Annals of hepatology最新文献_第7页

Comment on "Development of a prediction index for persistent acute kidney injury following orthotopic liver transplant". “原位肝移植术后持续性急性肾损伤预测指标的建立”评论。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-11 DOI: 10.1016/j.aohep.2025.102109

Zhaoyan Ding, Yunping Li, Yuanming Yang

引用次数: 0

Situational panorama of chronic liver diseases: A single-center experience at a university hospital in northeast Mexico (1995-2019). 慢性肝病的情境全景：墨西哥东北部大学医院的单中心体验（1995-2019）。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-11 DOI: 10.1016/j.aohep.2025.102116

Paula Cordero-Perez, Liliana Torres-González, Samuel Rivas-López, Carolina Treviño-García, Airam Regalado-Ceballos, Jaime R Zúñiga-Noriega, Ingrid G López-Reyna, Luz M Barbosa-Castillo, Isai E Hernández-Padilla, Linda E Muñoz-Espinosa

Introduction and objectives: Chronic liver disease (CLD) is characterized by a progressive decline in liver function, accompanied by inflammation, destruction, and scarring of the hepatic parenchyma. The most common etiologies of CLD globally include hepatitis B (HBV), hepatitis C (HCV), alcohol-related liver disease, autoimmune liver disease, and, more recently, metabolic dysfunction-associated steatotic liver disease (MASLD). The aim was to analyze the main etiologies of CLD observed in a Hepatology Center over a 25-year period.

Materials and methods: A retrospective and observational study was conducted with 2679 patients with CLD, recruited between January 1995 and December 2019. The patients were classified into three time periods: Group A (1995-2003), Group B (2004-2011), and Group C (2012-2019). A one-way analysis of variance was used to assess the differences between the groups.

Results: Significant differences were found in HCV, HBV, and MASLD between the analyzed periods (p = 0.0019, p < 0.001, and p < 0.001, respectively). Tukey's post hoc test revealed significant differences in HCV and HBV between group A and groups B and C (p < 0.01 and p < 0.001, respectively). For MASLD, a progressive increase was observed in each period (p < 0.01 for A vs. B; p ≤ 0.001 for A vs. C; p = 0.0042 for B vs. C).

Conclusions: Between 1995 and 2007, the predominant CLD in our clinic was caused by HCV. However, since 2008, MASLD has become the most frequent etiology (33 %), reaching 45 % in 2019 as the leading cause of CLD. By 2012, cirrhosis due to MASLD had the highest incidence among the analyzed etiologies, followed by HCV.

简介和目的：慢性肝病（CLD）的特点是肝功能进行性下降，伴有肝实质的炎症、破坏和瘢痕形成。全球最常见的CLD病因包括乙型肝炎（HBV）、丙型肝炎（HCV）、酒精相关肝病、自身免疫性肝病，以及最近的代谢功能障碍相关的脂肪变性肝病（MASLD）。目的是分析肝病中心25年来观察到的CLD的主要病因。材料和方法：对1995年1月至2019年12月招募的2679例CLD患者进行了回顾性观察性研究。将患者分为三个时间段：A组（1995-2003）、B组（2004-2011）和C组（2012-2019）。采用单因素方差分析来评估组间差异。结果：HCV、HBV和MASLD在分析期间存在显著差异（p = 0.0019,p < 0.001和p < 0.001）。Tukey事后检验显示，A组与B、C组在HCV和HBV方面存在显著差异（分别p < 0.01和p < 0.001）。对于MASLD，在每个时期观察到进行性增加（a与B相比p < 0.01； a与C相比p≤0.001；B与C相比p = 0.0042）。结论：1995 - 2007年间，我院主要的CLD是由HCV引起的。然而，自2008年以来，MASLD已成为最常见的病因（33%），在2019年达到45%，是CLD的主要原因。到2012年，在分析的病因中，MASLD导致的肝硬化发病率最高，其次是HCV。

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引用次数: 0

Simultaneous physical and nutritional intervention reduces frailty in patients with cirrhosis listed for liver transplantation: a randomized controlled trial 同时进行身体和营养干预可减少肝硬化肝移植患者的虚弱：一项随机对照试验。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-11 DOI: 10.1016/j.aohep.2025.102114

Carlos Benítez , Diego Reyes , Catalina Grandy , Isidora Thomas , Nicolás Lavados , Nicole Kim , Anny Gálvez , Silvana Valdés , Soledad Contreras , Roberto Candia

Introduction and Objectives

Frailty is associated with an increased morbidity and mortality among patients with cirrhosis. However, no specific treatment strategy has been formally recommended for these patients. This study aims to evaluate the effectiveness of a strategy based on exercise and nutritional intervention improving frailty in cirrhotic patients listed for transplantation.

