Annals of hepatology最新文献_第7页

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。

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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。

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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。

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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

AMA-NEGATIVE PRIMARY BILIARY CHOLANGITIS IN LATIN AMERICA: A DISTINCT SUBSET WITH LOWER TREATMENT RESPONSE 拉丁美洲ama阴性原发性胆道胆管炎：治疗反应较低的独特亚群

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.102013

Claudia Alves Couto , Guilherme Grossi Lopes Cançado , María Lucía Ferraz Ferraz , Debora Raquel Terrabuio , Alejandra Villamil , Lorena Castro Solari , Graciela Elia Castro-Narro , Ezequiel Ridruejo , Cristiane A. Villela-Nogueira , Danay Guerrero , Daniela Chiodi , Carla Enrique , Paulo Lisboa Bittencourt , Gustavo Pereira , Fernando Bessone , Stefanny Cornejo Hernández , Rodrigo Zapata , Hugo Cheinquer , Nicolás Ortiz López , Manuel Mendizabal , Nélia Hernandez

Introduction and Objectives

Primary biliary cholangitis (PBC) is an autoimmune cholestatic disease, typically diagnosed by the presence of anti-mitochondrial antibodies (AMA). Whether AMA-negative PBC represents a distinct clinical phenotype remains controversial. This study aimed to characterize the epidemiological profile of PBC according to AMA status in Latin America.

Materials and Methods

This ongoing, retrospective, international multicenter cohort study, sponsored by ALEH, includes PBC patients from multiple Latin American countries. Patients were stratified by AMA status; those with autoimmune hepatitis-PBC overlap were excluded.

Results

Data from 1,204 patients were analyzed: Brazil (48.3%), Argentina (23.4%), Chile (10.8%), Mexico (7.4%), and others. Most were female (92.3%) with a mean age at diagnosis of 53±13 years; 22.2% had cirrhosis at baseline. Overlap syndrome was excluded. AMA were positive in 76.8%. AMA-positive and AMA-negative patients had similar rates of female sex (92.5% each, p=0.963), baseline cirrhosis (22.4% vs. 23.6%, p=0.706), and symptomatic presentation (77.5% vs. 79.4%, p=0.544). MASLD was more frequent among AMA-negative patients (7.5% vs. 3.8%, p=0.024), which also had higher rates of sp100 (9.1% vs 2.5%, p< 0.001) and gp210 (7.3 vs 3.3%, p< 0.001) positivity. Treatment with UDCA was performed in 95.2% of patients and, from those, 28.3% had second line treatment indicated due to incomplete response to UDCA. AMA-positive patients showed higher response to ursodeoxycholic acid (UDCA) at 12 months, including ALP normalization (29.7% vs. 21.2%, p=0.035) and deep response (17.5% vs. 8.6%, p=0.007). Similar findings were observed after 12 months of fibrate therapy (34.8% vs. 9.4%, p=0.005). No difference was found in transplant-free survival (p=0.213).

Conclusions

AMA-negative PBC patients in Latin America present similar baseline features but have lower response rates to UDCA and fibrates, supporting the hypothesis of a biologically distinct disease subset.

原发性胆道胆管炎（PBC）是一种自身免疫性胆汁淤积性疾病，通常通过抗线粒体抗体（AMA）诊断。ama阴性PBC是否代表一种独特的临床表型仍然存在争议。本研究旨在根据拉丁美洲AMA状况描述PBC的流行病学特征。材料和方法这项正在进行的、回顾性的、国际多中心队列研究，由ALEH赞助，包括来自多个拉丁美洲国家的PBC患者。根据AMA状态对患者进行分层；排除自身免疫性肝炎- pbc重叠者。结果分析1204例患者的数据：巴西（48.3%）、阿根廷（23.4%）、智利（10.8%）、墨西哥（7.4%）等。多数为女性（92.3%），平均诊断年龄53±13岁；22.2%基线时有肝硬化。排除重叠综合征。AMA阳性占76.8%。ama阳性和ama阴性患者的女性比例相似（各92.5%,p=0.963），基线肝硬化（22.4%对23.6%,p=0.706），症状表现（77.5%对79.4%,p=0.544）。MASLD在ama阴性患者中更为常见（7.5%比3.8%,p=0.024）， sp100阳性率（9.1%比2.5%,p= 0.001）和gp210阳性率（7.3比3.3%,p= 0.001）也更高。95.2%的患者接受了UDCA治疗，其中28.3%的患者由于UDCA不完全缓解而接受了二线治疗。ama阳性患者在12个月时对熊去氧胆酸（UDCA）的反应更高，包括ALP正常化（29.7% vs. 21.2%, p=0.035）和深度反应（17.5% vs. 8.6%, p=0.007）。贝特治疗12个月后观察到类似的结果（34.8%比9.4%,p=0.005）。无移植生存无差异（p=0.213）。结论拉丁美洲的sama阴性PBC患者具有相似的基线特征，但对UDCA和贝特类药物的反应率较低，支持了生物学上不同疾病亚群的假设。

