Digestive and Liver Disease最新文献

{"title":"Occupational exposure and risk of complications in MASLD patients:updates from a case:control study","authors":"","doi":"10.1016/j.dld.2024.08.014","DOIUrl":"10.1016/j.dld.2024.08.014","url":null,"abstract":"<div><h3>Introduction</h3><p>Pollutants are increasingly being evaluated as possible contributors to the progression of liver damage in metabolic dysfunction-associated steatotic liver disease (MASLD). Recently, we published a case-control study showing that patients with MASLD-related advanced chronic liver disease (ACLD) and/or hepatocellular carcinoma (HCC) were more likely to report workplace toxicant exposure compared to those with uncomplicated MASLD. Consequently, an extension of the accrual and a transition to a multicenter study were decided.</p></div><div><h3>Aim</h3><p>To provide updated evidence following the first extension of the cohort from our original study, which aimed to assess the prevalence of self-reported occupational exposure to toxicants in patients with MASLD.</p></div><div><h3>Methods</h3><p>After the extension, this hospital-based prospective pilot study include 224 patients with MASLD. Data on workplace toxicant exposure were collected systematically using a structured questionnaire. Subsequently, patients with ACLD and/or HCC (n = 65) were compared to controls (n = 159). Logistic regression analysis and propensity score models were used to investigate the associations between self-reported occupational exposure and ACLD and/or HCC.</p></div><div><h3>Results</h3><p>The updated data confirmed that patients with ACLD/HCC are more likely to report exposure to metals, halogenated refrigerants, paint/resins, and fuel emissions than the controls. Durations of 21-30 years and &gt;30 years of occupational exposure to toxicants were also more frequently associated with ACLD/HCC, with odds ratios (ORs) of 2.42 (95% confidence interval [CI]: 1.11-4.94, p = 0.020) and 4.21 (95% CI: 2.36-7.53, p &lt; 0.001), respectively. These associations were confirmed after corrections for demographics and other confounders.</p></div><div><h3>Conclusions</h3><p>The extension of our cohort confirms that patients with MASLD complications are more likely to report workplace toxicant exposure than controls. A transition to a multicenter effort is underway. If confirmed, our results may help in developing prevention policies to reduce the risk of life-threatening diseases among exposed populations.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244222","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}

{"title":"Gait disorders and muscle changes in patients with liver cirrhosis: analysis of electroneurographic data of a subgroup of patients with and without cognitive impairment","authors":"","doi":"10.1016/j.dld.2024.08.016","DOIUrl":"10.1016/j.dld.2024.08.016","url":null,"abstract":"<div><p>Hepatic encephalopathy (HE) is a common complication of liver cirrhosis and minimal HE (MHE) increases the risk of falls. Gait alterations in cirrhotic patients are poorly understood, so the aims of this study is to describe the correlation between clinical parameters, such as HE, muscle changes, falls and gait disturbances, and electroneurographic changes.</p><p>Twenty-six patients underwent clinical and medical history evaluation to assess the presence of MHE and falls in the past year, and biochemical and instrumental evaluation to determine the presence of gait disturbances or sarcopenia by computed tomography (CT). Gait was assessed with the six-minute walk test (6MWT), the G-Walk device and G-STUDIO software. Ten patients underwent electroneurographic examination (ENG). Data obtained from gait analysis were compared with healthy subjects of the same age and sex.</p><p>In the gait analysis, the harmonic ratio (HR) and the recurrence quantification analysis (RQA) were considered. HR provides information on movement fluidity, balance and body coordination during movement, while RQA is based on the identification of parameters that quantify the regularity of time series.