Pub Date : 2025-10-27DOI: 10.1016/j.aohep.2025.102149
Jorge Emilio Lira-Vera , Ángel Daniel Santana-Vargas , Gabriela Gutiérrez-Reyes , Oscar Morales-Gutiérrez , María de Fátima Higuera-de la Tijera , Diana Montemira-Orozco , Christian Hinojosa-Segura , Moisés Martínez-Castillo , Samantha Sánchez-Valle , María de los Ángeles Lemus-Peña , Daniel Montes de Oca-Ángeles , Abigail Hernández-Barragán , Marisela Hernández-Santillán , Yadira Lilian Béjar-Ramírez , José Luis Pérez-Hernández
Introduction and Objectives
The concept of Metabolic dysfunction and alcohol-associated steatotic liver disease (MetALD) is recent. Patients with MetALD may have a higher risk of developing steatosis, inflammation, fibrosis, and cirrhosis than Metabolic dysfunction-associated steatotic liver disease (MASLD) or Alcohol-associated liver disease (ALD) patients. This study aims to evaluate the presence and grade of steatosis and liver fibrosis in the open Mexican population to determine the frequency and stage of MASLD, ALD, and MetALD.
Patients and Methods
Subjects aged 18 years or older, of any gender, and with a body mass index (BMI) of 18.5 or higher, who were healthy and without pre-existing chronic diseases, liver disease, or cancer, and who donated blood to our center's blood bank between June 1, 2021, and March 31, 2022, were included. To estimate the grade of steatosis and liver fibrosis, vibration-controlled transient elastography (VCTE) was performed. The subjects were classified according to VCTE and alcohol consumption pattern into one of four groups: healthy subjects (HS), ALD, MASLD, and MetALD.
Results
The prevalence of MASLD, ALD, and MetALD was 45.3%, 17.5%, and 5.8%, respectively. Only 31.4% were considered as HS. However, the average BMI was out of range in all four groups, including HS. Grade 3 steatosis was observed in the MASLD and MetALD groups. Liver stiffness showed higher values in the MetALD group.
Conclusions
MetALD has the lowest prevalence compared to MASLD and ALD. However, MetALD has the highest grade of steatosis and liver fibrosis. High BMI and risky alcohol consumption were associated with the severity of liver disease.
{"title":"Assessment of metabolic dysfunction-associated steatotic liver disease, alcohol-associated liver disease, and metabolic dysfunction and alcohol-associated steatotic liver disease in open Mexican population","authors":"Jorge Emilio Lira-Vera , Ángel Daniel Santana-Vargas , Gabriela Gutiérrez-Reyes , Oscar Morales-Gutiérrez , María de Fátima Higuera-de la Tijera , Diana Montemira-Orozco , Christian Hinojosa-Segura , Moisés Martínez-Castillo , Samantha Sánchez-Valle , María de los Ángeles Lemus-Peña , Daniel Montes de Oca-Ángeles , Abigail Hernández-Barragán , Marisela Hernández-Santillán , Yadira Lilian Béjar-Ramírez , José Luis Pérez-Hernández","doi":"10.1016/j.aohep.2025.102149","DOIUrl":"10.1016/j.aohep.2025.102149","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The concept of Metabolic dysfunction and alcohol-associated steatotic liver disease (MetALD) is recent. Patients with MetALD may have a higher risk of developing steatosis, inflammation, fibrosis, and cirrhosis than Metabolic dysfunction-associated steatotic liver disease (MASLD) or Alcohol-associated liver disease (ALD) patients. This study aims to evaluate the presence and grade of steatosis and liver fibrosis in the open Mexican population to determine the frequency and stage of MASLD, ALD, and MetALD.</div></div><div><h3>Patients and Methods</h3><div>Subjects aged 18 years or older, of any gender, and with a body mass index (BMI) of 18.5 or higher, who were healthy and without pre-existing chronic diseases, liver disease, or cancer, and who donated blood to our center's blood bank between June 1, 2021, and March 31, 2022, were included. To estimate the grade of steatosis and liver fibrosis, vibration-controlled transient elastography (VCTE) was performed. The subjects were classified according to VCTE and alcohol consumption pattern into one of four groups: healthy subjects (HS), ALD, MASLD, and MetALD.</div></div><div><h3>Results</h3><div>The prevalence of MASLD, ALD, and MetALD was 45.3%, 17.5%, and 5.8%, respectively. Only 31.4% were considered as HS. However, the average BMI was out of range in all four groups, including HS. Grade 3 steatosis was observed in the MASLD and MetALD groups. Liver stiffness showed higher values in the MetALD group.</div></div><div><h3>Conclusions</h3><div>MetALD has the lowest prevalence compared to MASLD and ALD. However, MetALD has the highest grade of steatosis and liver fibrosis. High BMI and risky alcohol consumption were associated with the severity of liver disease.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102149"},"PeriodicalIF":4.4,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145399785","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}
Pub Date : 2025-10-26DOI: 10.1016/j.aohep.2025.102150
Xiaohui Ye , Lingling He , Caihong Deng , Junru Yang , Ping Li , Hongshan Wei
Introduction and Objectives
Transient elastography (TE) has been widely used in clinical practice, but noninvasive prediction models based on TE for the assessment of liver fibrosis in primary biliary cholangitis (PBC) has not been reported before. The aim of this study is to develop the simple, accurate and noninvasive prediction models for the histologic staging of PBC based on TE.