Patients and Methods

Patients with increased Liver Frailty Index (LFI) (≥3.2) were randomized to a control group (standard exercise and nutritional counseling) or intervention group (guided by physical therapist and dietitian) for 12 weeks, LFI was measured, and patients were classified as frail or prefrail. The change in LFI was assessed at the end of study.

Results

Sixty-six patients were included (34 to the control group and 32 to the intervention group), age 59.3 ± 8.8, male 51.5 %, main etiologies: MASLD (40.9 %), ALD (15.2 %), MetALD (6.1 %), PBC (6.1 %), autoimmune hepatitis (4.5 %), MELD Na 17.2 ± 5, Child Pugh A/B/C 13.6 %/57.6 %/28.8 %, Na 137±3 mEq/L, creatinine 0.8 ± 0.3 mg/dL, bilirubin 3.3 ± 3 mg/dL, INR 1.5 ± 0.4, albumin 3.3 ± 0.5 g/dL, LFI 4.23 ± 0.5, frail/prefrail (%) 34.8/65.2. There was a significant improvement in LFI at the end of the study in the intervention group (ΔLFI 0.4 vs ΔLFI 0.14, p = 0.02). Notably, we found a significant reduction in the proportion of frail patients in the intervention group vs control group (28.1 % vs 8.8 %, p = 0.02) at the end of the study.

Conclusions

This randomized controlled trial conducted in patients listed for liver transplantation demonstrates that a dual intervention can effectively reduce frailty in this population.

简介和目的：虚弱与肝硬化患者发病率和死亡率增加有关。然而，对于这些患者，还没有正式推荐具体的治疗策略。本研究旨在评估基于运动和营养干预的策略在肝硬化移植患者中改善虚弱的有效性。患者和方法：肝脆弱指数（LFI）升高（≥3.2）的患者随机分为对照组（标准运动和营养咨询）或干预组（由物理治疗师和营养师指导），为期12周，测量LFI，并将患者分为虚弱或虚弱前期。在研究结束时评估LFI的变化。结果：纳入66例患者（对照组34例，干预组32例），年龄59.3±8.8岁，男性51.5%，主要病因：MASLD（40.9%）、ALD（15.2%）、MetALD（6.1%）、PBC（6.1%）、自身免疫性肝炎（4.5%）、MELD Na 17.2±5、Child Pugh A/B/C 13.6%/57.6%/28.8%、Na 137±3mEq/L、肌酐0.8±0.3 mg/dL、胆红素3.3±3 mg/dL、INR 1.5±0.4、白蛋白3.3±0.5 g/dL、LFI 4.23±0.5、体弱/体弱（%）34.8/65.2。干预组在研究结束时LFI有显著改善（ΔLFI 0.4 vs ΔLFI 0.14, p=0.02）。值得注意的是，在研究结束时，我们发现干预组中虚弱患者的比例明显低于对照组（28.1% vs 8.8%, p=0.02）。结论：这项在肝移植患者中进行的随机对照试验表明，双重干预可以有效地减少这一人群的脆弱性。

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引用次数: 0

Bidirectional association between chronic liver disease and chronic kidney disease: a longitudinal study based on CHARLS 2011–2020 data 慢性肝病与慢性肾病的双向关联：基于CHARLS 2011-2020数据的纵向研究

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-11 DOI: 10.1016/j.aohep.2025.102115

Yuan He, Fan Zhang, Zixuan Zhang, Xianwen Zhang, Yifei Zhong

Introduction and Objectives

Chronic liver disease (CLD) and chronic kidney disease (CKD) are major public health concerns with significant morbidity and mortality worldwide. This study aimed to investigate the bidirectional association between CLD and CKD.