</p><p>In the subgroup of patients undergoing ENG analysis, lower values of HR in the antero-posterior and vertical directions correlated with the presence of sensory (τbAP= -0.629, p=0.039; τbV= -0.707, p=0.020) and motor (τbAP= -0.707, p=0.020; τbV= -0.629, p=0.039) neuropathy. The highest worsening of RQA index after 6MWT in vertical direction correlated with the presence of motor neuropathy (τbDET= 0.550, p=0.035). The number of falls correlated with sensory and motor electroneurographic parameters, while MELD score was inversely correlated with sensory and motor conduction velocity (ρ=-0.590, p= 0.047; ρ=-0.896, p= 0.003) and directly correlated with motor latency (ρ= 0.783, p= 0.013). Psychometric hepatic encephalopathy score (PHES) values were inversely correlated with distal motor latency signals (ρ=0.854, p= 0.003), while skeletal muscle index (SMI) values were found to be inversely correlated with proximal motor latency (ρ=0.802, p= 0.005).</p><p>Gait alterations are common in patients with cirrhosis, especially those with cognitive impairment, and correlate with severity of disease and risk of falls, identifying patients at risk of injuries and hospitalizations.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244224","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}

{"title":"The effect of the COVID-19 pandemic on hospitalizations of cirrhotic patients","authors":"","doi":"10.1016/j.dld.2024.08.020","DOIUrl":"10.1016/j.dld.2024.08.020","url":null,"abstract":"<div><h3>Introduction</h3><p>The spread of SARS-CoV-2 has strained the global health system, necessitating a radical reorganization of health resources. In addition, the escalation in liver disease severity among hospitalized COVID-19 patients is a matter of serious concern, as it may lead to the deterioration of health outcomes for a larger population in the future.</p></div><div><h3>Aim</h3><p>We aimed at providing a comprehensive overview of COVID-19 impact on monthly hospitalization rates, clinical impairment, Length of Stay (LoS), and mortality of cirrhotic patients admitted to the Local Health Board 1 (LHB1) hospitals in the Abruzzo Region, Italy.</p></div><div><h3>Materials and Methods</h3><p>Using the International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM), we identified cases of alcohol-related cirrhosis, nonalcohol-related cirrhosis, and decompensated cirrhosis. We analysed 957 Hospital Discharge Records (HDR) from January 1, 2019, to December 31, 2019 (pre-pandemic), and from January 1, 2022, to December 31, 2022 (post-pandemic) and we evaluated patients' clinical impairment, LoS, and mortality before and after the pandemic.</p></div><div><h3>Results</h3><p>We identified 494 hospitalizations for nonalcohol-related cirrhosis and 310 for alcohol-related cirrhosis. In the post-pandemic period, hospitalizations for nonalcohol-related cirrhosis significantly decreased (69% vs. 48%; P&lt;.0001), while hospitalizations for alcohol-related cirrhosis significantly increased (31% vs. 52%; P&lt;.0001) compared to pre-pandemic. Additionally, the decompensated patients with alcohol-related cirrhosis significantly increased in the post-pandemic period (77% vs. 65%; P=.0216). Mortality risk significantly increased for both nonalcohol-related (11% vs. 18.5%; P=.0176) and alcohol-related cirrhosis (7.7% vs. 18%; P=.0059) in the post-pandemic era.</p></div><div><h3>Conclusions</h3><p>Our study pointed out important differences in hospitalization rates and outcomes of cirrhotic patients due to the pandemic, further highlighting the dramatic increase in hospitalizations for alcohol-related cirrhosis. Since this will have a prolonged impact on the natural history of chronic liver disease in Abruzzo Region, continued awareness as well as enhancement of prevention strategies and personalized follow-ups, will be essential.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244190","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}

