化症（MS）负相关。由于先前的研究规模较小或没有评估所有诊断方面，本研究的目的是评估具有多种血清胆红素测定的MS患者的大队列。患者和方法：研究纳入2,696例连续MS患者（中位年龄=37.1岁，病程=6.8年，随访时间=7.2年，扩展残疾状态量表(EDSS)=2.5），共28,501次就诊。来自捷克monica后研究的个体代表捷克一般人群（n=2,621）作为对照。研究对象的血清胆红素浓度与多种诊断和临床参数进行比较。结果：MS患者血清胆红素浓度明显低于普通人群（8.3 μmol/L vs. 9.6 μmol/L）， MS患者血清胆红素浓度明显低于普通人群（8.2 μmol/L vs. 12.5%）。结论：MS患者血清胆红素浓度明显较低，很可能是由于氧化应激增加期间的消耗，因为UGT1A1的频率在MS和对照组人群中是相当的。较高的血清胆红素与较低的残疾和较低的脑萎缩有关。

{"title":"Serum bilirubin concentrations and their association with clinical and radiological outcomes in multiple sclerosis: A large cohort study","authors":"Tomáš Uher , Pavlína Kleinová , Jana Woronyczová , Lubomír Štěpánek , Manuela Vaněčková , Jan Krásenský , Renata Cífková , Dana Horáková , Eva Havrdová , David Hoskovec , Martin Leníček , Libor Vítek","doi":"10.1016/j.aohep.2025.102117","DOIUrl":"10.1016/j.aohep.2025.102117","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Bilirubin is negatively associated with neurodegenerative diseases, including multiple sclerosis (MS). Since previous studies were small or did not evaluate all diagnostic aspects, the objective of the present study was to assess a large cohort of MS patients with multiple determinations of serum bilirubin.</div></div><div><h3>Patients and Methods</h3><div>The study was carried out in 2,696 consecutive MS patients (median age=37.1 years, disease duration=6.8 years, follow-up duration=7.2 years, and Expanded Disability Status Scale (EDSS)=2.5) with 28,501 visits. Individuals from the Czech post-MONICA study representing the general Czech population (n=2,621) were used as controls. Serum bilirubin concentrations in study subjects were compared with multiple diagnostic and clinical parameters.</div></div><div><h3>Results</h3><div>Serum bilirubin concentrations in MS patients were significantly lower compared to the general population (8.3 vs. 9.6 μmol/L, P<0.001). Hyperbilirubinemia >17 µmol/L in MS patients was much less frequent compared to the general population (8.2 vs. 12.5%, P<0.001). An increase in disease duration by 10 years was associated with an 8% decrease in bilirubin concentration (p<0.0001). Ten percent higher serum bilirubin concentration was associated with a 9% decrease in EDSS (p=0.001) and a 2.1% increase in normalized brain volume (p<0.0001). The frequencies of individual UGT1A1 (TA)n/n genotypes did not differ between MS patients and the control population.</div></div><div><h3>Conclusions</h3><div>MS patients have markedly lower serum bilirubin concentrations, most likely due to consumption during the increased oxidative stress since the frequencies of UGT1A1 were comparable in the MS and control populations. Higher serum bilirubin is associated with lower disability and lower brain atrophy.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102117"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Alpha-1 antitrypsin Pi*MZ variant increases the risk of liver disease progression in MASLD and MASH α -1抗胰蛋白酶Pi*MZ变异增加MASLD和MASH中肝脏疾病进展的风险。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-10-22 DOI: 10.1016/j.aohep.2025.102143

Bradley Jermy , Jack Brownrigg , Pavel Strnad , Rohit Loomba

Introduction and Objectives

Most investigational treatments for metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) show modest anti-fibrotic effects, likely due to a multifactorial aetiology. The Pi*Z mutation in SERPINA1 can lead to proteotoxic liver injury and progressive chronic liver disease. Here, we investigate whether the SERPINA1 Z mutation is associated with disease progression in MASLD/MASH.

Patients and Methods

A population of MASLD/MASH patients of European ancestry was identified in the UK Biobank using ICD-10 codes (N = 6319). We estimated odds ratios (OR) for advanced liver disease (composite of incident cirrhosis, hepatic decompensation, and liver-related death/transplant) with the MZ genotype. ORs were compared with metabolic risk factors (RFs; obesity, dyslipidaemia, hypertension, and type 2 diabetes) and established genetic RFs (PNPLA3, HSD17B13, and TM6SF2).

