European Journal of Gastroenterology & Hepatology最新文献

{"title":"Development of a machine learning-based noninvasive diagnostic model for liver fibrosis in metabolic-associated steatotic liver disease.","authors":"Yixin Hui, Yuping Zeng, Mei Zhang","doi":"10.1097/MEG.0000000000003206","DOIUrl":"10.1097/MEG.0000000000003206","url":null,"abstract":"<p><strong>Background: </strong>To address the lack of simple tools for assessing fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD), this study develops a machine learning-based diagnostic model to identify patients at high risk of significant fibrosis and advanced fibrosis.</p><p><strong>Methods: </strong>Data from biopsy-proven MASLD patients were randomly divided into training and validation sets. Variables were then selected, and models using Logistic, Support Vector Machine, and eXtreme Gradient Boosting (XGBoost) were compared with identify the optimal model. Finally, Shapley Additive Explanations-based interpretability analysis was applied to explain the best-performing model. The DeLong test was applied to compare the new model with the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) models.</p><p><strong>Results: </strong>The XGBoost models demonstrated robust accuracy. For the significant fibrosis outcome, the model incorporating age, total cholesterol, glycosylated hemoglobin (HbA1c), and albumin/globulin ratio achieved an area under the receiver operating characteristic curve (AUC) of 0.74 in the training set and 0.72 in the testing set. Regarding the advanced fibrosis outcome, the model including age, total cholesterol, HbA1c, platelets, white cell count, and albumin/globulin ratio yielded an AUC of 0.78 in the training set and 0.74 in the testing set. Decision curve analysis curves confirmed clinical utility, and performance surpassed APRI and FIB-4 ( P < 0.05).</p><p><strong>Conclusion: </strong>This study developed a novel noninvasive diagnostic model for MASLD using simple and easily accessible variables, which demonstrates superior performance compared with traditional serological models.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":"1063-1073"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological limitations in morphometric assessment of steatosis and fibrosis in metabolic dysfunction-associated steatotic liver disease.","authors":"Malaha Ali","doi":"10.1097/MEG.0000000000003239","DOIUrl":"https://doi.org/10.1097/MEG.0000000000003239","url":null,"abstract":"","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":"38 9","pages":"1112-1113"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric atrophy and gastric cancer: a meta-analytical assessment of risk and the influence of topographical distribution.","authors":"Eoghan Burke, Patricia Harkins, Mayilone Arumugasamy","doi":"10.1097/MEG.0000000000003191","DOIUrl":"10.1097/MEG.0000000000003191","url":null,"abstract":"<p><p>Gastric atrophy is a precursor in the Correa cascade leading to gastric cancer, yet the precise magnitude of risk remains uncertain, particularly in low-incidence Western populations. We performed a systematic review and meta-analysis of observational studies published between 2010 and 2024 to evaluate gastric cancer risk in gastric atrophy, with stratification by anatomical distribution. Ten studies comprising 21 006 patients were included. Pooled analysis demonstrated a markedly increased risk of gastric cancer in gastric atrophy, with a standardised incidence ratio of 20.7 (95% confidence interval: 14.0-30.2). Subgroup analysis confirmed significantly higher risk with extensive gastric atrophy compared with antral-predominant disease (pooled odds ratio: 0.27), supporting current guideline stratification. We also reviewed studies excluded from pooled analysis, including several large European cohorts that initially appeared eligible but failed on methodological grounds. Common limitations included inadequate distinction between gastric atrophy and intestinal metaplasia, lack of stratification between autoimmune and Helicobacter pylori -associated atrophy, and use of Operative Link staging systems without atrophy-specific outcomes. These exclusions highlight the fragility of the Western evidence base and its limited ability to inform surveillance recommendations. Our findings extend prior meta-analyses by incorporating topography-specific risk estimates and explicitly identifying evidence gaps in Western populations. Gastric atrophy confers a markedly increased risk of gastric cancer, particularly when extensive. Standardised biopsy mapping and atrophy-specific reporting are needed to refine surveillance strategies and tailor guidelines to regional risk profiles. Current surveillance recommendations for distal gastric atrophy in low-risk Western populations should be applied cautiously, given the evidence and absence of robust prospective data.