{"title":"Multidisciplinary management combining hepatologist counseling, cognitive/behavioral therapy, and nutritional support significantly improves clinical outcomes of Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) patients","authors":"","doi":"10.1016/j.dld.2024.08.009","DOIUrl":"10.1016/j.dld.2024.08.009","url":null,"abstract":"<div><h3>Introduction</h3><p>Lifestyle modifications represent the main therapeutic intervention for Metabolic dysfunction-associated Steatotic Liver disease (MASLD). Unfortunately, the dietary-behavioral prescription is constantly limited by poor compliance. In this context, the benefits of motivational support remain unexplored.</p></div><div><h3>Aim</h3><p>To evaluate the effectiveness of a multidisciplinary (hepatologist-nutritionist-psychologist) management in improving clinical outcomes in MASLD, via ameliorating adherence to specialistic tailored-indications.</p></div><div><h3>Materials and Methods</h3><p>MASLD patients (n.286) were consecutively enrolled and randomized in three cohorts: 72 followed generic hepatologist-provided dietary advice (“H”), 71 also received a nutritionists-prescribed individualized intervention (“HN”) (H+N= “standard of care”), and 143 were treated with an approach additionally involving cognitive/behavioral-based psychological support (“HNP”) (“experimental-group”). At baseline, anthropometric, biochemical, clinical, liver stiffness (LSM), controlled attenuation parameter (CAP), lifestyle habits, and body composition values were recorded. Along 18 months, semestral hepatological (for all), nutritional (H and HN), and psychological (HNP) follow-ups reassessed parameters and evaluated compliance.</p></div><div><h3>Results</h3><p>After 18 months, the prevalence of patients achieving a ≥ 10% decrease in body weight was significantly higher in HNP (HNP:62.09%; HN:44.9%; H:35.8%; HNP vs HN, <em>p</em>:0.01; HNP vs H, <em>p</em>:0.0002). In HNP, a significant improvement in Homeostatic-model-assessment-for-insulin-resistance (<em>p</em>:0.001), HDL (<em>p</em>&lt;0.0001), LSM (<em>p</em>:0.007), CAP (<em>p</em>:0.002), and Fat-Mass (<em>p</em> &lt; 0.0001) was observed. Loss of compliance rate was significantly lower in HNP (HNP:12.08%; HN:34.7%; H:45.8%; HNP vs HN, HNP vs H, <em>p</em>:0.001). Relevantly, HNP patients presented a significantly lower risk of acute cardiovascular events (ACEs) during the observation period [HR: 0.497, IC (0.236-0.751) 95%, <em>p</em>:0.04)] (Figure). Logistic regression analysis (adjusted for sex, age, and cardiovascular risk factors) revealed HNP adherence as significantly associated with lower ACEs occurrence (aOR: 0.81; C.I. 95%: 0.55-0.97; p:0.02). Dynamic work, city life, and large family emerged as social factors influencing compliance (OR: 2.11, 1.78, 1.12) (all <em>p</em>&lt;0.05).</p></div><div><h3>Conclusions</h3><p>Integrating standard hepatological-nutritional with psychological support significantly improves the outcomes of MASLD patients.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244219","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}

{"title":"Long-Term Albumin administration: a survival benefit in cirrhotic refractory ascites beyond TIPS eligibility","authors":"","doi":"10.1016/j.dld.2024.08.029","DOIUrl":"10.1016/j.dld.2024.08.029","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Evidence suggests that long-term albumin administration (LTA) prolongs overall survival in patients with cirrhosis and refractory ascites. However, LTA is not yet standard care, and the effects of its combination with TIPS (Transjugular Intrahepatic Portosystemic Shunt) placement remains unclear.</p></div><div><h3>Methods</h3><p>This observational study compared two groups of patients with cirrhosis and ascites who required at least one large volume paracentesis (LVP). The first group, observed from January 2019 to December 2021, received standard medical treatment (SMT: diuretics and albumin administration after LVP). The second group, observed from January 2022 to February 2024, received SMT plus LTA at a dosage of 40 mg/week. The primary endpoint was mortality and the cause-specific Cox model was used to estimate covariate effects. The Fine and Gray competing risks regression model was used account for death, and LT as competing risk.