Patients and Methods
Serologic testing, liver stiffness measurement (LSM), and histological assessment of 144 patients with PBC were collected retrospectively. In model group consisted of 96 patients, LSM and alkaline phosphatase (ALP) were identified as two independent predictors of PBC histological stage, which were used to establish two noninvasive models, Model A and Model B, to predict significant fibrosis (Ludwig stage ≥ 2) and advanced fibrosis (Ludwig stage ≥ 3), respectively. The performance of noninvasive models was then validated in the validation group (48 patients).
Results
The area under the ROC curve (AUROC) of Model A was 0.870 (95 % CI, 0.802-0.939) in the model group and 0.914 (95 % CI, 0.803-1.000) in the validation group. The AUROC of Model B was 0.948 (95 % CI, 0.888-0.998) in the model group and 0.906 (95 % CI, 0.824-0.987) in validation group. The above results were higher than the other five serologic markers.
Conclusions
The Model A and Model B were the efficient noninvasive models with high accuracy in predicting the histological stages of PBC.
{"title":"Noninvasive elastography-based assessment of liver fibrosis in primary biliary cholangitis","authors":"Xiaohui Ye , Lingling He , Caihong Deng , Junru Yang , Ping Li , Hongshan Wei","doi":"10.1016/j.aohep.2025.102150","DOIUrl":"10.1016/j.aohep.2025.102150","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Transient elastography (TE) has been widely used in clinical practice, but noninvasive prediction models based on TE for the assessment of liver fibrosis in primary biliary cholangitis (PBC) has not been reported before. The aim of this study is to develop the simple, accurate and noninvasive prediction models for the histologic staging of PBC based on TE.</div></div><div><h3>Patients and Methods</h3><div>Serologic testing, liver stiffness measurement (LSM), and histological assessment of 144 patients with PBC were collected retrospectively. In model group consisted of 96 patients, LSM and alkaline phosphatase (ALP) were identified as two independent predictors of PBC histological stage, which were used to establish two noninvasive models, Model A and Model B, to predict significant fibrosis (Ludwig stage ≥ 2) and advanced fibrosis (Ludwig stage ≥ 3), respectively. The performance of noninvasive models was then validated in the validation group (48 patients).</div></div><div><h3>Results</h3><div>The area under the ROC curve (AUROC) of Model A was 0.870 (95 % CI, 0.802-0.939) in the model group and 0.914 (95 % CI, 0.803-1.000) in the validation group. The AUROC of Model B was 0.948 (95 % CI, 0.888-0.998) in the model group and 0.906 (95 % CI, 0.824-0.987) in validation group. The above results were higher than the other five serologic markers.</div></div><div><h3>Conclusions</h3><div>The Model A and Model B were the efficient noninvasive models with high accuracy in predicting the histological stages of PBC.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102150"},"PeriodicalIF":4.4,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145385889","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}
Pub Date : 2025-10-24DOI: 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.
