Annals of hepatology最新文献_第6页

INFLUENCE OF CARDIOMETABOLIC RISK FACTORS AND ALCOHOL CONSUMPTION ON LIVER STIFFNESS IN PATIENTS WITH MASLD: A MULTICENTER STUDY IN COLOMBIA 心脏代谢危险因素和酒精摄入对masld患者肝脏僵硬的影响：哥伦比亚的一项多中心研究

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101979

Ismael de Jesus Yepes Barreto , Nicole Chamorro , Guillermo Donado , Pablo Osorio , Juan Carlos Restrepo , Santiago Pino , Clara Caez , Jorge Ortiz , Yohana Poveda

Introduction and Objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) includes patients with hepatic steatosis and at least one cardiometabolic risk factor (CMRF). However, the influence of individual CMRFs and their interactions on disease progression remains unclear.

To assess the association between CMRFs, their interactions (including with alcohol consumption), and liver stiffness in MASLD

Patients and Methods

This multicenter study included patients with MASLD from four Colombian cities. Transient elastography was used to assess liver stiffness. Other causes of chronic liver disease were excluded. Patients with significant alcohol intake (≥30 g/day for men, ≥20 g/day for women) were excluded. CMRFs were defined using ATP III criteria. Alcohol consumption was estimated as grams per week based on standard drink units. A multivariate linear regression model evaluated associations with liver stiffness, including interaction terms between CMRFs and with alcohol. Statistical significance was set at p ≤ 0.05

Results

A total of 354 patients were included (mean age: 54 years; 39.3% male). CMRF distribution: 1 (30.2%), 2 (31.9%), 3 (29.4%), and 4 (8.5%). The most prevalent CMRFs were dyslipidemia (68.6%) and hypertension (54.2%). In multivariate analysis, BMI (β = 0.14; 95% CI: 0.03–0.27; p = 0.012) and impaired glucose metabolism (β = 0.11; 95% CI: 0.08–2.6; p = 0.03) were independently associated with liver stiffness. Among interaction terms, only the diabetes–waist circumference interaction remained significant (β = 0.19; 95% CI: 1.15–4.4; p < 0.01). Alcohol consumption showed no association.

Conclusions

Diabetes and its interaction with waist circumference are key drivers of liver stiffness in MASLD, independent of alcohol intake.

代谢功能障碍相关脂肪变性肝病（MASLD）包括肝脂肪变性和至少一种心脏代谢危险因素（CMRF）的患者。然而，个体CMRFs及其相互作用对疾病进展的影响尚不清楚。为了评估CMRFs、它们的相互作用（包括酒精摄入）和MASLD患者肝僵硬之间的关系和方法，这项多中心研究纳入了来自哥伦比亚四个城市的MASLD患者。瞬时弹性成像用于评估肝脏硬度。排除了慢性肝病的其他原因。排除了显著酒精摄入量（男性≥30 g/天，女性≥20 g/天）的患者。CMRFs采用ATP III标准定义。根据标准饮酒单位，酒精消费量估计为每周克。一个多变量线性回归模型评估了肝僵硬的相关性，包括CMRFs和酒精之间的相互作用项。结果共纳入354例患者，平均年龄54岁，男性占39.3%。CMRF分布:1(30.2%)、2(31.9%),3(29.4%)和4(8.5%)。最常见的cmrf是血脂异常（68.6%）和高血压（54.2%）。在多变量分析中，BMI （β = 0.14;95% CI: 0.03 - 0.27; p = 0.012）和糖代谢受损（β = 0.11;95% CI: 0.08-2.6; p = 0.03）与肝脏僵硬独立相关。在相互作用项中，只有糖尿病与腰围的相互作用仍然显著（β = 0.19;95% CI: 1.15-4.4; p < 0.01）。酒精摄入则无关联。结论糖尿病及其与腰围的相互作用是MASLD患者肝脏僵硬的关键驱动因素，与酒精摄入无关。

{"title":"INFLUENCE OF CARDIOMETABOLIC RISK FACTORS AND ALCOHOL CONSUMPTION ON LIVER STIFFNESS IN PATIENTS WITH MASLD: A MULTICENTER STUDY IN COLOMBIA","authors":"Ismael de Jesus Yepes Barreto , Nicole Chamorro , Guillermo Donado , Pablo Osorio , Juan Carlos Restrepo , Santiago Pino , Clara Caez , Jorge Ortiz , Yohana Poveda","doi":"10.1016/j.aohep.2025.101979","DOIUrl":"10.1016/j.aohep.2025.101979","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) includes patients with hepatic steatosis and at least one cardiometabolic risk factor (CMRF). However, the influence of individual CMRFs and their interactions on disease progression remains unclear.</div><div>To assess the association between CMRFs, their interactions (including with alcohol consumption), and liver stiffness in MASLD</div></div><div><h3>Patients and Methods</h3><div>This multicenter study included patients with MASLD from four Colombian cities. Transient elastography was used to assess liver stiffness. Other causes of chronic liver disease were excluded. Patients with significant alcohol intake (≥30 g/day for men, ≥20 g/day for women) were excluded. CMRFs were defined using ATP III criteria. Alcohol consumption was estimated as grams per week based on standard drink units. A multivariate linear regression model evaluated associations with liver stiffness, including interaction terms between CMRFs and with alcohol. Statistical significance was set at p ≤ 0.05</div></div><div><h3>Results</h3><div>A total of 354 patients were included (mean age: 54 years; 39.3% male). CMRF distribution: 1 (30.2%), 2 (31.9%), 3 (29.4%), and 4 (8.5%). The most prevalent CMRFs were dyslipidemia (68.6%) and hypertension (54.2%). In multivariate analysis, BMI (β = 0.14; 95% CI: 0.03–0.27; p = 0.012) and impaired glucose metabolism (β = 0.11; 95% CI: 0.08–2.6; p = 0.03) were independently associated with liver stiffness. Among interaction terms, only the diabetes–waist circumference interaction remained significant (β = 0.19; 95% CI: 1.15–4.4; p < 0.01). Alcohol consumption showed no association.</div></div><div><h3>Conclusions</h3><div>Diabetes and its interaction with waist circumference are key drivers of liver stiffness in MASLD, independent of alcohol intake.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101979"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154153","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

BIOACTIVE COFFEE COMPOUNDS SYNERGISTICALLY ENHANCE THE ANTITUMOR EFFECTS OF CHEMO AND IMMUNOTHERAPY FOR HEPATOCELLULAR CARCINOMA IN VITRO 生物活性咖啡化合物协同增强体外化疗和免疫治疗肝癌的抗肿瘤作用

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101978

Leticia Valente Cardoso , Luana Casarin Riechelmann , Luis Barbisan Fernando , Guilherme Romualdo Ribeiro

Introduction and Objectives

Hepatocellular Carcinoma (HCC) yields high global incidence and mortality rates and an unfavorable prognosis. Although current therapies for advanced HCC are promising, their outcomes remain limited. In this context, there is increasing interest in innovative strategies, such as combining bioactive compounds (BCs) with chemo- and immunotherapies. BCs in coffee have stood out due to their chemopreventive effects reported in epidemiological and experimental studies. However, their antitumor potential, particularly in combination with conventional therapies, remains incompletely understood. In this study, we investigated whether coffee-derived compounds could enhance the antitumor effects of sorafenib (SOR) and atezolizumab plus bevacizumab (ATZ+BVZ) in vitro.