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":"1041-1051"},"PeriodicalIF":2.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generational differences in illness perception among adults with inflammatory bowel disease: a multicenter cross-sectional study.","authors":"Daniele Napolitano, Mattia Bozzetti, Franco Scaldaferri, Antonio Gasbarrini, Antonio Tursi, Alfredo Papa","doi":"10.1097/MEG.0000000000003266","DOIUrl":"https://doi.org/10.1097/MEG.0000000000003266","url":null,"abstract":"<p><strong>Background: </strong>Illness perception plays a key role in shaping coping strategies, treatment adherence, and quality of life in individuals with inflammatory bowel disease (IBD). Despite growing interest in patient-centered care, evidence on generational differences in illness perception among adults with IBD remains limited.</p><p><strong>Objectives: </strong>To examine differences in illness perception across generational cohorts of adults with IBD and to explore potential implications for generation-sensitive clinical care.</p><p><strong>Methods: </strong>A multicenter cross-sectional study was conducted between April and June 2024 across nine Italian IBD units. Adult outpatients with Crohn's disease or ulcerative colitis completed the Brief Illness Perception Questionnaire. Participants were categorized into Baby Boomers, Generation X, Millennials, or Generation Z based on year of birth. Between-group comparisons were performed, and propensity score-weighted analyses were applied to adjust for clinical and sociodemographic variables.</p><p><strong>Results: </strong>A total of 387 patients were included in the primary analysis. Significant differences in illness perception emerged across generational cohorts. Baby Boomers reported more threatening illness perceptions, characterized by greater perceived consequences, concern, chronicity, and overall illness threat. Younger cohorts reported lower perceived burden and higher perceived personal control. These patterns were broadly consistent after adjustment for measured sociodemographic, clinical, molecular, and therapeutic variables.</p><p><strong>Conclusion: </strong>Illness perception varies meaningfully across generational cohorts in adults with IBD. Incorporating age-cohort-specific perspectives into clinical communication and care planning may enhance patient engagement and support more tailored, effective management strategies.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of bioelectrical impedance analysis in assessing sarcopenia in inflammatory bowel disease.","authors":"Shravan Divakarla, Chloe Hinckfuss, Cristee Cruz, Haili Luo, Martin Dobes, Kavitha Subramaniam","doi":"10.1097/MEG.0000000000003265","DOIUrl":"https://doi.org/10.1097/MEG.0000000000003265","url":null,"abstract":"<p><strong>Introduction and aim: </strong>Sarcopenia, defined as the loss of muscle mass and strength, is an under-recognized complication in patients with inflammatory bowel disease (IBD). Sarcopenia is linked to poor clinical outcomes in IBD, including reduced treatment response, prolonged hospitalization, and frequent flares. We used bioelectrical impedance analysis (BIA) to determine the prevalence of sarcopenia in IBD patients and examine the relationship between the sarcopenic index and several disease activity markers.</p><p><strong>Materials and methods: </strong>We conducted a prospective cross-sectional study of IBD patients attending the Canberra Hospital between February and June 2024. BIA was used to assess skeletal muscle mass and sarcopenic index, with sarcopenia defined using European Working Group on Sarcopenia in Older People criteria. Disease activity data were extracted from medical records within a 2-week window of BIA and then analyzed for associations with sarcopenic index.</p><p><strong>Results: </strong>Of the 94 eligible IBD patients (mean age = 44.9 ± 15.4 years), 63% were classified as sarcopenic. Sarcopenia was more prevalent in males (89%) than in females (36%) and in Crohn's disease (73%) compared with ulcerative colitis (44%). Gender and type of IBD were both associated with sarcopenia (P < 0.0001). Lower sarcopenic index values were associated with clinical assessments of active disease (P < 0.05), higher platelet counts (P < 0.05), and lower hemoglobin levels (P < 0.0001).</p><p><strong>Conclusion: </strong>Sarcopenia is highly prevalent in IBD populations and is associated with several clinical and biochemical markers of active disease. Routine BIA assessment, may offer a practical way to identify patients who may benefit from early nutritional assessment or dietary/exercise intervention.