Results

Some individuals (7.9%) experienced advanced liver disease. The MZ genotype prevalence was greater in individuals who experienced advanced liver disease (7.6% vs 3.9%). After adjustment for established metabolic and genetic RFs, advanced liver disease was significantly associated with the MZ genotype (OR 2.01; 95% CI, 1.38–2.92). We replicated known associations in all genetic and metabolic RFs. The MZ genotype (OR 1.90; 1.33–2.73) was a risk equivalent to ≥2 metabolic RFs (OR 1.74; 1.44–2.09) and PNPLA3 (OR 1.32; 1.15–1.51).

Conclusions

Carriage of the Pi*Z mutation significantly affects the risk of future clinical outcomes among individuals with MASLD/MASH. The MZ genotype confers a risk equivalent to established RFs in MASLD/MASH, underscoring the importance of screening and further work to understand the underlying mechanisms.

简介和目的：大多数代谢功能障碍相关脂肪性肝病（MASLD）和代谢功能障碍相关脂肪性肝炎（MASH）的研究性治疗显示出适度的抗纤维化作用，可能是由于多因素病因。SERPINA1的Pi*Z突变可导致蛋白毒性肝损伤和进行性慢性肝病。在这里，我们研究SERPINA1 Z突变是否与MASLD/MASH的疾病进展相关。患者和方法：在英国生物银行使用ICD-10代码（N=6319）鉴定了欧洲血统的MASLD/MASH患者群体。我们估计了MZ基因型晚期肝病（合并肝硬化、肝功能失代偿和肝脏相关死亡/移植）的优势比（OR）。将ORs与代谢危险因素（rf；肥胖、血脂异常、高血压和2型糖尿病）和已建立的遗传rf （PNPLA3、HSD17B13和TM6SF2）进行比较。结果：部分患者（7.9%）出现晚期肝病。MZ基因型在晚期肝病患者中的患病率更高（7.6% vs 3.9%）。在对已建立的代谢和遗传RFs进行调整后，晚期肝病与MZ基因型显著相关（OR 2.01; 95% CI, 1.38-2.92）。我们在所有遗传和代谢RFs中复制了已知的关联。MZ基因型（OR 1.90; 1.33-2.73）与代谢RFs≥2 （OR 1.74; 1.44-2.09）和PNPLA3 （OR 1.32; 1.15-1.51）的风险相当。结论：携带Pi*Z突变显著影响MASLD/MASH患者未来临床结局的风险。MZ基因型的风险与MASLD/MASH中已建立的RFs相当，强调了筛查和进一步了解潜在机制的重要性。

{"title":"Alpha-1 antitrypsin Pi*MZ variant increases the risk of liver disease progression in MASLD and MASH","authors":"Bradley Jermy , Jack Brownrigg , Pavel Strnad , Rohit Loomba","doi":"10.1016/j.aohep.2025.102143","DOIUrl":"10.1016/j.aohep.2025.102143","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Most investigational treatments for metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) show modest anti-fibrotic effects, likely due to a multifactorial aetiology. The Pi*Z mutation in <em>SERPINA1</em> can lead to proteotoxic liver injury and progressive chronic liver disease. Here, we investigate whether the <em>SERPINA1</em> Z mutation is associated with disease progression in MASLD/MASH.</div></div><div><h3>Patients and Methods</h3><div>A population of MASLD/MASH patients of European ancestry was identified in the UK Biobank using ICD-10 codes (<em>N</em> = 6319). We estimated odds ratios (OR) for advanced liver disease (composite of incident cirrhosis, hepatic decompensation, and liver-related death/transplant) with the MZ genotype. ORs were compared with metabolic risk factors (RFs; obesity, dyslipidaemia, hypertension, and type 2 diabetes) and established genetic RFs (<em>PNPLA3, HSD17B13</em>, and <em>TM6SF2</em>).</div></div><div><h3>Results</h3><div>Some individuals (7.9%) experienced advanced liver disease. The MZ genotype prevalence was greater in individuals who experienced advanced liver disease (7.6% vs 3.9%). After adjustment for established metabolic and genetic RFs, advanced liver disease was significantly associated with the MZ genotype (OR 2.01; 95% CI, 1.38–2.92). We replicated known associations in all genetic and metabolic RFs. The MZ genotype (OR 1.90; 1.33–2.73) was a risk equivalent to ≥2 metabolic RFs (OR 1.74; 1.44–2.09) and <em>PNPLA3</em> (OR 1.32; 1.15–1.51).</div></div><div><h3>Conclusions</h3><div>Carriage of the Pi*Z mutation significantly affects the risk of future clinical outcomes among individuals with MASLD/MASH. The MZ genotype confers a risk equivalent to established RFs in MASLD/MASH, underscoring the importance of screening and further work to understand the underlying mechanisms.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102143"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pancreatic involvement and its prognostic impact in acute-on-chronic liver failure 急性-慢性肝衰竭患者胰腺受累及其预后影响。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-11-26 DOI: 10.1016/j.aohep.2025.102165

