Annals of hepatology最新文献

英文中文

Natural history and outcomes of MASLD and MetALD following non-alcoholic fatty liver disease reclassification in a Canadian cohort 加拿大非酒精性脂肪性肝病重分类后MASLD和MetALD的自然历史和结局

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-11-27 DOI: 10.1016/j.aohep.2025.102166

Yousef Almahanna , Francisco Idalsoaga , Luis Antonio Díaz , Ahmed Almohsen , Yi Nong Song , Amani Bajunayd , Rokhsana Mortuza , Jeemin Kim , Adrienne Abaya , Mohammad Qasim Khan , Juan Pablo Arab

Introduction and Objectives

Steatotic liver disease (SLD) affects 40 % of North Americans, with some progressing to advanced fibrosis. A recent nomenclature update redefined subtypes, distinguishing Metabolic dysfunction-associated steatotic liver disease (MASLD), Metabolic and alcohol-associated liver disease (MetALD), and alcohol-associated liver disease (ALD). This study aimed to assess the prevalence of MetALD and ALD in a previously Non-alcoholic fatty liver disease (NAFLD) -labeled cohort, evaluate cardiometabolic risk factors, and analyze short-term outcomes.

Materials and Methods

This retrospective observational cohort study included patients referred to a specialized NAFLD clinic in Ontario, Canada (October 2021–September 2023). Adults (age ≥18 years) with radiographic hepatic steatosis were categorized into MASLD, MetALD, or ALD based on gender-specific alcohol consumption thresholds documented in electronic medical records. Baseline characteristics and short-term outcomes were compared across groups.

Results

Among 445 patients, MASLD was most prevalent (88.3 %), followed by MetALD (8.9 %) and ALD (2.7 %). Males predominated in MetALD (67.5 %) and ALD (83.4 %) (p = 0.002). Smoking was strongly linked to ALD (p = 0.001). Diabetes was more common in MASLD (32.5 %, p = 0.012), while hypertension and dyslipidemia showed no significant differences across SLD subtypes. Advanced fibrosis (F3-F4) was present in 16.1 %. In a two-year follow-up, higher mortality incidences were observed in ALD (16.6 %). Additionally, regression of fibrosis was observed across all groups.

Conclusions

11.7 % of patients historically labeled as NAFLD met criteria for MetALD or ALD, underscoring the importance of updated nomenclature. High fibrosis prevalence and ALD-related mortality highlight the need for early screening, precise alcohol assessment, and multidisciplinary care to improve outcomes.

简介和目的：脂肪变性肝病（SLD）影响40%的北美人，其中一些进展为晚期纤维化。最近的命名更新重新定义了亚型，区分了代谢功能障碍相关脂肪变性肝病（MASLD），代谢和酒精相关肝病（MetALD）和酒精相关肝病（ALD）。本研究旨在评估先前非酒精性脂肪性肝病（NAFLD）标记队列中MetALD和ALD的患病率，评估心脏代谢危险因素，并分析短期结果。材料和方法：这项回顾性观察性队列研究纳入了在加拿大安大略省一家NAFLD专科诊所就诊的患者（2021年10月- 2023年9月）。根据电子病历中记录的性别特异性酒精消费阈值，影像学诊断为肝脂肪变性的成人（年龄≥18岁）被分为MASLD、MetALD或ALD。各组间比较基线特征和短期结果。结果：445例患者中，MASLD发生率最高（88.3%），其次为MetALD（8.9%）和ALD（2.7%）。男性以MetALD（67.5%）和ALD（83.4%）为主（p=0.002）。吸烟与ALD密切相关（p=0.001）。糖尿病在MASLD中更为常见（32.5%,p=0.012），而高血压和血脂异常在SLD各亚型间无显著差异。晚期纤维化（F3-F4）占16.1%。在两年的随访中，ALD患者的死亡率较高（16.6%）。此外，在所有组中都观察到纤维化的消退。结论：11.7%既往标记为NAFLD的患者符合MetALD或ALD的标准，强调了更新命名法的重要性。高纤维化患病率和ald相关死亡率强调需要早期筛查、精确的酒精评估和多学科护理来改善预后。