{"title":"Reevaluating the clinical course of AMA-positive patients with normal liver enzymes: A large retrospective cohort study","authors":"Ahmad Yahia , Fadi Abu Baker , Mifleh Tatour , Rawi Hazzan","doi":"10.1016/j.aohep.2025.102147","DOIUrl":"10.1016/j.aohep.2025.102147","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102147"},"PeriodicalIF":4.4,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457591","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}
Pub Date : 2025-10-24DOI: 10.1016/j.aohep.2025.102146
Martine A.M.C. Baven-Pronk , Camiel J.M. Marijnissen , Maaike Biewenga , Albert F. Stättermayer , Maarten E. Tushuizen , Bart van Hoek
Introduction and Objectives
Monitoring liver fibrosis during treatment of autoimmune hepatitis (AIH) is important to guide treatment. Transient elastography (TE) is not always available. Existing non-invasive fibrosis scores have been assessed primarily at diagnosis but not during treatment. This study aims to develop a non-invasive AIH fibrosis score (AIHFS) and validate its performance - alongside with existing fibrosis scores - for excluding advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE) during AIH treatment.
Patients and Methods
This study included adult patients with AIH and variant syndromes from Leiden (derivation cohort, n = 73) and Vienna (validation cohort, n = 81). All patients had been treated for at least 6 months and had valid TE and routine laboratory tests within 1 months of TE. Existing fibrosis scores were calculated and a novel AIHFS was developed using multivariate regression. TE served as the reference standard.
Results
The aspartate aminotransferase-to-platelet ratio index (APRI) and AIHFS (comprising APRI and albumin) were the only fibrosis scores significantly associated with liver stiffness during treatment. AIHFS did not outperform APRI. APRI demonstrated a high negative predictive value for advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE): 86 % and 93 % in the derivation cohort and 84 % and 95 % in the validation cohort, respectively. Based on an APRI threshold of 0.4874, only 22–40 % of patients would require further diagnostic assessment.
Conclusions
APRI is a simple, non-invasive, widely applicable score that reliably excludes advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE) during AIH treatment, potentially reducing the need for additional investigations.
{"title":"Aspartate aminotransferase‑to‑platelet ratio index (APRI) reliably excludes advanced fibrosis and cirrhosis in treated autoimmune hepatitis","authors":"Martine A.M.C. Baven-Pronk , Camiel J.M. Marijnissen , Maaike Biewenga , Albert F. Stättermayer , Maarten E. Tushuizen , Bart van Hoek","doi":"10.1016/j.aohep.2025.102146","DOIUrl":"10.1016/j.aohep.2025.102146","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Monitoring liver fibrosis during treatment of autoimmune hepatitis (AIH) is important to guide treatment. Transient elastography (TE) is not always available. Existing non-invasive fibrosis scores have been assessed primarily at diagnosis but not during treatment. This study aims to develop a non-invasive AIH fibrosis score (AIHFS) and validate its performance - alongside with existing fibrosis scores - for excluding advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE) during AIH treatment.</div></div><div><h3>Patients and Methods</h3><div>This study included adult patients with AIH and variant syndromes from Leiden (derivation cohort, <em>n</em> = 73) and Vienna (validation cohort, <em>n</em> = 81). All patients had been treated for at least 6 months and had valid TE and routine laboratory tests within 1 months of TE. Existing fibrosis scores were calculated and a novel AIHFS was developed using multivariate regression. TE served as the reference standard.</div></div><div><h3>Results</h3><div>The aspartate aminotransferase-to-platelet ratio index (APRI) and AIHFS (comprising APRI and albumin) were the only fibrosis scores significantly associated with liver stiffness during treatment. AIHFS did not outperform APRI. APRI demonstrated a high negative predictive value for advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE): 86 % and 93 % in the derivation cohort and 84 % and 95 % in the validation cohort, respectively. Based on an APRI threshold of 0.4874, only 22–40 % of patients would require further diagnostic assessment.</div></div><div><h3>Conclusions</h3><div>APRI is a simple, non-invasive, widely applicable score that reliably excludes advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE) during AIH treatment, potentially reducing the need for additional investigations.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102146"},"PeriodicalIF":4.4,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457605","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}
Pub Date : 2025-10-24DOI: 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.
{"title":"Trends and health inequalities of hepatitis virus-associated liver cancer mortality during 1990–2050","authors":"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","doi":"10.1016/j.aohep.2025.102144","DOIUrl":"10.1016/j.aohep.2025.102144","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102144"},"PeriodicalIF":4.4,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370153","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}
Pub Date : 2025-10-22DOI: 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.