Patients and Methods

We conducted two longitudinal studies using data from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020. Participants without baseline CKD were analyzed for the risk of CKD associated with CLD, and participants without baseline CLD were assessed for the risk of CLD associated with CKD. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs).

Results

Of 3651 participants without baseline CKD, 575 developed CKD over a median follow-up of 9 years. The incidence of CKD was significantly higher in those with baseline CLD (37.25 vs. 18.08 per 1000 population). Baseline CLD was independently associated with an elevated risk of incident CKD (adjusted HR=1.93; 95% CI: 1.37–2.72; P < 0.001). Conversely, of 5530 participants without baseline CLD, 474 developed CLD. Participants with CKD had a significantly higher incidence of CLD (13.56 vs. 8.89 per 1000 population). Baseline CKD was independently associated with an increased risk of incident CLD (adjusted HR=1.68; 95% CI: 1.31–2.16; P < 0.001). The bidirectional associations remained robust in sensitivity analyses, and the association persisted across different subgroups.

Conclusions

This study provides evidence of a bidirectional relationship between CLD and CKD. These findings highlight the importance of integrated management strategies targeting both liver and kidney health.

简介和目标：慢性肝病（CLD）和慢性肾病（CKD）是世界范围内发病率和死亡率高的主要公共卫生问题。本研究旨在探讨CLD与CKD之间的双向关系。患者和方法：我们使用2011年至2020年中国健康与退休纵向研究（CHARLS）的数据进行了两项纵向研究。对无基线CKD的参与者进行CKD合并CLD的风险分析，对无基线CLD的参与者进行CLD合并CKD的风险评估。采用多变量Cox比例风险模型估计95%置信区间（95% ci）的风险比（hr）。结果：在3,651名无基线CKD的参与者中，575名在中位9年随访期间发展为CKD。CKD的发生率在基线CLD患者中明显更高（37.25 vs. 18.08 / 1000）。基线CLD与CKD发生风险升高独立相关（调整后HR=1.93; 95% CI: 1.37-2.72; P < 0.001）。相反，在没有基线CLD的5530名参与者中，474人发展为CLD。CKD患者的CLD发病率明显更高（每千人13.56 vs 8.89）。基线CKD与CLD发生风险增加独立相关（调整后HR=1.68; 95% CI: 1.31-2.16; P < 0.001）。在敏感性分析中，双向关联仍然是稳健的，并且这种关联在不同的亚组中持续存在。结论：本研究提供了CLD和CKD之间双向关系的证据。这些发现强调了针对肝脏和肾脏健康的综合管理策略的重要性。

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引用次数: 0

Effects of artificial liver support systems on nosocomial infections and mortality in non-transplanted liver failure patients 人工肝支持系统对非移植性肝衰竭患者院内感染和死亡率的影响。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-09 DOI: 10.1016/j.aohep.2025.102113

Yuan Li , Xiaoting Wang , Junkai Fan, Jiale Xie, Huimin Liu, Chunrong Ping, Zhijie Feng, Yan Wang

Introduction and Objectives

Artificial liver support systems (ALSS) offer a technical solution for patients with liver failure (LF), serving as a bridge to recovery or transplantation. However, the number of LF patients eligible for transplants is limited. This study investigates the incidence of nosocomial infections and survival outcomes in LF patients treated with ALSS who do not undergo liver transplantation.

Patients and Methods

A retrospective cohort study was conducted on LF patients receiving standard medical care (SMC) with ALSS versus those treated only with SMC. General and laboratory data were collected from all LF patients. A logistic regression model was used to assess the risk of nosocomial infections associated with ALSS use, while a Cox proportional hazards model was used to evaluate mortality risk in LF patients undergoing ALSS treatment. Survival times for both groups were calculated using Kaplan–Meier analysis.

Results

A total of 306 LF patients were analyzed, comprising 200 males (65.4%) and 106 females (34.6%), with an average age of 49.9 years (95% CI = 48.2-51.6). Multivariate logistic regression analysis showed that ALSS was not linked to the risk of nosocomial infections (odds ratio =1.189, 95%CI=0.442-3.202, p=0.732). However, hazard ratio (HR) results indicated that ALSS is a protective factor for survival in LF patients (HR=0.533, 95%CI=0.374-0.760, p=0.001), supported by Kaplan–Meier curve analysis demonstrating prolonged survival time in the ALSS group among LF patients.