Materials and Methods

LX2 hepatic stellate cells and HepG2/C3A (HCC) cells were cultured in 3D (spheroids) and 2D (transwell) systems, and treated with caffeine (CAF), trigonelline (TRI), chlorogenic acid (CGA), caffeic acid (CA), kahweol (KWL), SOR, ATZ, and BVZ for 24 and 48 h for half maximum effective concentration (EC50) determination (MTT/LDH assays). Next, the coffee compounds were combined with SOR or ATZ+BVZ at sub-effective and physiologically plausible EC50 fractions (1/5, 1/6, or 1/10) and evaluated by MTT (3D), scratch (migration), and colony formation assays (2D), with combination index calculation.

Results

CGA, CA, and TRI showed antagonistic effects to the therapies. In contrast, CAF or KWL synergistically enhanced the anti-tumor effects of SOR and ATZ plus BVZ in reducing spheroid viability. The combination of CAF plus KWL further intensified the anti-tumor effects of both treatments, also inhibiting colony formation and cell motility.

Conclusions

These findings suggest that coffee-derived compounds may strengthen the therapeutic efficacy against HCC. Further experiments include in vitro metabolomics and transcriptomics, and in vivo xenograft mouse model.

简介和目的肝细胞癌（HCC）具有高的全球发病率和死亡率以及不良的预后。尽管目前晚期HCC的治疗方法很有希望，但其结果仍然有限。在这种背景下，人们对创新策略的兴趣越来越大，例如将生物活性化合物（bc）与化学和免疫疗法相结合。咖啡中的bc因其在流行病学和实验研究中报告的化学预防作用而脱颖而出。然而，它们的抗肿瘤潜力，特别是与传统疗法的结合，仍然不完全清楚。在这项研究中，我们研究了咖啡衍生的化合物是否可以增强sorafenib （SOR）和atezolizumab + bevacizumab （ATZ+BVZ）的体外抗肿瘤作用。材料与方法将slx2肝星状细胞和HepG2/C3A （HCC）细胞分别培养于3D （spheroids）和2D （transwell）体系中，分别用咖啡因（CAF）、葫芦巴碱（TRI）、绿原酸（CGA）、咖啡酸（CA）、咖啡豆醇（KWL）、SOR、ATZ和BVZ处理24和48 h，测定一半最大有效浓度（EC50）（MTT/LDH法）。接下来，将咖啡化合物与SOR或ATZ+BVZ以亚有效和生理上合理的EC50分数（1/ 5,1 /6或1/10）组合，并通过MTT (3D)，划痕（迁移）和菌落形成试验（2D）进行评估，并计算组合指数。结果scga、CA、TRI对治疗有拮抗作用。相反，CAF或KWL协同增强了SOR和ATZ + BVZ的抗肿瘤作用，降低了球体活力。CAF联合KWL进一步增强了两种治疗的抗肿瘤作用，也抑制了集落的形成和细胞的运动。结论咖啡衍生化合物可增强肝癌的治疗效果。进一步的实验包括体外代谢组学和转录组学，以及体内异种移植小鼠模型。

{"title":"BIOACTIVE COFFEE COMPOUNDS SYNERGISTICALLY ENHANCE THE ANTITUMOR EFFECTS OF CHEMO AND IMMUNOTHERAPY FOR HEPATOCELLULAR CARCINOMA IN VITRO","authors":"Leticia Valente Cardoso , Luana Casarin Riechelmann , Luis Barbisan Fernando , Guilherme Romualdo Ribeiro","doi":"10.1016/j.aohep.2025.101978","DOIUrl":"10.1016/j.aohep.2025.101978","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular Carcinoma (HCC) yields high global incidence and mortality rates and an unfavorable prognosis. Although current therapies for advanced HCC are promising, their outcomes remain limited. In this context, there is increasing interest in innovative strategies, such as combining bioactive compounds (BCs) with chemo- and immunotherapies. BCs in coffee have stood out due to their chemopreventive effects reported in epidemiological and experimental studies. However, their antitumor potential, particularly in combination with conventional therapies, remains incompletely understood. In this study, we investigated whether coffee-derived compounds could enhance the antitumor effects of sorafenib (SOR) and atezolizumab plus bevacizumab (ATZ+BVZ) in vitro.</div></div><div><h3>Materials and Methods</h3><div>LX2 hepatic stellate cells and HepG2/C3A (HCC) cells were cultured in 3D (spheroids) and 2D (transwell) systems, and treated with caffeine (CAF), trigonelline (TRI), chlorogenic acid (CGA), caffeic acid (CA), kahweol (KWL), SOR, ATZ, and BVZ for 24 and 48 h for half maximum effective concentration (EC50) determination (MTT/LDH assays). Next, the coffee compounds were combined with SOR or ATZ+BVZ at sub-effective and physiologically plausible EC50 fractions (1/5, 1/6, or 1/10) and evaluated by MTT (3D), scratch (migration), and colony formation assays (2D), with combination index calculation.</div></div><div><h3>Results</h3><div>CGA, CA, and TRI showed antagonistic effects to the therapies. In contrast, CAF or KWL synergistically enhanced the anti-tumor effects of SOR and ATZ plus BVZ in reducing spheroid viability. The combination of CAF plus KWL further intensified the anti-tumor effects of both treatments, also inhibiting colony formation and cell motility.</div></div><div><h3>Conclusions</h3><div>These findings suggest that coffee-derived compounds may strengthen the therapeutic efficacy against HCC. Further experiments include in vitro metabolomics and transcriptomics, and in vivo xenograft mouse model.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101978"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154154","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

GEOREFERENCING AS A MANAGEMENT STRATEGY FOR SITUATIONAL DIAGNOSIS OF THE TERRITORY IN THE CARE OF VIRAL HEPATITIS 在病毒性肝炎护理中，地理参考作为区域情境诊断的管理策略

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102046

João Vítor da Mota Silva , Aline Alves da Silva , Elton Carlos de Almeida , Leonardo Carrara Matsuura , Isabelle Cristine de Jesus Macedo , Ana Paula Maciel Gurski , Ana Mônica de Mello , José Nilton Neris Gomes , Mario Peribanez Gonzalez , João Vítor da Silva Mota , Carla Francisca dos Santos Cruz , Nathalia da Silva Cruz

Introduction and Objectives

Georeferencing, by mapping geographic coordinates, helps evaluate the decentralization of health services, contributing to increased user access.

To map the network for diagnosis, treatment, and follow-up of viral hepatitis cases in the municipalities of Santa Catarina.

Materials and Methods

This is an evaluative, quantitative study with a descriptive approach. Data were collected through a questionnaire applied throughout Brazil. Santa Catarina was selected for this analysis due to the higher response rate from its municipalities. For service analysis, georeferencing techniques using geographic coordinates of institutions collected via Google Earth were employed, followed by the creation of thematic maps using QGIS software.

Results

The study covered 88.8% of municipalities. Regarding georeferencing of services, 99.2% of municipalities offer rapid tests for viral hepatitis. However, 19.5% do not collect biological material for molecular testing. Furthermore, 86.3% of municipalities do not perform molecular testing within their territory. Additionally, 46.2% of municipalities refer patients to specialized services in other municipalities for treatment. Moreover, 41.6% of the patients who require clinical follow-up also needed to travel for care.

Conclusions

Significant progress was observed in expanding access to viral hepatitis diagnosis, with nearly all municipalities offering rapid tests. However, challenges remain in decentralizing biological material collection and molecular test analysis, as well as in access to treatment and clinical follow-up. The need for patient travel compromises care comprehensiveness and hinders treatment adherence.