</p></div><div><h3>Results</h3><p>A total of 153 patients were analyzed: 63 in the SMT+LTA group and 90 in the SMT group. No differences in liver disease etiology, age, gender, Child-Pugh score, presence of Hepatocellular Carcinoma(HCC), Hepatic Encephalopathy(HE), and eligibility for TIPS and OLT are observed between the two groups.</p><p>During the follow-up(median 9 months; range 2-67), 11 patients in the LTA group(17.4%) and 9 in the SMT group(10%) underwent TIPS(p=ns), 7(11.1%) and 8(9%) patients were transplanted in LTA and SMT group respectively(p=ns), and 16 patients in the LTA group(25.4%) versus 71 in the SMT group(79%) died(p&lt;0.001).</p><p>Multivariate analysis showed that LTA(HR:0.16; p&lt;0.001), creatinine(HR:1.40; p=0.025), bilirubin (HR:1.16; p=0.014), viral etiology (HR:0.24; p=0.013), and TIPS placement (HR:0.10; p&lt;0.001) were independently associated with mortality. The same results were observed when substituting TIPS placement with TIPS eligibility (Figure 1).</p></div><div><h3>Conclusions</h3><p>For patients with refractory ascites, LTA in addition to SMT significantly prolongs overall survival and may serve as a disease-modifying treatment, particularly for those contraindicated for TIPS.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243869","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}

{"title":"Appropriateness of proton pump Inhibitor therapy in patients with cirrhosis: a retrospective study","authors":"","doi":"10.1016/j.dld.2024.08.023","DOIUrl":"10.1016/j.dld.2024.08.023","url":null,"abstract":"<div><h3>Introduction</h3><p>Proton pump inhibitors (PPIs) are commonly prescribed for gastroesophageal reflux disease (GERD) or prophylaxis of non-steroidal anti-inflammatory drugs and aspirin-induced gastric damage. However, their prolonged use in cirrhotic patients has been linked to complications like spontaneous bacterial peritonitis (SBP) and hepatic encephalopathy (EE).</p></div><div><h3>Aim</h3><p>To evaluate the appropriateness of PPI therapy in patients with cirrhosis.</p></div><div><h3>Materials and Methods</h3><p>We reviewed medical records of 209 cirrhotic patients admitted to our gastrointestinal ward (December 2021-December 2022). Demographics, clinical characteristics, PPI use indications, and incidence of EE and SBP were assessed.</p></div><div><h3>Results</h3><p>The median age was 69 years, and 74.4% were males. Main reasons for hospitalization were hepatocellular carcinoma (n=63, 28.7%), elective diagnostic-therapeutic procedures (n=63, 28.7%), non-liver-related events (n=54, 24.7%), and acute decompensation (n=39, 17.7%). Etiology of liver disease was alcohol in 91 patients (41.6%), virus-related in 77 (35.1%), and metabolic-associated in 30 (13.7%). The median MELD-Na score was 10 (8-14). At admission, 145 patients (66.2%) were on PPIs: of these, 42 patients (29.0%) had confirmed GERD, 12 (8.3%) had esophagitis ≥grade B, and 27 (18.6%) were on aspirin with bleeding risk-factors. Overall, inappropriate PPI use was observed in 74 patients (44.1%). Patients on PPIs were older, with higher MELD-Na and creatinine, and lower hemoglobin and Na compared to those not on PPIs (p&lt;0.05). Multivariate analysis showed that PPI use was independently associated with older age (OR 1.03, IC95% 1.01-1.07) and lower hemoglobin (OR 0.82, IC95% 0.70-0.97). During a median follow-up of 18 months, the incidence of EE and SBP did not differ between PPI users and non-users.</p></div><div><h3>Conclusions</h3><p>A significant proportion of patients with cirrhosis is inappropriately prescribed PPIs. Although this did not correlate with major liver-related events in the short term, proper PPI prescription education is crucial to prevent potential long-term consequences.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244250","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}