Georg Kramer , Vlad Taru , Benedikt Simbrunner , Lorenz Balcar , Nina Dominik , Benedikt Silvester Hofer , Lukas Hartl , Mathias Jachs , Georg Semmler , Christian Sebesta , Paul Thöne , Marlene Hintersteininger , Mathias Schneeweiss-Gleixner , Philipp Schwabl , Michael Trauner , Mattias Mandorfer , Thomas Reiberger

Introduction and Objectives

Acute-on-chronic liver failure (ACLF) in cirrhotic patients is marked by a multiorgan failure and high mortality. The role of the pancreas in ACLF is poorly understood. This study evaluated the prevalence, progression and prognostic impact of elevated lipase (eLIP) and amylase (eAMY) in ACLF.

Patients and Methods

We retrospectively analyzed ACLF patients (EASL-CLIF criteria) at the Vienna General Hospital (11/2003–11/2022). eLIP and eAMY were defined as levels ≥3 times the upper limit of normal. Data were collected before ACLF onset, at diagnosis (D0), and on days 7 (D7), 28 (D28), and 90 (D90) post-diagnosis. Factors associated with eLIP were identified using univariable logistic regression, and survival was examined with uni- and adjusted multivariable Cox regression models.

Results

Among 193 patients, D28 and D90 mortalities were 39.9% and 53.9%, respectively. At D0, lipase and (alpha-)amylase elevations were found in 43.5% and 50.2% of patients, with strong correlation (Spearman’s rho: 0.687; p<0.001). eLIP was observed in 8.8% at D0 and 15.7% at D7. At D0, impaired circulation (MAP <70 mmHg, odds ratio [OR] 4.41; p=0.048) and kidney failure (OR 6.31; p=0.030) were linked to eLIP, and circulatory failure at D0 (OR 3.30; p=0.012) to D7 eLIP. Although D0 enzyme levels did not prognosticate mortality, eLIP at D7 independently predicted D28 (adjusted hazard ratio [aHR]: 2.15; p=0.031) and D90 mortality (aHR 2.14; p=0.011).

Conclusions

Increased lipase and (alpha-)amylase levels are common in ACLF. Notably, lipase levels ≥3x ULN at ACLF-D7 predict mortality independent from liver function, suggesting a role in disease progression.

简介和目的：肝硬化患者的急性慢性肝衰竭（ACLF）以多器官衰竭和高死亡率为特征。胰腺在ACLF中的作用尚不清楚。本研究评估了ACLF中脂肪酶（eLIP）和淀粉酶（eAMY）升高的患病率、进展和预后影响。患者和方法：我们回顾性分析了维也纳总医院（2003年11月- 2022年11月）的ACLF患者（EASL-CLIF标准）。eLIP和eAMY升高被定义为≥正常上限的3倍。数据收集于ACLF发病前、诊断时（D0）、诊断后第7天（D7）、28天（D28）和90天（D90）。使用单变量逻辑回归确定与eLIP相关的因素，并使用单变量和调整后的多变量Cox回归模型检查生存率。结果：193例患者中，D28和D90病死率分别为39.9%和53.9%。在D0时，脂肪酶和（α -）淀粉酶升高分别在43.5%和50.2%的患者中发现，两者具有很强的相关性（Spearman’s ρ: 0.687）。结论：脂肪酶和（α -）淀粉酶水平升高在ACLF中很常见。值得注意的是，脂肪酶水平≥3倍ULN的ACLF-D7预测死亡率独立于肝功能，提示在疾病进展中的作用。