前言和目标地理参考通过绘制地理坐标，有助于评价保健服务的分散化，有助于增加用户获取。绘制圣卡塔琳娜市病毒性肝炎病例诊断、治疗和随访网络地图。材料和方法这是一项描述性的评估性定量研究。数据是通过在巴西各地应用的问卷收集的。圣卡塔琳娜被选中进行分析是因为其市政当局的回复率较高。在服务分析方面，采用了利用谷歌Earth收集的机构地理坐标的地理参考技术，然后使用QGIS软件创建专题地图。结果研究覆盖了88.8%的城市。关于服务的地理参考，99.2%的城市提供病毒性肝炎的快速检测。然而，19.5%的人不收集生物材料进行分子检测。此外，86.3%的城市不在其领土内进行分子检测。此外，46.2%的城市将患者转介到其他城市的专门服务机构进行治疗。此外，41.6%需要临床随访的患者也需要旅行治疗。结论在扩大病毒性肝炎诊断可及性方面取得了重大进展，几乎所有城市都提供了快速检测。然而，在分散生物材料收集和分子测试分析以及获得治疗和临床随访方面仍然存在挑战。对患者旅行的需求损害了护理的全面性，并阻碍了治疗的依从性。

{"title":"GEOREFERENCING AS A MANAGEMENT STRATEGY FOR SITUATIONAL DIAGNOSIS OF THE TERRITORY IN THE CARE OF VIRAL HEPATITIS","authors":"João Vítor da Mota Silva , Aline Alves da Silva , Elton Carlos de Almeida , Leonardo Carrara Matsuura , Isabelle Cristine de Jesus Macedo , Ana Paula Maciel Gurski , Ana Mônica de Mello , José Nilton Neris Gomes , Mario Peribanez Gonzalez , João Vítor da Silva Mota , Carla Francisca dos Santos Cruz , Nathalia da Silva Cruz","doi":"10.1016/j.aohep.2025.102046","DOIUrl":"10.1016/j.aohep.2025.102046","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Georeferencing, by mapping geographic coordinates, helps evaluate the decentralization of health services, contributing to increased user access.</div><div>To map the network for diagnosis, treatment, and follow-up of viral hepatitis cases in the municipalities of Santa Catarina.</div></div><div><h3>Materials and Methods</h3><div>This is an evaluative, quantitative study with a descriptive approach. Data were collected through a questionnaire applied throughout Brazil. Santa Catarina was selected for this analysis due to the higher response rate from its municipalities. For service analysis, georeferencing techniques using geographic coordinates of institutions collected via Google Earth were employed, followed by the creation of thematic maps using QGIS software.</div></div><div><h3>Results</h3><div>The study covered 88.8% of municipalities. Regarding georeferencing of services, 99.2% of municipalities offer rapid tests for viral hepatitis. However, 19.5% do not collect biological material for molecular testing. Furthermore, 86.3% of municipalities do not perform molecular testing within their territory. Additionally, 46.2% of municipalities refer patients to specialized services in other municipalities for treatment. Moreover, 41.6% of the patients who require clinical follow-up also needed to travel for care.</div></div><div><h3>Conclusions</h3><div>Significant progress was observed in expanding access to viral hepatitis diagnosis, with nearly all municipalities offering rapid tests. However, challenges remain in decentralizing biological material collection and molecular test analysis, as well as in access to treatment and clinical follow-up. The need for patient travel compromises care comprehensiveness and hinders treatment adherence.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102046"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154256","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

THE RELATIONSHIP BETWEEN QUALITY OF LIFE IN ADULT SUBJECTS WITH COMPENSATED LIVER CIRRHOSIS AND BACTERIAL OVERGROWTH 成人代偿性肝硬化患者生活质量与细菌过度生长的关系

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101983

Nicole Chamorro Guzmán , Ismael de Jesús Yepes Barreto , Sindy Yohana Poveda Salinas

Introduction and Objectives

Small intestinal bacterial overgrowth (SIBO) has been associated with greater severity of cirrhosis, as measured by the Child-Pugh classification, and with an increased incidence of complications. However, its impact on quality of life and on the progression of compensated liver cirrhosis has been scarcely studied.

To evaluate the relationship between SIBO and quality of life in patients with compensated liver cirrhosis treated at an outpatient Hepatology center in Cartagena de Indias, Colombia.

Materials and Methods

A cross-sectional and analytical study was conducted. Adult patients diagnosed with compensated liver cirrhosis and evaluated in the outpatient Hepatology clinic were included. A hydrogen breath test was used to detect SIBO, and the Chronic Liver Disease Questionnaire (CLDQ) was applied to assess quality of life. Patients with a positive SIBO result were treated with rifaximin according to clinical guidelines. A univariate linear regression analysis was used to examine the relationship between SIBO (independent variable) and CLDQ scores (dependent variable).

Results

Most participants were male (62.5%) with a mean age of 65 years. Hypertension was present in 53.1%, and 42.2% had type 2 diabetes. SIBO was detected in 29.7% of patients. The average CLDQ scores across evaluated domains did not show statistically significant differences between patients with and without SIBO: abdominal (p=1.21), fatigue (p=1.46), systemic (p=1.09), activity (p=1.18), emotional (p=0.87), and worry (p=1.00).

Conclusions

So far, no significant differences in quality of life have been found between patients with and without SIBO in compensated liver cirrhosis.

根据Child-Pugh分类，小肠细菌过度生长（SIBO）与肝硬化的严重程度和并发症发生率增加有关。然而，其对生活质量和代偿性肝硬化进展的影响研究甚少。在哥伦比亚Cartagena de Indias的一家门诊肝病中心，评估SIBO与代偿性肝硬化患者生活质量的关系。材料与方法进行了横断面分析研究。诊断为代偿性肝硬化并在门诊肝病诊所评估的成年患者被纳入研究。采用氢呼气试验检测SIBO，采用慢性肝病问卷（CLDQ）评估生活质量。SIBO阳性患者根据临床指南给予利福昔明治疗。采用单变量线性回归分析检验SIBO（自变量）与CLDQ评分（因变量）之间的关系。结果大多数参与者为男性（62.5%），平均年龄65岁。53.1%的患者有高血压，42.2%的患者有2型糖尿病。29.7%的患者检测到SIBO。各评估领域的平均CLDQ评分在有SIBO和没有SIBO的患者之间没有统计学上的显著差异：腹部（p=1.21）、疲劳（p=1.46）、全身（p=1.09）、活动（p=1.18）、情绪（p=0.87）和担忧（p=1.00）。结论到目前为止，代偿性肝硬化伴SIBO与不伴SIBO患者的生活质量无显著差异。

{"title":"THE RELATIONSHIP BETWEEN QUALITY OF LIFE IN ADULT SUBJECTS WITH COMPENSATED LIVER CIRRHOSIS AND BACTERIAL OVERGROWTH","authors":"Nicole Chamorro Guzmán , Ismael de Jesús Yepes Barreto , Sindy Yohana Poveda Salinas","doi":"10.1016/j.aohep.2025.101983","DOIUrl":"10.1016/j.aohep.2025.101983","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Small intestinal bacterial overgrowth (SIBO) has been associated with greater severity of cirrhosis, as measured by the Child-Pugh classification, and with an increased incidence of complications. However, its impact on quality of life and on the progression of compensated liver cirrhosis has been scarcely studied.</div><div>To evaluate the relationship between SIBO and quality of life in patients with compensated liver cirrhosis treated at an outpatient Hepatology center in Cartagena de Indias, Colombia.</div></div><div><h3>Materials and Methods</h3><div>A cross-sectional and analytical study was conducted. Adult patients diagnosed with compensated liver cirrhosis and evaluated in the outpatient Hepatology clinic were included. A hydrogen breath test was used to detect SIBO, and the Chronic Liver Disease Questionnaire (CLDQ) was applied to assess quality of life. Patients with a positive SIBO result were treated with rifaximin according to clinical guidelines. A univariate linear regression analysis was used to examine the relationship between SIBO (independent variable) and CLDQ scores (dependent variable).</div></div><div><h3>Results</h3><div>Most participants were male (62.5%) with a mean age of 65 years. Hypertension was present in 53.1%, and 42.2% had type 2 diabetes. SIBO was detected in 29.7% of patients. The average CLDQ scores across evaluated domains did not show statistically significant differences between patients with and without SIBO: abdominal (p=1.21), fatigue (p=1.46), systemic (p=1.09), activity (p=1.18), emotional (p=0.87), and worry (p=1.00).</div></div><div><h3>Conclusions</h3><div>So far, no significant differences in quality of life have been found between patients with and without SIBO in compensated liver cirrhosis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101983"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154236","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