{"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":"2025-10-22","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}
Pub Date : 2025-10-22DOI: 10.1016/j.aohep.2025.102142
Fátima Higuera-de-la-Tijera , Mario Reis Alvares-da-Silva , Graciela Elia Castro-Narro , Josué Barahona-Garrido , Enrique Carrera-Estupiñán , Jorge Garavito-Rentería , Héctor Adolfo Henríquez-Meléndez , Geovanny Hernández-Cely , Javier Mora-Lazo , Manuel Mendizabal , Gabriel Alejandro Mezzano-Puentes , Claudia P. Oliveira , Mário Guimarães Pessoa , Yanette Suárez-Quintero , José Antonio Velarde-Ruiz Velasco
Introduction and Objectives
Hepatic encephalopathy (HE) is a frequent and severe complication of cirrhosis, leading to rapid deterioration and increased mortality. Management varies across Latin America due to differences in disease awareness, diagnostic and therapeutic resources, and healthcare system structures. Standardized guidelines are crucial to improve outcomes.
Materials and Methods
To evaluate therapeutic strategies and develop region-specific recommendations, the Latin American Association for the Study of the Liver (ALEH) convened 15 experts from 9 countries. The consensus process, conducted in 9 phases using the Nominal Group Technique, included virtual meetings, platform-based collaboration, virtual voting, and two in-person sessions to finalize recommendations and the publication draft.
Results
The panel issued 23 recommendations covering the treatment of minimal and overt HE, as well as the prophylaxis and management of recurrent HE in cirrhotic patients.
Conclusions
This consensus provides updated, evidence-based guidelines emphasizing early diagnosis and effective management. It aims to optimize clinical outcomes, standardize treatment approaches, and enhance patient quality of life. Additionally, these recommendations seek to reduce morbidity, mortality, and hospital readmissions, addressing key challenges in the Latin American healthcare landscape.
{"title":"First Latin American consensus on the treatment and prophylaxis of hepatic encephalopathy","authors":"Fátima Higuera-de-la-Tijera , Mario Reis Alvares-da-Silva , Graciela Elia Castro-Narro , Josué Barahona-Garrido , Enrique Carrera-Estupiñán , Jorge Garavito-Rentería , Héctor Adolfo Henríquez-Meléndez , Geovanny Hernández-Cely , Javier Mora-Lazo , Manuel Mendizabal , Gabriel Alejandro Mezzano-Puentes , Claudia P. Oliveira , Mário Guimarães Pessoa , Yanette Suárez-Quintero , José Antonio Velarde-Ruiz Velasco","doi":"10.1016/j.aohep.2025.102142","DOIUrl":"10.1016/j.aohep.2025.102142","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatic encephalopathy (HE) is a frequent and severe complication of cirrhosis, leading to rapid deterioration and increased mortality. Management varies across Latin America due to differences in disease awareness, diagnostic and therapeutic resources, and healthcare system structures. Standardized guidelines are crucial to improve outcomes.</div></div><div><h3>Materials and Methods</h3><div>To evaluate therapeutic strategies and develop region-specific recommendations, the Latin American Association for the Study of the Liver (ALEH) convened 15 experts from 9 countries. The consensus process, conducted in 9 phases using the Nominal Group Technique, included virtual meetings, platform-based collaboration, virtual voting, and two in-person sessions to finalize recommendations and the publication draft.</div></div><div><h3>Results</h3><div>The panel issued 23 recommendations covering the treatment of minimal and overt HE, as well as the prophylaxis and management of recurrent HE in cirrhotic patients.</div></div><div><h3>Conclusions</h3><div>This consensus provides updated, evidence-based guidelines emphasizing early diagnosis and effective management. It aims to optimize clinical outcomes, standardize treatment approaches, and enhance patient quality of life. Additionally, these recommendations seek to reduce morbidity, mortality, and hospital readmissions, addressing key challenges in the Latin American healthcare landscape.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102142"},"PeriodicalIF":4.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367393","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}
Pub Date : 2025-10-22DOI: 10.1016/j.aohep.2025.102145
Shiqi Zhu , Lihe Liu , Yiping Shen , Rui Li , Jiaxi Lin , Lu Liu , Xiaolin Liu , Hongpeng Sun , Jinzhou Zhu
Introduction and Objectives
While excessive sodium intake is associated with hepatic steatosis, its precise role in metabolic dysfunction-associated steatotic liver disease (MASLD) remains underexplored. This study investigated the relationship between different measures of sodium intake and the risk of MASLD.