{"title":"Natural history and outcomes of MASLD and MetALD following non-alcoholic fatty liver disease reclassification in a Canadian cohort","authors":"Yousef Almahanna , Francisco Idalsoaga , Luis Antonio Díaz , Ahmed Almohsen , Yi Nong Song , Amani Bajunayd , Rokhsana Mortuza , Jeemin Kim , Adrienne Abaya , Mohammad Qasim Khan , Juan Pablo Arab","doi":"10.1016/j.aohep.2025.102166","DOIUrl":"10.1016/j.aohep.2025.102166","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Steatotic liver disease (SLD) affects 40 % of North Americans, with some progressing to advanced fibrosis. A recent nomenclature update redefined subtypes, distinguishing Metabolic dysfunction-associated steatotic liver disease (MASLD), Metabolic and alcohol-associated liver disease (MetALD), and alcohol-associated liver disease (ALD). This study aimed to assess the prevalence of MetALD and ALD in a previously Non-alcoholic fatty liver disease (NAFLD) -labeled cohort, evaluate cardiometabolic risk factors, and analyze short-term outcomes.</div></div><div><h3>Materials and Methods</h3><div>This retrospective observational cohort study included patients referred to a specialized NAFLD clinic in Ontario, Canada (October 2021–September 2023). Adults (age ≥18 years) with radiographic hepatic steatosis were categorized into MASLD, MetALD, or ALD based on gender-specific alcohol consumption thresholds documented in electronic medical records. Baseline characteristics and short-term outcomes were compared across groups.</div></div><div><h3>Results</h3><div>Among 445 patients, MASLD was most prevalent (88.3 %), followed by MetALD (8.9 %) and ALD (2.7 %). Males predominated in MetALD (67.5 %) and ALD (83.4 %) (<em>p</em> = 0.002). Smoking was strongly linked to ALD (<em>p</em> = 0.001). Diabetes was more common in MASLD (32.5 %, <em>p</em> = 0.012), while hypertension and dyslipidemia showed no significant differences across SLD subtypes. Advanced fibrosis (F3-F4) was present in 16.1 %. In a two-year follow-up, higher mortality incidences were observed in ALD (16.6 %). Additionally, regression of fibrosis was observed across all groups.</div></div><div><h3>Conclusions</h3><div>11.7 % of patients historically labeled as NAFLD met criteria for MetALD or ALD, underscoring the importance of updated nomenclature. High fibrosis prevalence and ALD-related mortality highlight the need for early screening, precise alcohol assessment, and multidisciplinary care to improve outcomes.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102166"},"PeriodicalIF":4.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626953","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

Alarming increase of acute liver failure during Sudan's conflict: a call for urgent global hepatology response. 苏丹冲突期间急性肝衰竭病例惊人增加：呼吁全球肝病学紧急应对。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-11-26 DOI: 10.1016/j.aohep.2025.102167

Mumen Abdalazim Dafallah, Manasik Mamoun

引用次数: 0

Toward standardization and translation of stem cell therapy in liver failure 肝衰竭干细胞治疗的规范化和转化。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-11-26 DOI: 10.1016/j.aohep.2025.102164

Parth Aphale , Himanshu Shekhar , Shashank Dokania

引用次数: 0

Early-life exposure to tobacco smoke and chronic liver disease incidence in adulthood 生命早期接触烟草烟雾与成年期慢性肝病发病率。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-11-26 DOI: 10.1016/j.aohep.2025.102168

Xiaoqin Xu , Jiang Li , Yanqi Fu , Jie Li , Wenqi Shen , Xiao Tan , Jinyi Wu , Ningjian Wang , Yingli Lu , Bin Wang

Introduction and Objectives

Tobacco exposure during critical developmental windows may have lasting health effects, but its role in the development of chronic liver disease (CLD) remains unclear. This study aimed to examine the association between early-life tobacco exposure and CLD incidence in adulthood.

Materials and Methods

We included 429,603 participants without prior liver diseases from the UK Biobank. Information on in utero tobacco exposure and the age of smoking initiation was extracted, categorized as never-smokers, adulthood (≥18 y), adolescence (15–17 y), and childhood (5–14 y). Composite CLD and individual endpoints, including non-alcoholic fatty liver disease (NAFLD), fibrosis/cirrhosis, alcohol-related liver disease (ALD), viral hepatitis, and liver cancer, were ascertained through electronic health records.

Results

After covariate adjustment, in utero tobacco exposure was associated with a greater risk of incident CLD (HR 1.27; 95 % CI 1.21, 1.34). A significant dose-response association was observed between the age of smoking initiation and CLD risk; the HRs (95 % CIs) for smoking initiation in adulthood, adolescence, and childhood were 1.45 (1.36, 1.54), 1.48 (1.40, 1.57), and 1.81 (1.68, 1.96), respectively (P trend <0.001). The results were similar for NAFLD, fibrosis/cirrhosis, and ALD. Participants with both in utero tobacco exposure and smoking initiation in childhood had the highest CLD risk (HR 2.22; 95 % CI 1.98, 2.48). Among participants who started smoking in childhood or adolescence, the risk of CLD was substantially reduced in those with smoking cessation in midlife compared to those who continued smoking. The mediation analysis indicated that metabolic traits including obesity-related traits, lipid profile, and liver function partially explained the association between early-life tobacco exposure and CLD incidence.