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引用次数: 0

FULL COMPLIANCE TO QUALITY INDICATORS IN ACUTE VARICEAL BLEEDING REDUCES 6-WEEK MORTALITY. 完全符合急性静脉曲张出血的质量指标可降低6周死亡率。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101993

Edgar Suarez , Juan Carlos Montaño , Ezequiel Demirdjian , Diego Arufe

Introduction and Objectives

Introduction: Quality indicators (QIs) for the management of acute variceal bleeding (AVB) encompass guideline-recommended interventions aimed at reducing mortality. However, the cumulative impact of full adherence to these measures remains unclear.

To evaluate whether complete compliance with five established QIs during AVB episodes is associated with reduced 6-week mortality.

Materials and Methods

This retrospective observational study included 135 AVB episodes from 2017 to 2024. Adherence to five QIs was assessed: antibiotic administration within 24 hours, vasoactive agent used within 24 hours, diagnostic endoscopy within 24 hours, endoscopic treatment, and beta-blocker prescription at discharge. Full adherence was defined as compliance with all five interventions. The primary outcome was 6-week mortality. Descriptive statistics and multivariate logistic regression adjusted for MELD score (<15 vs. ≥15) and Child-Pugh class (A/B vs. C) were performed. An interaction term was included to evaluate whether the effect of QI compliance differed by Child-Pugh class.

Results

Overall 6-week mortality was 13.8%. Full adherence was achieved in 54.8% of episodes. Mortality rates by adherence level were 4.1% for full adherence, 16.3% for four QIs, and 42.9% for three or fewer QIs (p < 0.001). In multivariate analysis, full adherence was independently associated with lower mortality (OR 0.20; 95% CI 0.05–0.82; p = 0.025). Child-Pugh class C was also significantly associated with increased mortality (OR 9.68; p = 0.001). An interaction analysis showed that the protective effect of QI adherence did not differ significantly between Child-Pugh A/B and Child-Pugh C patients (interaction term p = 0.87), suggesting a consistent benefit across severity strata.

Conclusions

Complete compliance with evidence-based quality indicators significantly reduces 6-week mortality in patients with AVB, independent of baseline liver disease severity. Rigorous implementation of these measures should be prioritized as a standard of care in cirrhotic patients presenting with AVB.

简介和目的简介：急性静脉曲张出血（AVB）管理的质量指标（QIs）包括指南推荐的旨在降低死亡率的干预措施。然而，全面遵守这些措施的累积影响仍不清楚。评估AVB发作期间完全遵守5个已建立的QIs是否与降低6周死亡率相关。材料与方法本回顾性观察研究纳入2017 - 2024年135例AVB发作。评估5个QIs的依从性：24小时内给药抗生素，24小时内使用血管活性药物，24小时内诊断内窥镜检查，内窥镜治疗，出院时处方β受体阻滞剂。完全依从性被定义为遵守所有五种干预措施。主要终点为6周死亡率。对MELD评分（<15 vs.≥15）和Child-Pugh分级（A/B vs. C）进行描述性统计和多因素logistic回归校正。采用交互作用项来评价不同Child-Pugh班级的QI依从性是否存在差异。结果6周总死亡率为13.8%。54.8%的发作达到完全依从性。完全依从性组死亡率为4.1%，4次QIs组死亡率为16.3%，3次或更少QIs组死亡率为42.9% （p < 0.001）。在多变量分析中，完全依从性与较低的死亡率独立相关（OR 0.20; 95% CI 0.05-0.82; p = 0.025）。Child-Pugh C级也与死亡率增加显著相关（OR 9.68; p = 0.001）。相互作用分析显示，QI依从性的保护作用在Child-Pugh A/B和Child-Pugh C患者之间没有显著差异（相互作用项p = 0.87），表明在不同严重程度的患者中都有一致的益处。结论：完全符合循证质量指标可显著降低AVB患者6周死亡率，与基线肝病严重程度无关。严格实施这些措施应优先作为肝硬化AVB患者的标准护理。