Materials and Methods
The complete data of 286,073 participants on their self-reported frequency of adding salt to food and estimated 24-h urinary sodium excretion from the UK Biobank were analyzed. Cox proportional hazards models quantified hazard ratios (HRs) for incident MASLD, cirrhosis or liver cancer, and liver-related mortality. Mediation analyses evaluated potential mediating between sodium intake and MASLD. Energy-adjusted dietary sodium intake was evaluated in a sub-cohort of 119,073 participants with ≥2 dietary recalls.
Results
During a median follow-up of 13.3 years, 3147 MASLD, 1354 cirrhosis or liver cancer, and 523 liver-related mortality cases were identified. After adjusting for confounders, participants who reported “always” adding salt had an increased risk of MASLD (HR=1.36, 95 % CI=1.19–1.56). Higher urinary sodium excretion was also associated with incident MASLD (HR=1.62, 95 % CI=1.53–1.72), displaying a J-shaped nonlinear relationship with the threshold point at 1.93 g/d. Inflammatory dysregulation, insulin resistance and renal function impairment partly mediated this association. In the sub-cohort, every 1 g increase in energy-adjusted dietary sodium intake conferred a 14 % higher risk of MASLD (HR=1.14, 95 % CI=1.01–1.28).
Conclusions
The habit of always adding salt to food, a 24-h urinary sodium excretion above 1.93 g/day, and energy-adjusted dietary sodium intake above 1.49g/d increased the risk of MASLD, partly mediated through inflammation, insulin resistance, and renal dysfunction. It is recommended that public health strategies target reducing MASLD risk based on these findings.
{"title":"Different measures of sodium intake and the risk of metabolic dysfunction-associated steatotic liver disease: Evidence from the UK Biobank","authors":"Shiqi Zhu , Lihe Liu , Yiping Shen , Rui Li , Jiaxi Lin , Lu Liu , Xiaolin Liu , Hongpeng Sun , Jinzhou Zhu","doi":"10.1016/j.aohep.2025.102145","DOIUrl":"10.1016/j.aohep.2025.102145","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>While excessive sodium intake is associated with hepatic steatosis, its precise role in metabolic dysfunction-associated steatotic liver disease (MASLD) remains underexplored. This study investigated the relationship between different measures of sodium intake and the risk of MASLD.</div></div><div><h3>Materials and Methods</h3><div>The complete data of 286,073 participants on their self-reported frequency of adding salt to food and estimated 24-h urinary sodium excretion from the UK Biobank were analyzed. Cox proportional hazards models quantified hazard ratios (HRs) for incident MASLD, cirrhosis or liver cancer, and liver-related mortality. Mediation analyses evaluated potential mediating between sodium intake and MASLD. Energy-adjusted dietary sodium intake was evaluated in a sub-cohort of 119,073 participants with ≥2 dietary recalls.</div></div><div><h3>Results</h3><div>During a median follow-up of 13.3 years, 3147 MASLD, 1354 cirrhosis or liver cancer, and 523 liver-related mortality cases were identified. After adjusting for confounders, participants who reported “always” adding salt had an increased risk of MASLD (HR=1.36, 95 % CI=1.19–1.56). Higher urinary sodium excretion was also associated with incident MASLD (HR=1.62, 95 % CI=1.53–1.72), displaying a J-shaped nonlinear relationship with the threshold point at 1.93 g/d. Inflammatory dysregulation, insulin resistance and renal function impairment partly mediated this association. In the sub-cohort, every 1 g increase in energy-adjusted dietary sodium intake conferred a 14 % higher risk of MASLD (HR=1.14, 95 % CI=1.01–1.28).</div></div><div><h3>Conclusions</h3><div>The habit of always adding salt to food, a 24-h urinary sodium excretion above 1.93 g/day, and energy-adjusted dietary sodium intake above 1.49<em>g</em>/d increased the risk of MASLD, partly mediated through inflammation, insulin resistance, and renal dysfunction. It is recommended that public health strategies target reducing MASLD risk based on these findings.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102145"},"PeriodicalIF":4.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367415","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}
Pub Date : 2025-10-11DOI: 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":"2025-10-11","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}
Pub Date : 2025-10-11DOI: 10.1016/j.aohep.2025.102140
Toni Herta , Annegret Franke , Tobias Müller , Kerstin Stein , Heike Bantel , Rainer Günther , Gerald Denk , Philipp A. Reuken , Jörn M. Schattenberg , Uwe Naumann , Tobias Böttler , Andreas Weber , Stefan Zeuzem , Matthias Hinz , Robin Greinert , Christoph Berg , Thaddäus Till Wissniowski , Karl-Georg Simon , Jonel Trebicka , Rüdiger Behrens , Andreas E. Kremer
Introduction and Objectives
Pruritus is a frequent and burdensome symptom in patients with primary biliary cholangitis (PBC), significantly affecting quality of life. Despite its clinical relevance, data on the prevalence and management, particularly across different levels of healthcare, remain limited. We aimed to assess prevalence, severity, and treatment of pruritus in PBC patients across secondary and tertiary care.