CHANGES IN BODY COMPOSITION AND HEPATIC ELASTOGRAPHY VALUES IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE AT A MEDICAL CENTER IN CARTAGENA – COLOMBIA, DURING THE PERIOD FROM OCTOBER 2023 TO JANUARY 2025 2023年10月至2025年1月期间，哥伦比亚卡塔赫纳医疗中心代谢功能障碍相关脂肪变性肝病患者的身体组成和肝脏弹性成像值的变化

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101985

Arturo Jose Viera Oliveros , Ismael Yepes Barreto , Yohana Poveda Salinas , Fernando García del Risco

Introduction and Objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the accumulation of triglycerides in the liver, linked to cardiometabolic risk factors. Its global prevalence exceeds 30%, rising in parallel with overweight and type 2 diabetes. Visceral fat is associated with systemic inflammation and hepatic fat accumulation. Although elastography is useful for assessing disease progression, its high cost and limited availability necessitate the exploration of alternative tools. The use of body composition parameters has been proposed as potential predictors of disease progression.

To determine the relationship between changes in body composition and hepatic elastography values in patients with liver disease associated with metabolic dysfunction.

Materials and Methods

This was an analytical, observational, and prospective study. Patients over 18 years old with a previous diagnosis of steatotic liver disease were included. All underwent elastography and bioelectrical impedance analysis at baseline and after one year to assess progression risk factors. The patients signed the informed consent.

Results

A total of 88 patients were included, 52.3% of whom were women. Initial elastography readings averaged 9.2 kPa; the controlled attenuation parameter (CAP) was 269 dB/m. Factors associated with elevated liver stiffness included type 2 diabetes, chronic kidney disease, AST, APRI, and FIB-4 scores. During follow-up, smoking, alcohol consumption, CAP, and changes in body fat were linked to disease progression. In multivariate analysis, only smoking and baseline CAP were independent predictors.

Conclusions

Smoking and baseline CAP were significantly associated with the risk of MASLD progression, suggesting their potential utility in guiding timely interventions.

代谢功能障碍相关脂肪变性肝病（MASLD）的特征是肝脏中甘油三酯的积累，与心脏代谢危险因素相关。其全球患病率超过30%，与超重和2型糖尿病同时上升。内脏脂肪与全身炎症和肝脏脂肪堆积有关。虽然弹性成像对评估疾病进展是有用的，但其高成本和有限的可用性需要探索替代工具。已提出使用身体成分参数作为疾病进展的潜在预测指标。目的：探讨伴有代谢功能障碍的肝病患者体成分变化与肝弹性图值的关系。材料与方法这是一项分析性、观察性和前瞻性研究。患者年龄超过18岁，既往诊断为脂肪变性肝病。在基线和一年后，所有患者都进行了弹性成像和生物电阻抗分析，以评估进展危险因素。患者在知情同意书上签字。结果共纳入88例患者，其中女性占52.3%。初始弹性图读数平均为9.2 kPa；控制衰减参数为269 dB/m。与肝僵硬度升高相关的因素包括2型糖尿病、慢性肾病、AST、APRI和FIB-4评分。在随访期间，吸烟、饮酒、CAP和体脂变化与疾病进展有关。在多变量分析中，只有吸烟和基线CAP是独立的预测因子。结论吸烟和基线CAP与MASLD进展风险显著相关，提示其在指导及时干预方面的潜在效用。

{"title":"CHANGES IN BODY COMPOSITION AND HEPATIC ELASTOGRAPHY VALUES IN PATIENTS WITH METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE AT A MEDICAL CENTER IN CARTAGENA – COLOMBIA, DURING THE PERIOD FROM OCTOBER 2023 TO JANUARY 2025","authors":"Arturo Jose Viera Oliveros , Ismael Yepes Barreto , Yohana Poveda Salinas , Fernando García del Risco","doi":"10.1016/j.aohep.2025.101985","DOIUrl":"10.1016/j.aohep.2025.101985","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the accumulation of triglycerides in the liver, linked to cardiometabolic risk factors. Its global prevalence exceeds 30%, rising in parallel with overweight and type 2 diabetes. Visceral fat is associated with systemic inflammation and hepatic fat accumulation. Although elastography is useful for assessing disease progression, its high cost and limited availability necessitate the exploration of alternative tools. The use of body composition parameters has been proposed as potential predictors of disease progression.</div><div>To determine the relationship between changes in body composition and hepatic elastography values in patients with liver disease associated with metabolic dysfunction.</div></div><div><h3>Materials and Methods</h3><div>This was an analytical, observational, and prospective study. Patients over 18 years old with a previous diagnosis of steatotic liver disease were included. All underwent elastography and bioelectrical impedance analysis at baseline and after one year to assess progression risk factors. The patients signed the informed consent.</div></div><div><h3>Results</h3><div>A total of 88 patients were included, 52.3% of whom were women. Initial elastography readings averaged 9.2 kPa; the controlled attenuation parameter (CAP) was 269 dB/m. Factors associated with elevated liver stiffness included type 2 diabetes, chronic kidney disease, AST, APRI, and FIB-4 scores. During follow-up, smoking, alcohol consumption, CAP, and changes in body fat were linked to disease progression. In multivariate analysis, only smoking and baseline CAP were independent predictors.</div></div><div><h3>Conclusions</h3><div>Smoking and baseline CAP were significantly associated with the risk of MASLD progression, suggesting their potential utility in guiding timely interventions.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101985"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154238","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

EXPLORING THE ROLE OF METABOLIC DYSFUNCTION IN ALCOHOL-ASSOCIATED HEPATITIS: A GLOBAL STUDY 探索代谢功能障碍在酒精相关性肝炎中的作用：一项全球研究

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101970

María Ignacia Pérez Garayar , Vania Cari Gormaz , Ignacio Téllez , Francisco Idalsoaga , Gene Im , Bastian Alcayaga , Muzzafar Haque , Stephanie Rutledge , Hanna Blaney , Pojsakorn Danpanichkul , Arun Valsan , Gowripriya Nair , Gustavo Ayares , Renata Farías , Jorge Arnold , Pedro Acuña , Kaanthi Rama , Carlos Esteban Coronel-Castillo , María Ayala-Valverde , Carolina Ramirez-Cadiz , Juan Pablo Arab

Introduction and Objectives

Severe alcohol-associated hepatitis (AH) carries high mortality. Although the role of cardiometabolic risk factors (CMRF)—including obesity, type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia (DLP)—has been characterized in steatotic liver disease, their role in the severity of AH remains unclear.

To evaluate the impact of CMRF on mortality and infection risk in AH.

Materials and Methods

Multinational prospective cohort study (2015–2024) including hospitalized patients with severe AH across 24 centers in 14 countries (Global AlcHep Network). Diagnosis of AH was done using NIAAA criteria. Analyses included competing-risk models, with liver transplantation as a competing risk. Models were adjusted by age, sex, ethnicity, history of cirrhosis, CMRF, corticosteroids use, MELD, and ACLF grade.