Conclusions

In utero and childhood/adolescence exposure to tobacco smoke was associated with an increased risk of CLD later in life.

简介和目的：在关键发育窗口期接触烟草可能对健康产生持久影响，但其在慢性肝病（CLD）发展中的作用尚不清楚。本研究旨在探讨早期吸烟与成年后CLD发病率之间的关系。材料和方法：我们从英国生物银行纳入了429,603名既往无肝脏疾病的参与者。提取子宫内烟草暴露和开始吸烟年龄的信息，分类为从不吸烟者、成年期（≥18岁）、青春期（15-17岁）和儿童期（5-14岁）。通过电子健康记录确定复合CLD和个体终点，包括非酒精性脂肪性肝病（NAFLD）、纤维化/肝硬化、酒精相关性肝病（ALD）、病毒性肝炎和肝癌。结果：经协变量调整后，子宫内接触烟草与CLD发生风险增加相关（HR 1.27; 95% CI 1.21, 1.34）。开始吸烟年龄与CLD风险之间存在显著的剂量-反应相关性；成年期、青春期和儿童期开始吸烟的hr （95% ci）分别为1.45（1.36,1.54）、1.48（1.40,1.57）和1.81 (1.68,1.96)（P趋势）。结论：子宫内和儿童期/青春期接触烟草烟雾与以后生活中CLD风险增加有关。

{"title":"Early-life exposure to tobacco smoke and chronic liver disease incidence in adulthood","authors":"Xiaoqin Xu , Jiang Li , Yanqi Fu , Jie Li , Wenqi Shen , Xiao Tan , Jinyi Wu , Ningjian Wang , Yingli Lu , Bin Wang","doi":"10.1016/j.aohep.2025.102168","DOIUrl":"10.1016/j.aohep.2025.102168","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Tobacco exposure during critical developmental windows may have lasting health effects, but its role in the development of chronic liver disease (CLD) remains unclear. This study aimed to examine the association between early-life tobacco exposure and CLD incidence in adulthood.</div></div><div><h3>Materials and Methods</h3><div>We included 429,603 participants without prior liver diseases from the UK Biobank. Information on in utero tobacco exposure and the age of smoking initiation was extracted, categorized as never-smokers, adulthood (≥18 y), adolescence (15–17 y), and childhood (5–14 y). Composite CLD and individual endpoints, including non-alcoholic fatty liver disease (NAFLD), fibrosis/cirrhosis, alcohol-related liver disease (ALD), viral hepatitis, and liver cancer, were ascertained through electronic health records.</div></div><div><h3>Results</h3><div>After covariate adjustment, in utero tobacco exposure was associated with a greater risk of incident CLD (HR 1.27; 95 % CI 1.21, 1.34). A significant dose-response association was observed between the age of smoking initiation and CLD risk; the HRs (95 % CIs) for smoking initiation in adulthood, adolescence, and childhood were 1.45 (1.36, 1.54), 1.48 (1.40, 1.57), and 1.81 (1.68, 1.96), respectively (<em>P</em> trend <0.001). The results were similar for NAFLD, fibrosis/cirrhosis, and ALD. Participants with both in utero tobacco exposure and smoking initiation in childhood had the highest CLD risk (HR 2.22; 95 % CI 1.98, 2.48). Among participants who started smoking in childhood or adolescence, the risk of CLD was substantially reduced in those with smoking cessation in midlife compared to those who continued smoking. The mediation analysis indicated that metabolic traits including obesity-related traits, lipid profile, and liver function partially explained the association between early-life tobacco exposure and CLD incidence.</div></div><div><h3>Conclusions</h3><div>In utero and childhood/adolescence exposure to tobacco smoke was associated with an increased risk of CLD later in life.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102168"},"PeriodicalIF":4.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145628000","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 epidemiological link: Targeting the gut-liver-kidney axis in hepatorenal disease 超越流行病学联系：针对肝肾疾病的肠-肝-肾轴。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-11-23 DOI: 10.1016/j.aohep.2025.102163

Songhe Chen, Ye Chen, Kai Chen

引用次数: 0

Clinical and molecular implications of antipsychotics in MASLD. 抗精神病药物在MASLD中的临床和分子意义。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-11-15 DOI: 10.1016/j.aohep.2025.102158

Celina Gonzalez, Misael Uribe, Norberto C Chavez-Tapia

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.