Patients and Methods
Within the German PBC registry, the intensity and management of pruritus were assessed cross-sectionally by treating physicians using a standardized 4-point verbal rating scale (absent, mild, moderate, severe), as well as by analyzing prescribed antipruritic medications.
Results
Pruritus was reported in 23 % (n = 120/515) of patients and classified as mild, moderate, or severe in 59 (49 %), 41 (34 %), and 20 (17 %) cases, respectively. The prevalence of pruritus was 27 % (n = 96/360) for tertiary versus 16 % (n = 24/155) for secondary care (p = 0.006). Moderate or severe pruritus was observed in 13.3 % (n = 48/360) of patients at tertiary centers compared to 8.4 % (n = 13/155) at secondary centers (p = 0.137). Antipruritic therapies were used in only 22.5 % (n = 27/120) patients with pruritus, with bezafibrate being the most frequently prescribed medication (63 %, n = 17/27). Patients with pruritus were more likely to receive antipruritic therapies in tertiary than secondary care: 26 % (n = 25/96) vs. 8 % (n = 2/24) (p = 0.098).
Conclusions
Pruritus in patients with PBC is common and under-treated in the real-world scenario. Assessment and management vary by healthcare level, highlighting the need for standardized care and greater awareness of treatment options across all settings.
{"title":"Pruritus in primary biliary cholangitis: insights from the German PBC registry across secondary and tertiary care","authors":"Toni Herta , Annegret Franke , Tobias Müller , Kerstin Stein , Heike Bantel , Rainer Günther , Gerald Denk , Philipp A. Reuken , Jörn M. Schattenberg , Uwe Naumann , Tobias Böttler , Andreas Weber , Stefan Zeuzem , Matthias Hinz , Robin Greinert , Christoph Berg , Thaddäus Till Wissniowski , Karl-Georg Simon , Jonel Trebicka , Rüdiger Behrens , Andreas E. Kremer","doi":"10.1016/j.aohep.2025.102140","DOIUrl":"10.1016/j.aohep.2025.102140","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Pruritus is a frequent and burdensome symptom in patients with primary biliary cholangitis (PBC), significantly affecting quality of life. Despite its clinical relevance, data on the prevalence and management, particularly across different levels of healthcare, remain limited. We aimed to assess prevalence, severity, and treatment of pruritus in PBC patients across secondary and tertiary care.</div></div><div><h3>Patients and Methods</h3><div>Within the German PBC registry, the intensity and management of pruritus were assessed cross-sectionally by treating physicians using a standardized 4-point verbal rating scale (absent, mild, moderate, severe), as well as by analyzing prescribed antipruritic medications.</div></div><div><h3>Results</h3><div>Pruritus was reported in 23 % (<em>n</em> = 120/515) of patients and classified as mild, moderate, or severe in 59 (49 %), 41 (34 %), and 20 (17 %) cases, respectively. The prevalence of pruritus was 27 % (n = 96/360) for tertiary versus 16 % (n = 24/155) for secondary care (p = 0.006). Moderate or severe pruritus was observed in 13.3 % (n = 48/360) of patients at tertiary centers compared to 8.4 % (n = 13/155) at secondary centers (p = 0.137). Antipruritic therapies were used in only 22.5 % (n = 27/120) patients with pruritus, with bezafibrate being the most frequently prescribed medication (63 %, n = 17/27). Patients with pruritus were more likely to receive antipruritic therapies in tertiary than secondary care: 26 % (n = 25/96) vs. 8 % (n = 2/24) (p = 0.098).</div></div><div><h3>Conclusions</h3><div>Pruritus in patients with PBC is common and under-treated in the real-world scenario. Assessment and management vary by healthcare level, highlighting the need for standardized care and greater awareness of treatment options across all settings.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102140"},"PeriodicalIF":4.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285342","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}
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