{"title":"Predicting post-TIPS hepatic encephalopathy risk in patients with cirrhosis and refractory ascites: a proof-of-concept study using a 4D MRI perfusional model","authors":"","doi":"10.1016/j.dld.2024.08.007","DOIUrl":"10.1016/j.dld.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established treatment for refractory ascites (RA) in patients with cirrhosis. However, a major drawback is the development of post-procedural hepatic encephalopathy (HE), which results from the diversion of blood from the portal vein. According to the first-pass effect, this diversion reduces the liver's capacity to metabolize substances from the gut, leading to an accumulation of toxic compounds in the brain. Given that liver perfusion relies on arterial compensation (hepatic arterial buffer), it is plausible that effective compensation, which also depends on cardiac function, may reduce the risk of encephalopathy by detoxifying the blood during the second-pass metabolism.</p></div><div><h3>Aims</h3><p>To evaluate by Dynamic Contrast Enhanced-Magnetic Resonance Imaging (DCE-MRI) the changes in liver perfusion induced by TIPS in patients with RA and their relationship with the risk of HE.</p></div><div><h3>Materials</h3><p>Twenty-nine consecutive patients underwent DCE-MRI, cardiac and hepatic hemodynamic evaluation before and after TIPS. MRI images were processed by a homemade software using the Dual Input Dual Compartment (DIDC) model, focusing on perfusion parameters.</p></div><div><h3>Results</h3><p>The DIDC model showed that total hepatic perfusion decreased by 24% after TIPS (248 ml/min/100ml vs 189 ml/min/100ml, p 0.095). As expected, a significant reduction in portal perfusion (decreased by 67%; 128.6 ml/min/100ml vs 42.4 ml/min/100ml, p 0.004) and an increase in hepatic arterial fraction post-TIPS (48% vs 77%, p 0.001) was observed. Post-TIPS residual total hepatic perfusion inversely correlated with one-year HE risk: patients with perfusion ≤ 130 ml/min/100ml had a HE risk of 67.6% vs 36.4% for those &gt; 130 ml/min/100ml (HR: 2.1, p 0.039).</p></div><div><h3>Conclusion</h3><p>Perfusion MRI is able to elucidate the impact of TIPS on liver perfusion, quantifying the extent of hepatic perfusion and its correlation with the development of post-TIPS HE.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243876","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}

{"title":"Hepatic venous pressure gradient (HVPG)-3P score as predictor tool of endoscopic signs of portal hypertension and liver-related events in patients with advanced chronic liver disease","authors":"","doi":"10.1016/j.dld.2024.08.008","DOIUrl":"10.1016/j.dld.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><p>Clinically significant portal hypertension (CSPH) in patients with advanced chronic liver disease (ACLD) is high-risk condition for liver-related events (LRE). According with BAVENO VII, non-invasive tests (NIT) should be preferred to rule in or out for CSPH to avoid endoscopy. The novel score HVPG-3Parameters gave a prediction of HVPG showing good accuracy in CSPH prediction.</p></div><div><h3>Aim</h3><p>Aim is to evaluate the ability of HVPG-3P in PH and LRE prediction.</p></div><div><h3>Methods</h3><p>A retrospective study was conducted in two different Italian centers: University of Naples and University of Marche. In 10 years, consecutive compensated-ACLD patients who underwent upper-GI endoscopy for PH assessment were enrolled. NIT (FIB-4,ANTICIPATE,PLT/spleen-diameter ratio and HVPG-3P) were calculated. During the follow-up any LRE were recorded.</p></div><div><h3>Results</h3><p>Two-hundred and ninety-one ACLD subjects (with no differences between centers) were recruited (62.1% males, mean age 60 years).</p><p>Mean LSM was 23.6±11.7kPa; HVPG-3P was 13.3±2.0mmHg, ANTICIPATE was 1.0±1.6, FIB-4 was 5.0±3.2, platelets/spleen-diameter ratio was 906.5±568.2.</p><p>One-hundred and forty-two (48,9%) subjects showed PH endoscopic signs. They had higher LSM (26.6±12.4vs20.8±10.3kPa, p=0.00002), HVPG-3P (14.2±1.6vs12.4±2.0mmHg, p&lt;0.001), ANTICIPATE (1.66±1.4vs0.31±1.5, p&lt;0.001), FIB-4 (5.87±3.28vs4.13±2.84, p=0.001) and lower platelets/spleen-diameter ratio (652.4±323.6vs1148.6±641.8, p&lt;0.0001) compared to subjects without PH endoscopic signs.