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of efruxifermin in improving liver fibrosis in patients with metabolic dysfunction-associated steatohepatitis/nonalcoholic steatohepatitis: a systematic review and meta-analysis of randomized controlled trials.","authors":"Zain Ul Abideen, Muhammad Hassan Waseem, Areeba Shoaib, Muhammad Osama, Tehreem Fatima, Muhammad Hasnain Panjwani, Noor-Ul-Huda Ramzan, Pawan Kumar Thada, Prasun Kumar Jalal","doi":"10.1097/MEG.0000000000003259","DOIUrl":"https://doi.org/10.1097/MEG.0000000000003259","url":null,"abstract":"<p><p>In addition to demonstrating a predominant association with liver morbidity and mortality, metabolic dysfunction-associated steatohepatitis (MASH) constitutes a leading cause of liver transplantation. Efruxifermin, a bivalently linked fibroblast growth factor 21 analogue, inhibits fibrosis and protects hepatocytes from cellular distress. Although phase 2 clinical trials have investigated its histological and biochemical effects on the improvement of fibrosis, the results lack a pooled synthesis. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials to retrieve relevant articles from inception till July 2025. Data for various outcomes were extracted after computing the risk ratios with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences with 95% CIs for continuous outcomes. The quality assessment of the included randomized controlled trials (RCTs) was performed using the Cochrane Risk of Bias (RoB 2.0) tool. A total of four RCTs were included. Efruxifermin demonstrated a higher incidence of improvement in liver fibrosis by greater than or equal to one stage without worsening of MASH (risk ratio = 1.73; 95% CI = 1.14-2.62; P = 0.01). With regards to noninvasive biomarkers of fibrosis, efruxifermin showed improvement in enhanced liver fibrosis score (mean difference = -0.59; 95% CI = -0.87 to -0.32; P < 0.0001), N-terminal type-III collagen pro-peptide (Pro-C3; mean difference = -6.38; 95% CI = -10.44 to -2.32; P = 0.002) and liver stiffness by FibroScan (mean difference = -2.66; 95% CI = -4.32 to -1.01; P = 0.002). However, it demonstrated a higher risk of treatment-emergent adverse events (risk ratio = 1.18; 95% CI = 1.01-1.38; P = 0.04) compared to placebo. Subgroup analysis stratified by efruxifermin dosages showed that treatment with 28 mg dose (risk ratio = 1.71; 95% CI = 1.08-2.72; P = 0.02) and 50 mg dose (risk ratio = 1.75; 95% CI = 1.11-2.76; P = 0.02) showed significant improvement in fibrosis by greater than or equal to one stage without worsening of MASH. Among the various pharmacologic interventions, efruxifermin combines clinically meaningful antifibrotic efficacy with systemic metabolic improvements in a balanced profile.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transarterial chemoembolization combined with radiofrequency ablation versus hepatectomy for hepatocellular carcinoma within the Milan criteria: a systematic review and meta-analysis.","authors":"Wenwu Wan, Hao Zhang, Li Zhang, Ding Xiong","doi":"10.1097/MEG.0000000000003253","DOIUrl":"https://doi.org/10.1097/MEG.0000000000003253","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) meeting the Milan criteria (single lesion ≤5 cm or ≤3 lesions each ≤3 cm) is most commonly treated with surgical resection, the current gold standard for curative treatment. However, surgical resection is often limited by poor hepatic reserve, unfavorable tumor location, or patient comorbidities, while the minimally invasive strategy combining transarterial chemoembolization and radiofrequency ablation (TACE-RFA) has emerged as an alternative, with its efficacy and safety vs. surgical resection remaining controversial. This meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with a systematic search of PubMed, Embase, Cochrane Library, Web of Science, and MEDLINE from database inception to 24 October 2025. We included comparative randomized controlled trials and retrospective studies reporting overall survival (OS), disease-free survival (DFS), or severe complications (Clavien-Dindo grade ≥III), with bias risk assessed via RoB 2 and ROBINS-I tools. A total of 12 studies enrolling 1625 patients (797 in the TACE-RFA group, 828 in the surgical resection group) were included. Pooled analysis showed surgical resection provided significantly better OS [hazard ratio = 1.17, 95% confidence interval (CI): 1.05-1.30, P = 0.003], with no significant DFS difference between groups (hazard ratio = 1.05, 95% CI: 0.89-1.23, P = 0.55). TACE-RFA was associated with markedly fewer severe complications (odds ratios = 0.24, 95% CI: 0.14-0.39, P < 0.00001). Subgroup analyses revealed surgical resection yielded significant OS benefits in 3-5 cm tumors, primary HCC, and high-quality studies, while TACE-RFA achieved comparable OS for tumors 3 cm or less or recurrent HCC. In conclusion, for Milan criteria HCC, surgical resection improves long-term survival, especially for primary and 3-5 cm tumors, while TACE-RFA has a superior safety profile with comparable tumor control for smaller/recurrent lesions, optimal for high surgical risk patients. Treatment should be individualized.