Results

935 participants were included. Median BMI was 24.2kg/m2, prevalence of T2DM was 21%, HTN 17%, DLP 7%. In adjusted competing-risk models, age (sHR 1.02, 95%CI: 1.01-1.04; p<0.001), MELD (sHR 1.04, 95%CI: 1.01–1.06; p<0.001), infections (sHR 1.76, 95%CI: 1.28–2.41; p<0.001), and ACLF grade 2 (sHR 1.67, 95%CI: 1.05–2.69; p<0.032) and 3 (sHR 3.06, 95%CI: 1.88–4.99; p<0.001) were associated with higher risk of mortality, while obesity (sHR 0.67, 95%CI: 0.48–0.93; p=0.016) and corticosteroids use (sHR 0.67, 95%CI: 0.49–0.92; p=0.014) were associated with lower mortality. T2DM, HTN and DLP weren’t associated with higher mortality.

Conclusions

Metabolic dysfunction was not associated with increased mortality in AH. Although obesity may be a protective factor, these findings could be explained by a better nutritional status than the lean population.

重度酒精相关性肝炎（AH）死亡率高。尽管心脏代谢危险因素（CMRF）——包括肥胖、2型糖尿病（T2DM）、高血压（HTN）和血脂异常（DLP）——在脂肪变性肝病中的作用已被证实，但它们在AH严重程度中的作用仍不清楚。评价CMRF对AH患者死亡率和感染风险的影响。材料和方法一项跨国前瞻性队列研究（2015-2024），包括14个国家24个中心的严重AH住院患者（Global AlcHep Network）。AH的诊断采用NIAAA标准。分析包括以肝移植为竞争风险的竞争风险模型。模型根据年龄、性别、种族、肝硬化史、CMRF、皮质类固醇使用、MELD和ACLF分级进行调整。结果共纳入935名受试者。中位BMI为24.2kg/m2， T2DM患病率为21%，HTN为17%，DLP为7%。在调整后的竞争风险模型中，年龄（sHR 1.02, 95%CI: 1.01-1.04; p<0.001）、MELD （sHR 1.04, 95%CI: 1.01-1.06; p<0.001）、感染（sHR 1.76, 95%CI: 1.28-2.41; p<0.001）和ACLF 2级（sHR 1.67, 95%CI: 1.05-2.69; p<0.032）和3级（sHR 3.06, 95%CI: 1.88-4.99; p<0.001）与较高的死亡率相关，而肥胖（sHR 0.67, 95%CI: 0.48-0.93; p=0.016）和皮质类固醇使用（sHR 0.67, 95%CI: 0.49-0.92; p=0.014）与较低的死亡率相关。T2DM、HTN和DLP与较高的死亡率无关。结论：代谢功能障碍与AH患者死亡率增加无关。虽然肥胖可能是一个保护因素，但这些发现可以用比瘦人更好的营养状况来解释。

{"title":"EXPLORING THE ROLE OF METABOLIC DYSFUNCTION IN ALCOHOL-ASSOCIATED HEPATITIS: A GLOBAL STUDY","authors":"María Ignacia Pérez Garayar , Vania Cari Gormaz , Ignacio Téllez , Francisco Idalsoaga , Gene Im , Bastian Alcayaga , Muzzafar Haque , Stephanie Rutledge , Hanna Blaney , Pojsakorn Danpanichkul , Arun Valsan , Gowripriya Nair , Gustavo Ayares , Renata Farías , Jorge Arnold , Pedro Acuña , Kaanthi Rama , Carlos Esteban Coronel-Castillo , María Ayala-Valverde , Carolina Ramirez-Cadiz , Juan Pablo Arab","doi":"10.1016/j.aohep.2025.101970","DOIUrl":"10.1016/j.aohep.2025.101970","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Severe alcohol-associated hepatitis (AH) carries high mortality. Although the role of cardiometabolic risk factors (CMRF)—including obesity, type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia (DLP)—has been characterized in steatotic liver disease, their role in the severity of AH remains unclear.</div><div>To evaluate the impact of CMRF on mortality and infection risk in AH.</div></div><div><h3>Materials and Methods</h3><div>Multinational prospective cohort study (2015–2024) including hospitalized patients with severe AH across 24 centers in 14 countries (Global AlcHep Network). Diagnosis of AH was done using NIAAA criteria. Analyses included competing-risk models, with liver transplantation as a competing risk. Models were adjusted by age, sex, ethnicity, history of cirrhosis, CMRF, corticosteroids use, MELD, and ACLF grade.</div></div><div><h3>Results</h3><div>935 participants were included. Median BMI was 24.2kg/m2, prevalence of T2DM was 21%, HTN 17%, DLP 7%. In adjusted competing-risk models, age (sHR 1.02, 95%CI: 1.01-1.04; p<0.001), MELD (sHR 1.04, 95%CI: 1.01–1.06; p<0.001), infections (sHR 1.76, 95%CI: 1.28–2.41; p<0.001), and ACLF grade 2 (sHR 1.67, 95%CI: 1.05–2.69; p<0.032) and 3 (sHR 3.06, 95%CI: 1.88–4.99; p<0.001) were associated with higher risk of mortality, while obesity (sHR 0.67, 95%CI: 0.48–0.93; p=0.016) and corticosteroids use (sHR 0.67, 95%CI: 0.49–0.92; p=0.014) were associated with lower mortality. T2DM, HTN and DLP weren’t associated with higher mortality.</div></div><div><h3>Conclusions</h3><div>Metabolic dysfunction was not associated with increased mortality in AH. Although obesity may be a protective factor, these findings could be explained by a better nutritional status than the lean population.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101970"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154313","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

IDENTIFICATION OF NOVEL INTESTINAL MICROBIOTA-BASED MARKERS ASSOCIATED WITH DYSBIOSIS, SEPSIS AND SHORT-TERM MORTALITY IN ALCOHOL-RELATED DECOMPENSATED CIRRHOSIS AND ACUTE-ON-CHRONIC LIVER FAILURE 鉴定与酒精相关失代偿性肝硬化和急性慢性肝衰竭中生态失调、败血症和短期死亡率相关的新型肠道微生物群标志物

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101972

María Daniela Sánchez Gutiérrez , Paula Alejandra Castaño Jimenéz , Luis Gilberto Huerta Gómez , Marina Campos Valdez , Miriam Ruth Bueno Topete , Tonatiuh Abimael Baltazar Díaz

Introduction and Objectives

Decompensated cirrhosis (DC) and acute-on-chronic liver failure (ACLF) related to alcohol present high morbidity and mortality and complications such as sepsis and multiorgan failure. The intestinal microbiota (IM) suffers from marked dysbiosis, altering SCFA biosynthesis and affecting the gut-liver axis. The microbial pathways involved, poorly understood in these pathologies, could represent useful prognostic markers.

To evaluate the relative quantification of bacterial SCFA genes in the IM of patients with CD and ACLF, and their association with different clinical outcomes and alpha-diversity.

Materials and Methods

Retrospective analytical study. Fecal samples from 19 ACLF patients, 16 DC, and 16 healthy controls (HC) were included. The butCoA, buk, ackA, and mmdA genes were quantified by qPCR. ROC curves and Kaplan-Meier analyses were performed using GraphPad. Approval number: CI-01023. No conflicts of interest are reported.

Results

Relative abundances of butCoA and ackA genes were significantly decreased in DC and ACLF patients (p<0.05), whereas mmdA increased in DC. buk increased in patients who died at 28 days (p<0.01) and showed a negative correlation with alpha-diversity, being associated with dysbiosis. Furthermore, buk and butCoA discriminated 28-day mortality in DC and ACLF (AUROC 0.75 and 0.85, respectively). In Kaplan-Meier analyses, increased buk was associated with 28-day mortality of 53% in DC and 71% in ACLF.

Conclusions

Intestinal microbiota of DC/ACLF showed reduction of butCoA, ackA, and mmdA, correlating with functional loss. Increased buk was associated with 28-day mortality, loss of alpha-diversity and sepsis. These findings propose novel microbial biomarkers in the Mexican population which will have to be validated later.