代谢功能障碍相关脂肪变性肝病（MASLD），以前称为非酒精性脂肪性肝病（NAFLD），已成为严重精神疾病（SMI）患者的主要合并症，特别是那些使用第二代抗精神病药物（SGAs）治疗的患者。这些药物通过脂肪组织功能障碍、线粒体损伤和肝脂质代谢失调等机制诱导全身代谢紊乱。越来越多的证据表明SGAs是肝功能障碍的重要因素，通过激活甾醇调节元件结合蛋白（SREBPs）、线粒体呼吸功能损伤、低度炎症、AMPK信号通路改变和肠道微生物群失调。总的来说，这些过程促进肝脏脂质积累，胰岛素抵抗，并向非酒精性脂肪性肝炎（NASH）发展。此外，非侵入性生物标志物，如脂肪肝指数（FLI）和FIB-4评分，已被证明在精神病人群的早期筛查和风险分层中具有潜在的效用。总的来说，SGAs通过破坏线粒体稳态、脂质代谢和肠-肝轴通讯在MASLD的发病机制中发挥核心作用。常规肝脏监测应纳入精神病学护理，未来的研究必须侧重于预防和治疗策略，以保护肝功能而不损害精神稳定。

{"title":"Clinical and molecular implications of antipsychotics in MASLD.","authors":"Celina Gonzalez, Misael Uribe, Norberto C Chavez-Tapia","doi":"10.1016/j.aohep.2025.102158","DOIUrl":"10.1016/j.aohep.2025.102158","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102158"},"PeriodicalIF":4.4,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145538794","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 : 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

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 : 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。

{"title":"Real-world BCLC adherence and survival in hepatocellular carcinoma: first prospective study from Central America","authors":"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","doi":"10.1016/j.aohep.2025.102154","DOIUrl":"10.1016/j.aohep.2025.102154","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>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.</div></div><div><h3>Patients and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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) (<em>p</em> < 0.001). Adherent patients had significantly longer median survival (722 vs. 535 days; <em>p</em> = 0.001). Adherence conferred survival benefit in BCLC 0/A (1404 vs. 807 days; <em>p</em> = 0.005) and C (492 vs. 168 days; <em>p</em> = 0.029). Child-Pugh B/C (aOR: 3.82; <em>p</em> < 0.001) and ECOG > 0 (aOR: 5.04; <em>p</em> = 0.022) were associated with adherence, while stages B, C, and D were inversely associated.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102154"},"PeriodicalIF":4.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426527","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 : 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":"2025-10-30","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

Relationship between sleep patterns and incident liver related events: retrospective analysis of prospectively collected data from UK Biobank participants. 睡眠模式与肝脏相关事件之间的关系：对英国生物银行参与者前瞻性收集数据的回顾性分析

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-10-30 DOI: 10.1016/j.aohep.2025.102151

Xiangxia Zeng, Shijia Wang, Peiting Zhang, Ailan Chen, Hongliang Xue

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.

前言和目的：不健康的睡眠模式与肝脏相关事件的风险增加有关，包括发展为晚期肝病。虽然之前的研究将睡眠模式与肝硬化和死亡率联系起来，但睡眠行为与总体肝脏相关事件（LRE）之间的关系仍未得到充分探讨。本研究探讨了健康睡眠模式（HSP）与LRE（包括肝硬化和肝癌）发病率之间的关系。患者和方法：这项前瞻性队列研究包括来自英国生物银行的356501名欧洲参与者。健康的睡眠模式通过五个关键参数进行评估：睡眠时间、睡眠类型、失眠、白天嗜睡和打鼾。使用Cox比例风险模型评估健康睡眠评分（HSS）与LRE、肝硬化和肝癌风险之间的关系。结果：在12.8年的中位随访中，记录了2441例肝脏相关事件（LRE）， 2197例肝硬化和661例肝癌。多变量调整后，与HSS 0-1相比，健康睡眠评分（HSS）为5与LRE风险降低44% （HR=0.56; 95% CI: 0.46-0.70）、肝硬化风险降低46% （HR=0.54; 95% CI: 0.43-0.67）和肝癌风险降低45% （HR=0.55; 95% CI: 0.37-0.80）显著相关。HSS和LRE之间的负相关关系在年轻参与者、久坐行为个体和糖尿病患者中更为明显（P < 0.05）。结论：坚持健康的睡眠模式与降低肝脏相关事件、肝硬化和肝癌的风险独立相关。这种关联在年轻人、久坐行为（每天超过40小时）的个体和糖尿病患者中尤为明显。

{"title":"Relationship between sleep patterns and incident liver related events: retrospective analysis of prospectively collected data from UK Biobank participants.","authors":"Xiangxia Zeng, Shijia Wang, Peiting Zhang, Ailan Chen, Hongliang Xue","doi":"10.1016/j.aohep.2025.102151","DOIUrl":"10.1016/j.aohep.2025.102151","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":" ","pages":"102151"},"PeriodicalIF":4.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426582","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

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Annals of hepatology

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