Conclusions

ALSS is not an independent risk factor for nosocomial infections and could effectively prolong the lifespan of LF patients without liver transplantation. Further intervention studies are needed to validate these findings.

简介和目的：人工肝支持系统（ALSS）为肝功能衰竭（LF）患者提供了一种技术解决方案，可作为恢复或移植的桥梁。然而，适合移植的LF患者数量有限。本研究调查了不接受肝移植的接受ALSS治疗的LF患者的医院感染发生率和生存结局。患者和方法：对接受标准医疗护理（SMC）联合ALSS治疗的LF患者与仅接受SMC治疗的LF患者进行了回顾性队列研究。收集所有LF患者的一般和实验室数据。采用logistic回归模型评估与ALSS使用相关的医院感染风险，采用Cox比例风险模型评估接受ALSS治疗的LF患者的死亡风险。采用Kaplan-Meier分析计算两组患者的生存时间。结果：共分析LF患者306例，其中男性200例（65.4%），女性106例（34.6%），平均年龄49.9岁（95% CI = 48.2-51.6）。多因素logistic回归分析显示，ALSS与院内感染风险无关（优势比=1.189,95%CI=0.442 ~ 3.202, p=0.732）。然而，风险比（HR）结果显示，ALSS是LF患者生存的保护因素（HR=0.533, 95%CI=0.374-0.760, p=0.001）， Kaplan-Meier曲线分析支持ALSS组在LF患者中延长生存时间。结论：ALSS不是院内感染的独立危险因素，可有效延长非肝移植的LF患者的生存期。需要进一步的干预研究来验证这些发现。

{"title":"Effects of artificial liver support systems on nosocomial infections and mortality in non-transplanted liver failure patients","authors":"Yuan Li , Xiaoting Wang , Junkai Fan, Jiale Xie, Huimin Liu, Chunrong Ping, Zhijie Feng, Yan Wang","doi":"10.1016/j.aohep.2025.102113","DOIUrl":"10.1016/j.aohep.2025.102113","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Artificial liver support systems (ALSS) offer a technical solution for patients with liver failure (LF), serving as a bridge to recovery or transplantation. However, the number of LF patients eligible for transplants is limited. This study investigates the incidence of nosocomial infections and survival outcomes in LF patients treated with ALSS who do not undergo liver transplantation.</div></div><div><h3>Patients and Methods</h3><div>A retrospective cohort study was conducted on LF patients receiving standard medical care (SMC) with ALSS versus those treated only with SMC. General and laboratory data were collected from all LF patients. A logistic regression model was used to assess the risk of nosocomial infections associated with ALSS use, while a Cox proportional hazards model was used to evaluate mortality risk in LF patients undergoing ALSS treatment. Survival times for both groups were calculated using Kaplan–Meier analysis.</div></div><div><h3>Results</h3><div>A total of 306 LF patients were analyzed, comprising 200 males (65.4%) and 106 females (34.6%), with an average age of 49.9 years (95% CI = 48.2-51.6). Multivariate logistic regression analysis showed that ALSS was not linked to the risk of nosocomial infections (odds ratio =1.189, 95%CI=0.442-3.202, p=0.732). However, hazard ratio (HR) results indicated that ALSS is a protective factor for survival in LF patients (HR=0.533, 95%CI=0.374-0.760, p=0.001), supported by Kaplan–Meier curve analysis demonstrating prolonged survival time in the ALSS group among LF patients.</div></div><div><h3>Conclusions</h3><div>ALSS is not an independent risk factor for nosocomial infections and could effectively prolong the lifespan of LF patients without liver transplantation. Further intervention studies are needed to validate these findings.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102113"},"PeriodicalIF":4.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038883","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

Impact of neohepatic albumin-bilirubin scores on renal outcomes following living donor liver transplantation: a propensity score analysis 新肝白蛋白-胆红素评分对活体肝移植后肾脏预后的影响：倾向评分分析。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-08 DOI: 10.1016/j.aohep.2025.102111