与酒精相关的失代偿性肝硬化（DC）和急性慢性肝衰竭（ACLF）具有很高的发病率和死亡率以及脓毒症和多器官衰竭等并发症。肠道微生物群（IM）遭受明显的生态失调，改变SCFA生物合成并影响肠-肝轴。所涉及的微生物途径，在这些病理中知之甚少，可以代表有用的预后标记。评估CD和ACLF患者IM中细菌SCFA基因的相对定量，以及它们与不同临床结局和α -多样性的关系。材料与方法回顾性分析研究。纳入了19例ACLF患者、16例DC和16例健康对照（HC）的粪便样本。采用qPCR法对bucoa、buk、ackA和mmdA基因进行定量分析。使用GraphPad进行ROC曲线和Kaplan-Meier分析。批准文号：CI-01023。无利益冲突报告。结果DC和ACLF患者的butCoA和ackA基因相对丰度显著降低（p < 0.05），而DC患者的mmdA相对丰度升高。Buk在28天死亡的患者中升高（p<0.01），并与α -多样性呈负相关，与生态失调有关。此外，buk和butCoA区分DC和ACLF的28天死亡率（AUROC分别为0.75和0.85）。Kaplan-Meier分析显示，体重增加与DC患者28天死亡率相关，分别为53%和71%。结论DC/ACLF患者肠道菌群中bucoa、ackA和mmdA的减少与功能丧失相关。buk增加与28天死亡率、α -多样性丧失和败血症有关。这些发现在墨西哥人群中提出了新的微生物生物标志物，这将在以后得到验证。

{"title":"IDENTIFICATION OF NOVEL INTESTINAL MICROBIOTA-BASED MARKERS ASSOCIATED WITH DYSBIOSIS, SEPSIS AND SHORT-TERM MORTALITY IN ALCOHOL-RELATED DECOMPENSATED CIRRHOSIS AND ACUTE-ON-CHRONIC LIVER FAILURE","authors":"María Daniela Sánchez Gutiérrez , Paula Alejandra Castaño Jimenéz , Luis Gilberto Huerta Gómez , Marina Campos Valdez , Miriam Ruth Bueno Topete , Tonatiuh Abimael Baltazar Díaz","doi":"10.1016/j.aohep.2025.101972","DOIUrl":"10.1016/j.aohep.2025.101972","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Decompensated cirrhosis (DC) and acute-on-chronic liver failure (ACLF) related to alcohol present high morbidity and mortality and complications such as sepsis and multiorgan failure. The intestinal microbiota (IM) suffers from marked dysbiosis, altering SCFA biosynthesis and affecting the gut-liver axis. The microbial pathways involved, poorly understood in these pathologies, could represent useful prognostic markers.</div><div>To evaluate the relative quantification of bacterial SCFA genes in the IM of patients with CD and ACLF, and their association with different clinical outcomes and alpha-diversity.</div></div><div><h3>Materials and Methods</h3><div>Retrospective analytical study. Fecal samples from 19 ACLF patients, 16 DC, and 16 healthy controls (HC) were included. The butCoA, buk, ackA, and mmdA genes were quantified by qPCR. ROC curves and Kaplan-Meier analyses were performed using GraphPad. Approval number: CI-01023. No conflicts of interest are reported.</div></div><div><h3>Results</h3><div>Relative abundances of butCoA and ackA genes were significantly decreased in DC and ACLF patients (p<0.05), whereas mmdA increased in DC. buk increased in patients who died at 28 days (p<0.01) and showed a negative correlation with alpha-diversity, being associated with dysbiosis. Furthermore, buk and butCoA discriminated 28-day mortality in DC and ACLF (AUROC 0.75 and 0.85, respectively). In Kaplan-Meier analyses, increased buk was associated with 28-day mortality of 53% in DC and 71% in ACLF.</div></div><div><h3>Conclusions</h3><div>Intestinal microbiota of DC/ACLF showed reduction of butCoA, ackA, and mmdA, correlating with functional loss. Increased buk was associated with 28-day mortality, loss of alpha-diversity and sepsis. These findings propose novel microbial biomarkers in the Mexican population which will have to be validated later.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101972"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154316","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

TRANSFORMING OUTPATIENT HEPATIC CARE IN LATIN AMERICA: A SCALABLE, NURSE-DRIVEN APPROACH 拉丁美洲门诊肝脏护理的转变：可扩展的、护士驱动的方法

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101962

Francisco Vargas-Navarro , Maria Soto-Echeverri , Daniel Mondragón-Bustos , Wagner Ramírez-Quesada , Maria Lynch-Mejía , Roy Quesada-Mora , Alejandra Ochoa-Palominos , Pablo Coste

Introduction and Objectives

Chronic liver diseases are increasingly prevalent in Latin America, where fragmented care and hospital overcrowding limit timely, cost-effective management. Nurse-led outpatient programs may offer a viable alternative in resource-constrained environments.

To evaluate the safety and cost-effectiveness of a nurse-driven Outpatient Intervention Program (OIP) for patients with liver disease and its potential scalability across Latin America.

Materials and Methods

An OIP was implemented in 2019 at a tertiary care transplantation center. The program included outpatient liver biopsies (LB), albumin and blood product infusions, and diagnostic/therapeutic paracentesis. Retrospective data from 2019-2024 were analyzed.

Results

A total of 418 procedures were performed on 258 patients: 162 LB, 104 albumin or blood product infusions, and 152 paracentesis. This demonstrates a 3,240% increase in the number of LB and a 1,680% increase in paracentesis compared to 2018, before the program began.

The overall complication rate was 0.87% (4 complications), with only 2 major events (0.43%): spontaneous bacterial peritonitis after paracentesis and post-biopsy bleeding.

LB costs dropped from $2,894 to $549, generating $379,890 in savings over six years, due to avoiding overnight hospitalization. Paracentesis, albumin infusions and blood transfusions were previously performed in the emergency department, incurring an additional expense of $420. This transition to OIP generated total savings of $107,160 and contributed to reduced congestion in the emergency department.

Conclusions

This nurse-led model yields promising results in outpatient liver care and represents a cost-effective, Potential intervention. Its integration into public health systems across Latin America could contribute to more efficient management of CLD.

介绍和目的慢性肝病在拉丁美洲日益流行，在那里，分散的护理和医院过度拥挤限制了及时、具有成本效益的管理。护士主导的门诊项目可能在资源有限的环境中提供一个可行的替代方案。评估护士驱动的肝病患者门诊干预计划（OIP）的安全性和成本效益及其在拉丁美洲的潜在可扩展性。材料与方法san OIP于2019年在一家三级医疗移植中心实施。该计划包括门诊肝活检（LB），白蛋白和血液制品输注，以及诊断/治疗性穿刺。对2019-2024年的回顾性数据进行分析。结果258例患者共行418例手术，其中LB 162例，白蛋白或血液制品输注104例，穿刺152例。这表明，与该计划开始前的2018年相比，LB数量增加了3240%，穿刺术增加了1680%。总并发症发生率为0.87%（4例并发症），主要事件仅2例（0.43%）：穿刺后自发性细菌性腹膜炎和活检后出血。LB费用从2,894美元降至549美元，由于避免了过夜住院治疗，六年内节省了379,890美元。以前在急诊科进行穿刺术、白蛋白注射和输血，额外费用420美元。向伊办的过渡共节省107 160美元，并有助于减少急诊科的拥挤情况。结论：这种护士主导的模式在门诊肝脏护理中取得了良好的效果，代表了一种具有成本效益的潜在干预措施。将其纳入整个拉丁美洲的公共卫生系统可能有助于更有效地管理CLD。