{"title":"Pancreatic involvement and its prognostic impact in acute-on-chronic liver failure","authors":"Georg Kramer , Vlad Taru , Benedikt Simbrunner , Lorenz Balcar , Nina Dominik , Benedikt Silvester Hofer , Lukas Hartl , Mathias Jachs , Georg Semmler , Christian Sebesta , Paul Thöne , Marlene Hintersteininger , Mathias Schneeweiss-Gleixner , Philipp Schwabl , Michael Trauner , Mattias Mandorfer , Thomas Reiberger","doi":"10.1016/j.aohep.2025.102165","DOIUrl":"10.1016/j.aohep.2025.102165","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Acute-on-chronic liver failure (ACLF) in cirrhotic patients is marked by a multiorgan failure and high mortality. The role of the pancreas in ACLF is poorly understood. This study evaluated the prevalence, progression and prognostic impact of elevated lipase (eLIP) and amylase (eAMY) in ACLF.</div></div><div><h3>Patients and Methods</h3><div>We retrospectively analyzed ACLF patients (EASL-CLIF criteria) at the Vienna General Hospital (11/2003–11/2022). eLIP and eAMY were defined as levels ≥3 times the upper limit of normal. Data were collected before ACLF onset, at diagnosis (D0), and on days 7 (D7), 28 (D28), and 90 (D90) post-diagnosis. Factors associated with eLIP were identified using univariable logistic regression, and survival was examined with uni- and adjusted multivariable Cox regression models.</div></div><div><h3>Results</h3><div>Among 193 patients, D28 and D90 mortalities were 39.9% and 53.9%, respectively. At D0, lipase and (alpha-)amylase elevations were found in 43.5% and 50.2% of patients, with strong correlation (Spearman’s rho: 0.687; p<0.001). eLIP was observed in 8.8% at D0 and 15.7% at D7. At D0, impaired circulation (MAP <70 mmHg, odds ratio [OR] 4.41; p=0.048) and kidney failure (OR 6.31; p=0.030) were linked to eLIP, and circulatory failure at D0 (OR 3.30; p=0.012) to D7 eLIP. Although D0 enzyme levels did not prognosticate mortality, eLIP at D7 independently predicted D28 (adjusted hazard ratio [aHR]: 2.15; p=0.031) and D90 mortality (aHR 2.14; p=0.011).</div></div><div><h3>Conclusions</h3><div>Increased lipase and (alpha-)amylase levels are common in ACLF. Notably, lipase levels ≥3x ULN at ACLF-D7 predict mortality independent from liver function, suggesting a role in disease progression.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102165"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term albumin treatment for decompensated cirrhosis in Italy: A propensity score-matched, retrospective, real-world chart analysis 长期白蛋白治疗失代偿肝硬化在意大利：倾向评分匹配，回顾性，现实世界的图表分析。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2026-01-01 Epub Date: 2025-10-30 DOI: 10.1016/j.aohep.2025.102153

Wim Laleman , Jonel Trebicka , Alastair O’Brien , Giacomo Zaccherini , Paolo Caraceni , Joana F. Rodrigues , Xiang Zhang , Maebh Kelly , Kyle Rodney , Sofia Schweiger , Paolo Angeli

Introduction and Objectives

International guidelines recommend short-term albumin in specific acute conditions related to decompensated cirrhosis. Recent data from the large-scale ANSWER trial suggest long-term albumin (LTA) can be beneficial in selected patients. This study compared clinical outcomes in patients with decompensated cirrhosis in Italy, treated with LTA plus standard of care (SOC; LTA cohort) versus SOC alone (non-LTA cohort).

Materials and Methods

A retrospective chart analysis assessed patients with decompensated cirrhosis and ascites, receiving LTA (regular albumin, ≥40 g per infusion per week) plus SOC (albumin administered for acute complications) versus SOC alone. Propensity score matching was used to balance the cohorts. The primary endpoint was the incidence of therapeutic paracentesis.