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引用次数: 0

IMPLEMENTATION OF A TEST AND TREAT MODEL FOR HCV CARE UTILIZING POINT OF CARE HCV RNA TESTING IN LA BODEGA 在la bodega利用护理点HCV RNA检测实现HCV护理的测试和治疗模型

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology

Pub Date : 2025-09-01 DOI: 10.1016/j.aohep.2025.101998

Anthony Martinez , Scott Springer , Sean Owen

Introduction and Objectives

The World Health Organization (WHO) aims to eliminate hepatitis C virus (HCV) by 2030; however, the United States (US) is unlikely to meet this target. Screening, linkage, and treatment initiation remain suboptimal.

To evaluate Point-of-care (POC) HCV RNA test (Xpert® HCV) in a test and treat model of care among People Who Use Drugs (PWUD).

Materials and Methods

La Bodega, a co-localized hepatology and addiction medicine program in Buffalo, New York (NY), specializes in HCV management among active PWUD. POC HCV RNA testing is utilized on-site. Patients with a positive HCV RNA initiate HCV therapy at the time of the initial visit. POC HCV RNA testing is also used in conjunction with lab-based RNA testing on serum to evaluate SVR4 when indicated.

Results

65 people were screened with POC HCV RNA of whom 40 had a previous HCV antibody. 11 individuals were found to be HCV RNA positive. Eleven individuals were assessed for SVR, all of whom had both undetectable serum HCV RNA and negative POC HCV RNA results. Among RNA-positive individuals, one was linked to their primary care clinic based on the patient’s preference and 10 individuals initiated therapy, receiving the full 8 or 12 weeks of therapy, depending on the chosen regimen. Two individuals remain on treatment; 6 are pending SVR assessment, and 2 achieved SVR, one of whom was pregnant and treated with sofosbuvir/velpatasvir.

Conclusions

POC HCV RNA testing is advantageous in shortening the HCV care cascade, enabling a true test-and-treat model of care for HCV.

世界卫生组织（WHO）的目标是到2030年消除丙型肝炎病毒（HCV）；然而，美国不太可能实现这一目标。筛查、联系性和开始治疗仍不理想。评估即时护理（POC） HCV RNA检测（Xpert®HCV）在药物使用人群（PWUD）的检测和治疗模式中的应用。材料和方法sla Bodega是位于纽约州布法罗市的肝病学和成瘾医学联合项目，专门研究活动性PWUD患者的HCV管理。现场使用POC HCV RNA检测。HCV RNA阳性的患者在初次就诊时开始HCV治疗。如有需要，POC HCV RNA检测也可与基于实验室的血清RNA检测结合使用，以评估SVR4。结果65人筛查出POC HCV RNA，其中40人既往有HCV抗体。11例HCV RNA阳性。对11名患者进行SVR评估，所有患者血清HCV RNA均检测不到，POC HCV RNA结果均为阴性。在rna阳性的个体中，根据患者的偏好，1人与他们的初级保健诊所联系，10人开始治疗，接受完整的8或12周的治疗，取决于所选择的方案。两人仍在接受治疗；6人正在等待SVR评估，2人达到SVR，其中1人怀孕并接受sofosbuvir/velpatasvir治疗。结论spoc HCV RNA检测有利于缩短HCV护理级联，实现真正的HCV检测和治疗模式。

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