{"title":"TRANSFORMING OUTPATIENT HEPATIC CARE IN LATIN AMERICA: A SCALABLE, NURSE-DRIVEN APPROACH","authors":"Francisco Vargas-Navarro , Maria Soto-Echeverri , Daniel Mondragón-Bustos , Wagner Ramírez-Quesada , Maria Lynch-Mejía , Roy Quesada-Mora , Alejandra Ochoa-Palominos , Pablo Coste","doi":"10.1016/j.aohep.2025.101962","DOIUrl":"10.1016/j.aohep.2025.101962","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Chronic liver diseases are increasingly prevalent in Latin America, where fragmented care and hospital overcrowding limit timely, cost-effective management. Nurse-led outpatient programs may offer a viable alternative in resource-constrained environments.</div><div>To evaluate the safety and cost-effectiveness of a nurse-driven Outpatient Intervention Program (OIP) for patients with liver disease and its potential scalability across Latin America.</div></div><div><h3>Materials and Methods</h3><div>An OIP was implemented in 2019 at a tertiary care transplantation center. The program included outpatient liver biopsies (LB), albumin and blood product infusions, and diagnostic/therapeutic paracentesis. Retrospective data from 2019-2024 were analyzed.</div></div><div><h3>Results</h3><div>A total of 418 procedures were performed on 258 patients: 162 LB, 104 albumin or blood product infusions, and 152 paracentesis. This demonstrates a 3,240% increase in the number of LB and a 1,680% increase in paracentesis compared to 2018, before the program began.</div><div>The overall complication rate was 0.87% (4 complications), with only 2 major events (0.43%): spontaneous bacterial peritonitis after paracentesis and post-biopsy bleeding.</div><div>LB costs dropped from $2,894 to $549, generating $379,890 in savings over six years, due to avoiding overnight hospitalization. Paracentesis, albumin infusions and blood transfusions were previously performed in the emergency department, incurring an additional expense of $420. This transition to OIP generated total savings of $107,160 and contributed to reduced congestion in the emergency department.</div></div><div><h3>Conclusions</h3><div>This nurse-led model yields promising results in outpatient liver care and represents a cost-effective, Potential intervention. Its integration into public health systems across Latin America could contribute to more efficient management of CLD.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101962"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154382","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

CHARACTERIZATION AND DESCRIPTION OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE ASSESSED BY HEPATIC ELASTOGRAPHY IN A CENTER IN BOGOTA 波哥大某中心肝脏弹性成像评估代谢功能障碍相关脂肪变性肝病的特征和描述

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102029

Lina Marcela Dorado Delgado , Laura Cristina Arocha Dugand , Martin Alonso Garzón Olarte , Danna Lesley Cruz Reyes , Nicole Guzmán , Oscar Beltrán , Geovanny Hernández , Carolina Salinas , Cristina Torres , Adriana Varón Puerta

Introduction and Objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally, with 25–30% of patients progressing to fibrosis. It is associated with complications such as cirrhosis, liver failure, and liver cancer. Transient liver elastography (TLE) is a non-invasive, reliable tool to assess hepatic steatosis and fibrosis, with lower risk than biopsy. This study aims to characterize patients with MASLD at Fundación Cardioinfantil by analyzing demographic and clinical factors, and the grade of liver steatosis and fibrosis using TLE

Materials and Methods

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally, with 25–30% of patients progressing to fibrosis. It is associated with complications such as cirrhosis, liver failure, and liver cancer. Transient liver elastography (TLE) is a non-invasive, reliable tool to assess hepatic steatosis and fibrosis, with lower risk than biopsy. This study aims to characterize patients with MASLD at Fundación Cardioinfantil by analyzing demographic and clinical factors, and the grade of liver steatosis and fibrosis using TLE

Results

In the interim analysis of 899 patients, elastography results met international quality standards (IQR/M 18.3). The average BMI was 27.2 kg/m², and common comorbidities included hypertension and diabetes. Steatosis was typically moderate (LiSA S2), with a higher LiSA score in those with higher BMI (graphic 1). Fibrosis was absent in 78.3% of cases, while 21.7% showed progression (table 1) of this population 69.9% have overweight or obesity.

Conclusions

MASLD is primarily associated with metabolic diseases. This study found that higher BMI is linked to an increased risk of steatosis, and higher levels of fibrosis were seen in older patients (with no linear relationship). These patients should be prioritized for early screening and treatment, reducing complications and overall morbidity and mortality.

代谢功能障碍相关脂肪变性肝病（MASLD）是全球最常见的肝脏疾病，25-30%的患者进展为纤维化。它与肝硬化、肝功能衰竭和肝癌等并发症有关。瞬时肝弹性成像（TLE）是一种评估肝脏脂肪变性和纤维化的无创、可靠的工具，其风险低于活检。本研究旨在通过分析人口统计学和临床因素来表征Fundación Cardioinfantil的MASLD患者，并使用le分析肝脏脂肪变性和纤维化的等级。材料和方法代谢功能障碍相关的脂肪变性肝病（MASLD）是全球最常见的肝脏疾病，25-30%的患者进展为纤维化。它与肝硬化、肝功能衰竭和肝癌等并发症有关。瞬时肝弹性成像（TLE）是一种评估肝脏脂肪变性和纤维化的无创、可靠的工具，其风险低于活检。本研究旨在通过分析人口统计学和临床因素，以及使用tlerr分析肝脂肪变性和纤维化的分级来表征Fundación Cardioinfantil的MASLD患者。结果在899例患者的中期分析中，弹性成像结果符合国际质量标准（IQR/M 18.3）。平均BMI为27.2 kg/m2，常见合并症包括高血压和糖尿病。脂肪变性通常为中度（LiSA S2）， BMI越高，LiSA评分越高（图1）。78.3%的病例没有纤维化，而21.7%的患者有进展（表1），69.9%的患者超重或肥胖。结论smasld主要与代谢性疾病相关。该研究发现，较高的BMI与脂肪变性风险增加有关，老年患者的纤维化水平较高（没有线性关系）。这些患者应优先进行早期筛查和治疗，减少并发症和总体发病率和死亡率。

{"title":"CHARACTERIZATION AND DESCRIPTION OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE ASSESSED BY HEPATIC ELASTOGRAPHY IN A CENTER IN BOGOTA","authors":"Lina Marcela Dorado Delgado , Laura Cristina Arocha Dugand , Martin Alonso Garzón Olarte , Danna Lesley Cruz Reyes , Nicole Guzmán , Oscar Beltrán , Geovanny Hernández , Carolina Salinas , Cristina Torres , Adriana Varón Puerta","doi":"10.1016/j.aohep.2025.102029","DOIUrl":"10.1016/j.aohep.2025.102029","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally, with 25–30% of patients progressing to fibrosis. It is associated with complications such as cirrhosis, liver failure, and liver cancer. Transient liver elastography (TLE) is a non-invasive, reliable tool to assess hepatic steatosis and fibrosis, with lower risk than biopsy. This study aims to characterize patients with MASLD at Fundación Cardioinfantil by analyzing demographic and clinical factors, and the grade of liver steatosis and fibrosis using TLE</div></div><div><h3>Materials and Methods</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally, with 25–30% of patients progressing to fibrosis. It is associated with complications such as cirrhosis, liver failure, and liver cancer. Transient liver elastography (TLE) is a non-invasive, reliable tool to assess hepatic steatosis and fibrosis, with lower risk than biopsy. This study aims to characterize patients with MASLD at Fundación Cardioinfantil by analyzing demographic and clinical factors, and the grade of liver steatosis and fibrosis using TLE</div></div><div><h3>Results</h3><div>In the interim analysis of 899 patients, elastography results met international quality standards (IQR/M 18.3). The average BMI was 27.2 kg/m<sup>2</sup>, and common comorbidities included hypertension and diabetes. Steatosis was typically moderate (LiSA S2), with a higher LiSA score in those with higher BMI (graphic 1). Fibrosis was absent in 78.3% of cases, while 21.7% showed progression (table 1) of this population 69.9% have overweight or obesity.</div></div><div><h3>Conclusions</h3><div>MASLD is primarily associated with metabolic diseases. This study found that higher BMI is linked to an increased risk of steatosis, and higher levels of fibrosis were seen in older patients (with no linear relationship). These patients should be prioritized for early screening and treatment, reducing complications and overall morbidity and mortality.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102029"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154400","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