Hye-Won Jeong , Hye-Mee Kwon , Sung-Hoon Kim , Seong-Mi Yang , In-Gu Jun , Jun-Gol Song , Gyu-Sam Hwang

Introduction and Objectives

Acute kidney injury (AKI) after liver transplantation (LT) impacts patient and graft outcomes. The Albumin-Bilirubin (ALBI) score, an objective and sensitive liver function index, may help predict post-LT outcomes. This study evaluated the association between neohepatic ALBI scores and renal outcomes in living donor LT (LDLT) recipients.

Patients and Methods

We examined 2171 adult LDLT recipients between 2012 and 2019. Outcomes included severe post-LT AKI, renal replacement therapy (RRT), chronic kidney disease (CKD) at 1 year, early allograft dysfunction (EAD), and overall graft failure. Multivariate logistic regression, Cox proportional hazards regression, and propensity score matched (PSM) analyses were performed to evaluate the association between neohepatic ALBI and post-LT outcomes.

Results

Severe AKI, RRT, CKD, EAD, and overall graft failure occurred in 21.6%, 2.2%, 41.9%, 5.9%, and 15.8% of patients, respectively. Higher neohepatic ALBI scores (≥-1.615) were significantly associated with severe AKI (OR: 2.34, 95% CI: 1.79–3.04, P<0.001, multivariate analysis; OR: 2.18, 95% CI: 1.62–2.95, P<0.001, PSM analysis), RRT (OR: 3.80, 95% CI: 1.53–11.31, P=0.008, multivariate analysis; OR: 7.17, 95% CI: 1.61–31.89, P=0.010, PSM analysis), CKD (OR: 1.22, 95% CI: 1.00–1.47, P=0.044, multivariate analysis; OR: 1.43, 95% CI: 1.11–1.85, P=0.006, PSM analysis), and overall graft failure (HR: 1.30, 95% CI: 1.01–1.68, P=0.041, multivariate analysis; HR: 1.55, 95% CI: 1.08–2.23, P=0.018, PSM analysis).

Conclusions

Neohepatic ALBI scores are significantly associated with post-LT severe AKI, RRT, CKD, and graft failure, underscoring their prognostic value in LDLT recipients.

简介和目的：肝移植（LT）后急性肾损伤（AKI）影响患者和移植物的预后。白蛋白-胆红素（ALBI）评分是一种客观且敏感的肝功能指数，可能有助于预测肝移植后的预后。本研究评估了活体肝移植（LDLT）受者新肝ALBI评分与肾脏预后之间的关系。患者和方法：我们在2012年至2019年期间检查了2171名成年LDLT受体。结果包括严重的lt后AKI、肾脏替代治疗（RRT）、1年后慢性肾病（CKD）、早期同种异体移植物功能障碍（EAD）和整体移植物衰竭。采用多变量logistic回归、Cox比例风险回归和倾向评分匹配（PSM）分析来评估新肝性ALBI与肝移植后预后之间的关系。结果：严重AKI、RRT、CKD、EAD和整体移植物衰竭发生率分别为21.6%、2.2%、41.9%、5.9%和15.8%。较高的新肝ALBI评分（≥-1.615）与严重AKI显著相关（OR: 2.34, 95% CI: 1.79-3.04）。结论：新肝ALBI评分与lt后严重AKI、RRT、CKD和移植物衰竭显著相关，强调了其在LDLT受体中的预后价值。