Results

Overall, 311 charts were screened; 125 matched pairs in the LTA and non-LTA cohorts were analyzed. The incidence per patient per year of therapeutic paracentesis procedures was significantly reduced in the LTA cohort versus the non-LTA cohort (-47.8 %; p < 0.001). The incidence per patient per year of refractory ascites (-44.2 %; p = 0.018), spontaneous bacterial peritonitis (-52.7 %; p = 0.009), and hepatorenal syndrome (-62.6 %; p = 0.003), as well as duration of hospitalization per patient per year for cirrhosis-related complications (-35.0 %; p = 0.015), were also significantly reduced in the LTA cohort versus the non-LTA cohort. There were no significant differences between cohorts in the incidence per patient per year of hospital admissions for cirrhosis-related complications (-24.6 %; p = 0.050) and hepatic encephalopathy (-13.1 %; p = 0.605).

Conclusions

This real-world study provides evidence that LTA can improve the care of patients with decompensated cirrhosis and may reduce related healthcare burden.

简介和目的：国际指南推荐短期白蛋白用于与失代偿期肝硬化相关的特定急性疾病。最近来自大规模ANSWER试验的数据表明，长期白蛋白（LTA）对选定的患者是有益的。这项研究比较了意大利失代偿性肝硬化患者接受LTA加标准治疗（SOC； LTA队列）与单独使用SOC（非LTA队列）的临床结果。材料和方法：回顾性图表分析评估了失代偿性肝硬化和腹水患者，接受LTA（常规白蛋白，每周输注≥40 g）加SOC（急性并发症给予白蛋白）与单独SOC。使用倾向评分匹配来平衡队列。主要终点是治疗性穿刺的发生率。结果：共筛选病例311例；对LTA组和非LTA组的125对配对组进行分析。与非LTA组相比，LTA组患者每年治疗性穿刺手术的发生率显著降低（-47.8%）。结论：这项现实世界的研究提供了证据，证明LTA可以改善失代偿期肝硬化患者的护理，并可能减轻相关的医疗负担。

{"title":"Long-term albumin treatment for decompensated cirrhosis in Italy: A propensity score-matched, retrospective, real-world chart analysis","authors":"Wim Laleman , Jonel Trebicka , Alastair O’Brien , Giacomo Zaccherini , Paolo Caraceni , Joana F. Rodrigues , Xiang Zhang , Maebh Kelly , Kyle Rodney , Sofia Schweiger , Paolo Angeli","doi":"10.1016/j.aohep.2025.102153","DOIUrl":"10.1016/j.aohep.2025.102153","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>International guidelines recommend short-term albumin in specific acute conditions related to decompensated cirrhosis. Recent data from the large-scale ANSWER trial suggest long-term albumin (LTA) can be beneficial in selected patients. This study compared clinical outcomes in patients with decompensated cirrhosis in Italy, treated with LTA plus standard of care (SOC; LTA cohort) versus SOC alone (non-LTA cohort).</div></div><div><h3>Materials and Methods</h3><div>A retrospective chart analysis assessed patients with decompensated cirrhosis and ascites, receiving LTA (regular albumin, ≥40 g per infusion per week) plus SOC (albumin administered for acute complications) versus SOC alone. Propensity score matching was used to balance the cohorts. The primary endpoint was the incidence of therapeutic paracentesis.</div></div><div><h3>Results</h3><div>Overall, 311 charts were screened; 125 matched pairs in the LTA and non-LTA cohorts were analyzed. The incidence per patient per year of therapeutic paracentesis procedures was significantly reduced in the LTA cohort versus the non-LTA cohort (-47.8 %; <em>p</em> < 0.001). The incidence per patient per year of refractory ascites (-44.2 %; <em>p</em> = 0.018), spontaneous bacterial peritonitis (-52.7 %; <em>p</em> = 0.009), and hepatorenal syndrome (-62.6 %; <em>p</em> = 0.003), as well as duration of hospitalization per patient per year for cirrhosis-related complications (-35.0 %; <em>p</em> = 0.015), were also significantly reduced in the LTA cohort versus the non-LTA cohort. There were no significant differences between cohorts in the incidence per patient per year of hospital admissions for cirrhosis-related complications (-24.6 %; <em>p</em> = 0.050) and hepatic encephalopathy (-13.1 %; <em>p</em> = 0.605).</div></div><div><h3>Conclusions</h3><div>This real-world study provides evidence that LTA can improve the care of patients with decompensated cirrhosis and may reduce related healthcare burden.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102153"},"PeriodicalIF":4.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0