</p><p>During a median follow-up of 41.5months (IQR 17.8-74.0) LRE occurred in a median of 18.9months (IQR 7.5-37) in 126/291 (43.2%).</p><p>Patients who experienced LRE showed higher LSM (26.0±12.3 vs21.9±11.0kPa, p=0.003), HVPG-3P (14.1±1.7vs12.6±2.0mmHg, p&lt;0.0001), ANTICIPATE (1.54±1.57vs0.55±1.56, p&lt;0.0001), FIB-4 (6.02±3.36vs4.19±2.79, p&lt;0.0001) and lower platelets/spleen-diameter ratio (694.9±385.7vs1068.0±630.0, p&lt;0.0001).</p><p>The HVPG-3P seems to have a good performance in PH and LRE prediction (considering the results from Random Forest model: MDA 4.52 and 6.55, higher than the majority of variables).</p></div><div><h3>Conclusions</h3><p>HVPG-3P is a simple tool for non-invasive prediction of PH and could be used to stratify the risk of LRE in patients with ACLD. However, this score needs to be validated in larger cohorts.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243877","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}

{"title":"Thromboembolic events in prospectively enrolled series of patients with cirrhosis followed for one year","authors":"","doi":"10.1016/j.dld.2024.08.025","DOIUrl":"10.1016/j.dld.2024.08.025","url":null,"abstract":"<div><h3>Introduction</h3><p>Coagulation in cirrhosis involves a complex imbalance between procoagulant and anticoagulant factors due to liver dysfunction. This results in a delicate hemostatic equilibrium that increases the risk of both bleeding and thrombosis.</p></div><div><h3>Aim</h3><p>To analyze the occurrence of thromboembolic events in a prospective series of patients with liver cirrhosis, and to assess patients’ characteristics.</p></div><div><h3>Materials and Methods</h3><p>We prospectively enrolled 188 patients with cirrhosis admitted to our gastrointestinal ward (December 2021-December 2022). We evaluated general and liver disease-related characteristics as well as the incidence of venous thromboembolism (VTE), and death during the first year following hospital admission.</p></div><div><h3>Results</h3><p>Median age was 63 years, and 72.9% were males. The primary cause of hospitalization was acute decompensation (n=101, 53.7%), followed by hepatocellular carcinoma (n=34, 18.1%) or liver-related elective diagnostic-therapeutic procedures (28, 14.9%). Twenty-five (13.3%) patients were admitted due to non-liver related events. The median length of hospitalization was 9 days (IQR 5-14). Most of patients had decompensated cirrhosis (Child-Pugh B: 41.5%; Child-Pugh C: 26.6%), with median MELD-Na=14, and clinically significant portal-hypertension (CSPH) in 148 (78.7%). Sixty-two (32.9%) patients had hepatocellular carcinoma. Thirty-one patients (16.5%) were on anticoagulants. During a 1-year follow-up, three (1.6%) patients experienced VTE while 26 (13.8%) patients had variceal bleeding. Overall mortality was 42.0% (n=79). Padua and Improve-VTE risk scores, MELD-Na, Child-Pugh class, and presence of CSPH were no different between patients with or without VTE. A competitive-risk model focused on experiencing VTE and risk of death and bleeding as competing events showed no significant association between VTE and use of anticoagulant, Charlson comorbidity index, CSPH, male gender, HCC, length of hospitalization and Improve-VTE, Padua and MELD-Na scores.</p></div><div><h3>Conclusions</h3><p>VTE is a rare event in patients with cirrhosis, occurring in only 1.6% of prospectively evaluated population, and no significant association between VTE and various risk factors was identified.</p></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244251","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}

{"title":"Full Title Page /Editorial Board","authors":"","doi":"10.1016/S1590-8658(24)00977-0","DOIUrl":"10.1016/S1590-8658(24)00977-0","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1590865824009770/pdfft?md5=faee63a9f3b15f9423d303123ae6b0e9&pid=1-s2.0-S1590865824009770-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142243873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}