{"title":"Impact of neohepatic albumin-bilirubin scores on renal outcomes following living donor liver transplantation: a propensity score analysis","authors":"Hye-Won Jeong , Hye-Mee Kwon , Sung-Hoon Kim , Seong-Mi Yang , In-Gu Jun , Jun-Gol Song , Gyu-Sam Hwang","doi":"10.1016/j.aohep.2025.102111","DOIUrl":"10.1016/j.aohep.2025.102111","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Acute kidney injury (AKI) after liver transplantation (LT) impacts patient and graft outcomes. The Albumin-Bilirubin (ALBI) score, an objective and sensitive liver function index, may help predict post-LT outcomes. This study evaluated the association between neohepatic ALBI scores and renal outcomes in living donor LT (LDLT) recipients.</div></div><div><h3>Patients and Methods</h3><div>We examined 2171 adult LDLT recipients between 2012 and 2019. Outcomes included severe post-LT AKI, renal replacement therapy (RRT), chronic kidney disease (CKD) at 1 year, early allograft dysfunction (EAD), and overall graft failure. Multivariate logistic regression, Cox proportional hazards regression, and propensity score matched (PSM) analyses were performed to evaluate the association between neohepatic ALBI and post-LT outcomes.</div></div><div><h3>Results</h3><div>Severe AKI, RRT, CKD, EAD, and overall graft failure occurred in 21.6%, 2.2%, 41.9%, 5.9%, and 15.8% of patients, respectively. Higher neohepatic ALBI scores (≥-1.615) were significantly associated with severe AKI (OR: 2.34, 95% CI: 1.79–3.04, <em>P</em><0.001, multivariate analysis; OR: 2.18, 95% CI: 1.62–2.95, <em>P</em><0.001, PSM analysis), RRT (OR: 3.80, 95% CI: 1.53–11.31, <em>P</em>=0.008, multivariate analysis; OR: 7.17, 95% CI: 1.61–31.89, <em>P</em>=0.010, PSM analysis), CKD (OR: 1.22, 95% CI: 1.00–1.47, <em>P</em>=0.044, multivariate analysis; OR: 1.43, 95% CI: 1.11–1.85, <em>P</em>=0.006, PSM analysis), and overall graft failure (HR: 1.30, 95% CI: 1.01–1.68, <em>P</em>=0.041, multivariate analysis; HR: 1.55, 95% CI: 1.08–2.23, <em>P</em>=0.018, PSM analysis).</div></div><div><h3>Conclusions</h3><div>Neohepatic ALBI scores are significantly associated with post-LT severe AKI, RRT, CKD, and graft failure, underscoring their prognostic value in LDLT recipients.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 1","pages":"Article 102111"},"PeriodicalIF":4.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032524","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

DURATION OF TYPE 2 DIABETES AS A CLINICAL PREDICTOR OF LIVER FIBROSIS IN PATIENTS WITH METABOLIC DYSFUNCTION ASSOCIATED STEATOTIC LIVER DISEASE 2型糖尿病病程作为代谢功能障碍相关脂肪变性肝病患者肝纤维化的临床预测因子

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101992

Daniza Alexandra Contreras de los Santos , Invis Perez Mendez , Omar Ebrahim Ibrahim

Introduction and Objectives

Metabolic dysfuntion associated liver disease (MASLD) is highly prevalent in patients with type 2 diabetes mellitus (T2DM), and fibrosis progression is the main prognostic factor. However, clinical predictors of fibrosis remain unclear. Diabetes duration has been suggested as a potencial independent risk factor.

To assess the association between T2DM duration and liver fibrosis estimated by the FIB-4 index and liver stiffness measurement (LSM) in Dominican patients with MASLD.

Materials and Methods

A retrospective cohort study was conducted including 127 adults with MASLD, diagnosed based on hepatic steatosis detected by abdominal ultrasound and coexisting T2DM, following international criteria. Patients were evaluated at a tertiary care center in the Dominican Republic between July 2024 and January 2025.

The FIB-4 was calculated using AST, ALT, platelet count, and age.LSM by transient elastography was available 32 cases. Diabetes duration was extracted from medical records and categorized into five groups (0-5, 6-10, 11-15, 16-20 y >20 years). Spearman correlation assessed associations between diabetes duration, FIB-4, and LSM. Nonparametric test compared fibrosis by duration groups. Significance was set at p<0.05.

Results

Mean age was 56.6 ± 13.9 years; 63 % were women. FIB-4 showed moderate correlation with T2DM duration (ρ=0.26, p=0.005) and age (ρ=0.49, p<0.001). In patient aged 35-65 years, FIB-4 strongly correlated with LSM (ρ=0.77, p<0.001). According to FIB-4 classification, 63.8% were low-risk (<1.3), 32.3% intermediate-risk (1.3-2.67), and 3.9% high-risk (>2.67) for advanced fibrosis.