LATIN AMERICAN SURVEILLANCE REGISTRY REVEALS HIGHER ANTIMICROBIAL RESISTANCE IN INVASIVE ISOLATES FROM PATIENTS WITH CIRRHOSIS COMPARED TO EUROPEAN BENCHMARKS 拉丁美洲监测登记显示，与欧洲基准相比，来自肝硬化患者的侵袭性分离株的抗菌素耐药性更高

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101959

Gonzalo Gomez Perdiguero , Maria Dolores Murga , Ana Palazzo , Esteban Gonzalez Ballerga , Ilse Pardo Ivirico , Maria Daniela Perez , Lorena Notari , Josefina Pages , Manuel Mendizabal , Camila Maria Briz , Agustin Di Santo , Julia Brutti , Brenda Osso Sanchez , Margarita Anders , Pablo Calzetta , Alina Raquel Zerega , Angelo Z. Mattos , Astrid Smud , Laura R. Maboni , Maximiliano Castro , Sebastian Marciano

Introduction and Objectives

Given the growing burden of antimicrobial resistance (AMR), we aimed to report the prevalence of key AMR patterns in Latin American patients with cirrhosis and compare them with the European Antimicrobial Resistance Surveillance Network (EARS-Net) data

Materials and Methods

Cross-sectional study of invasive isolates (blood, ascitic or pleural fluid) from adults with cirrhosis enrolled in the Latin American surveillance registry (ClinicalTrials.gov: NCT0634940). AMR patterns were reported for key pathogens: E. coli, K. pneumoniae, S. aureus, Acinetobacter spp., E. faecium, and P. aeruginosa.

Results

Between December 2020 and May 2025, 908 bacterial isolates were collected from Argentina, Uruguay, Brazil, and Peru. Of these, 226 (25%) were obtained from invasive sites and correspond to predefined bacteria of epidemiological interest included in the analysis. Isolates were 39% nosocomial, 38% community-acquired, and 23% healthcare-associated. The main infections were spontaneous bacteremia (38%) and SBP (32%). Quinolone resistance was higher in Latin American vs. Europe for K. pneumoniae (56% vs. 34%) and E. coli (46% vs. 24%). Carbapenem resistance in K. pneumoniae was 46% (vs. 13%), and in E. coli, 5.3% (vs. 0.3%). Methicillin resistance among S. aureus was higher in Latin American (32%) than in Europe (16%). Other pathogens also showed higher resistance (Table).

Conclusions

The elevated resistance rates observed in Latin American patients with cirrhosis demand attention. In a region where regulatory gaps at multiple levels may contribute to antibiotic misuse, these findings call for urgent action to strengthen rational antibiotic use and implement effective stewardship strategies.

鉴于抗菌素耐药性（AMR）的负担日益加重，我们旨在报告拉丁美洲肝硬化患者中主要AMR模式的流行情况，并将其与欧洲抗菌素耐药性监测网络（ear - net）数据进行比较。材料和方法对拉丁美洲监测登记处（ClinicalTrials.gov: NCT0634940）登记的成年肝硬化患者的侵袭性分离物（血液、腹水或胸膜液）进行横断面研究。报告了主要病原体的抗菌素耐药性模式：大肠杆菌、肺炎克雷伯菌、金黄色葡萄球菌、不动杆菌、粪肠杆菌和铜绿假单胞菌。结果2020年12月至2025年5月，在阿根廷、乌拉圭、巴西和秘鲁共分离到908株细菌。其中226个（25%）来自入侵点，与分析中预先确定的流行病学兴趣细菌相对应。分离株39%是医院感染，38%是社区获得，23%是卫生保健相关。主要感染为自发性菌血症（38%）和收缩压（32%）。拉丁美洲的肺炎克雷伯菌（56%对34%）和大肠杆菌（46%对24%）对喹诺酮类药物的耐药性高于欧洲。肺炎克雷伯菌对碳青霉烯的耐药性为46% (vs. 13%)，大肠杆菌为5.3% （vs. 0.3%）。金黄色葡萄球菌对甲氧西林的耐药性在拉丁美洲（32%）高于欧洲（16%）。其他病原体也表现出更高的耐药性（表）。结论拉丁美洲肝硬化患者耐药率升高值得关注。在一个多个层面的监管缺口可能导致抗生素滥用的地区，这些发现呼吁采取紧急行动，加强抗生素的合理使用并实施有效的管理战略。

{"title":"LATIN AMERICAN SURVEILLANCE REGISTRY REVEALS HIGHER ANTIMICROBIAL RESISTANCE IN INVASIVE ISOLATES FROM PATIENTS WITH CIRRHOSIS COMPARED TO EUROPEAN BENCHMARKS","authors":"Gonzalo Gomez Perdiguero , Maria Dolores Murga , Ana Palazzo , Esteban Gonzalez Ballerga , Ilse Pardo Ivirico , Maria Daniela Perez , Lorena Notari , Josefina Pages , Manuel Mendizabal , Camila Maria Briz , Agustin Di Santo , Julia Brutti , Brenda Osso Sanchez , Margarita Anders , Pablo Calzetta , Alina Raquel Zerega , Angelo Z. Mattos , Astrid Smud , Laura R. Maboni , Maximiliano Castro , Sebastian Marciano","doi":"10.1016/j.aohep.2025.101959","DOIUrl":"10.1016/j.aohep.2025.101959","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Given the growing burden of antimicrobial resistance (AMR), we aimed to report the prevalence of key AMR patterns in Latin American patients with cirrhosis and compare them with the European Antimicrobial Resistance Surveillance Network (EARS-Net) data</div></div><div><h3>Materials and Methods</h3><div>Cross-sectional study of invasive isolates (blood, ascitic or pleural fluid) from adults with cirrhosis enrolled in the Latin American surveillance registry (ClinicalTrials.gov: NCT0634940). AMR patterns were reported for key pathogens: E. coli, K. pneumoniae, S. aureus, Acinetobacter spp., E. faecium, and P. aeruginosa.</div></div><div><h3>Results</h3><div>Between December 2020 and May 2025, 908 bacterial isolates were collected from Argentina, Uruguay, Brazil, and Peru. Of these, 226 (25%) were obtained from invasive sites and correspond to predefined bacteria of epidemiological interest included in the analysis. Isolates were 39% nosocomial, 38% community-acquired, and 23% healthcare-associated. The main infections were spontaneous bacteremia (38%) and SBP (32%). Quinolone resistance was higher in Latin American vs. Europe for K. pneumoniae (56% vs. 34%) and E. coli (46% vs. 24%). Carbapenem resistance in K. pneumoniae was 46% (vs. 13%), and in E. coli, 5.3% (vs. 0.3%). Methicillin resistance among S. aureus was higher in Latin American (32%) than in Europe (16%). Other pathogens also showed higher resistance (Table).</div></div><div><h3>Conclusions</h3><div>The elevated resistance rates observed in Latin American patients with cirrhosis demand attention. In a region where regulatory gaps at multiple levels may contribute to antibiotic misuse, these findings call for urgent action to strengthen rational antibiotic use and implement effective stewardship strategies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101959"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154479","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