Conclusions

T2DM duration moderately correlates with FIB-4, especially in mind-aged adults, supporting its role in fibrosis risk models.

代谢功能障碍相关肝病（MASLD）在2型糖尿病（T2DM）患者中非常普遍，纤维化进展是主要的预后因素。然而，纤维化的临床预测因素仍不清楚。糖尿病病程被认为是一个潜在的独立危险因素。通过FIB-4指数和肝硬度测量（LSM）评估多米尼加MASLD患者的T2DM病程与肝纤维化之间的关系。材料与方法采用回顾性队列研究，纳入127例成人MASLD，根据腹部超声检查肝脏脂肪变性诊断并合并T2DM，遵循国际标准。2024年7月至2025年1月期间，患者在多米尼加共和国的一家三级保健中心接受评估。FIB-4通过AST、ALT、血小板计数和年龄计算。利用瞬态弹性成像对32例LSM进行了分析。从病历中提取糖尿病病程，将其分为5组（0-5岁、6-10岁、11-15岁、16-20岁）。Spearman相关性评估糖尿病病程、FIB-4和LSM之间的关系。非参数检验比较病程组间的纤维化。显著性设置为p<；0.05。结果患者平均年龄56.6±13.9岁；63%是女性。FIB-4与T2DM病程（ρ=0.26, p=0.005）和年龄（ρ=0.49, p= 0.001）有中度相关性。在35-65岁的患者中，FIB-4与LSM密切相关（ρ=0.77, p<0.001）。根据FIB-4分级，63.8%为低危（<1.3）， 32.3%为中危（< 2.67）， 3.9%为高危（>2.67）。st2dm持续时间与FIB-4中度相关，特别是在心智年龄较大的成年人中，支持其在纤维化风险模型中的作用。

{"title":"DURATION OF TYPE 2 DIABETES AS A CLINICAL PREDICTOR OF LIVER FIBROSIS IN PATIENTS WITH METABOLIC DYSFUNCTION ASSOCIATED STEATOTIC LIVER DISEASE","authors":"Daniza Alexandra Contreras de los Santos , Invis Perez Mendez , Omar Ebrahim Ibrahim","doi":"10.1016/j.aohep.2025.101992","DOIUrl":"10.1016/j.aohep.2025.101992","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfuntion associated liver disease (MASLD) is highly prevalent in patients with type 2 diabetes mellitus (T2DM), and fibrosis progression is the main prognostic factor. However, clinical predictors of fibrosis remain unclear. Diabetes duration has been suggested as a potencial independent risk factor.</div><div>To assess the association between T2DM duration and liver fibrosis estimated by the FIB-4 index and liver stiffness measurement (LSM) in Dominican patients with MASLD.</div></div><div><h3>Materials and Methods</h3><div>A retrospective cohort study was conducted including 127 adults with MASLD, diagnosed based on hepatic steatosis detected by abdominal ultrasound and coexisting T2DM, following international criteria. Patients were evaluated at a tertiary care center in the Dominican Republic between July 2024 and January 2025.</div><div>The FIB-4 was calculated using AST, ALT, platelet count, and age.LSM by transient elastography was available 32 cases. Diabetes duration was extracted from medical records and categorized into five groups (0-5, 6-10, 11-15, 16-20 y >20 years). Spearman correlation assessed associations between diabetes duration, FIB-4, and LSM. Nonparametric test compared fibrosis by duration groups. Significance was set at p<0.05.</div></div><div><h3>Results</h3><div>Mean age was 56.6 ± 13.9 years; 63 % were women. FIB-4 showed moderate correlation with T2DM duration (ρ=0.26, p=0.005) and age (ρ=0.49, p<0.001). In patient aged 35-65 years, FIB-4 strongly correlated with LSM (ρ=0.77, p<0.001). According to FIB-4 classification, 63.8% were low-risk (<1.3), 32.3% intermediate-risk (1.3-2.67), and 3.9% high-risk (>2.67) for advanced fibrosis.</div></div><div><h3>Conclusions</h3><div>T2DM duration moderately correlates with FIB-4, especially in mind-aged adults, supporting its role in fibrosis risk models.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101992"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154152","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

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