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication adherence level and its predictors among inflammatory bowel disease sufferers in a resource-strained healthcare setting.","authors":"Woretaw S Zewdu, Tigabu E Zerihun, Zemen A Emiru, Samuel B Dagnew, Tilaye A Moges, Desalegn A Mussie, Yared A Ferede, Sisay S Anberbr, Muluken A Alemu, Teferi B Melese, Abel T Kassaw","doi":"10.1097/MEG.0000000000003166","DOIUrl":"10.1097/MEG.0000000000003166","url":null,"abstract":"<p><strong>Background: </strong>Despite novel breakthroughs in the inflammatory bowel disease (IBD) therapeutics armamentarium, nonadherence remains an invisible epidemic. However, its prevalence and determining features were unknown within resource-strained healthcare settings.</p><p><strong>Methods: </strong>A hospital-based cross-sectional study was conducted on adults with IBD from December 2023 to July 2024. A standardized questionnaire and medical record review checklist were used to gather data. Multiple ordinal logistic regression analysis was used to adjudicate potential covariates. A variable was deemed statistically significant if its adjusted odds ratio had a P value of below 0.05 at 95% confidence interval.</p><p><strong>Results: </strong>This study comprised 237 patient cohort (age: mean ± SD, 53.81 ± 6.71 years). Among them, 32.9, 29.96, and 37.14% were low, medium, and high adherents, respectively. Just under half (43.05%) of participants had a high medication regimen complexity score (mean ± SD, 19.46 ± 2.11). Health insurance status, active disease state, medication regimen complexity score, stigma, comorbidity status, adverse drug reactions, and polypharmacy were the potential predictors identified in the final model.</p><p><strong>Conclusion: </strong>Nearly two-thirds of the study's cohort exhibited suboptimal medication adherence, highlighting a significant clinical concern. Policymakers could consider developing key strategies such as integrating pharmacists and Medication Regimen Complexity Index-65 into IBD chronic care, and leveraging a validated, local-language adherence assessment tool offer a powerful approach to optimize treatment adherence among IBD sufferers.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":"916-924"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum immunoglobulin G levels in patients with cirrhosis due to autoimmune hepatitis or other etiologies.","authors":"Yu Su, Qianyi Wang, Xiaoyi Sun, Xinyu Zhao, Xinyan Zhao, Jidong Jia, Shan Shan","doi":"10.1097/MEG.0000000000003209","DOIUrl":"10.1097/MEG.0000000000003209","url":null,"abstract":"<p><strong>Objectives: </strong>Immunoglobulin G (IgG) elevation is a key laboratory finding of autoimmune hepatitis (AIH). However, the IgG elevation also occurs in patients with cirrhosis due to diverse etiologies. Therefore, we compared serum levels of globulin (GLB) and immunoglobulins among cirrhotic patients and optimized the IgG level to improve its diagnostic accuracy for AIH in the context of cirrhosis.</p><p><strong>Methods: </strong>In this cross-sectional study, we included age- and gender-matched patients with cirrhosis due to AIH and non-AIH etiologies. Demographic and key laboratory profiles were compared, focusing on the levels of GLB and immunoglobulins. Receiver operating characteristic curves were constructed. Bilateral P  < 0.05 and area under receiver operating characteristic curves greater than 0.5 were considered statistically significant.</p><p><strong>Results: </strong>A total of 60 AIH patients and 259 patients with cirrhosis of non-AIH etiologies were analyzed. The AIH group exhibited higher alanine aminotransferase and aspartate aminotransferase levels. Elevations of GLB (9.8-58.3%) and IgG (47.4-97.2%) levels were observed in all groups of cirrhosis, with the highest levels of IgG, immunoglobulin M, and immunoglobulin A occurring in the patients with cirrhosis due to AIH, primary biliary cholangitis, and alcoholic liver disease group, respectively. At a cutoff IgG level of 2000 mg/dl (1.25× upper limit of normal), the sensitivity and specificity for the diagnosis of AIH cirrhosis were 81.7% and 74.1%, respectively, with an area under receiver operating characteristic curves of 0.814 ( P  < 0.001).</p><p><strong>Conclusion: </strong>Hyperimmunoglobulinemia occurs in patients with cirrhosis due to different etiology. However, the different patterns of immunoglobulin subtype elevation may facilitate the differentiation of the underlying etiology of cirrhosis, with IgG level more than 2000 mg/dl (1.25× upper limit of normal) having a fair diagnostic performance for AIH-related cirrhosis.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":"941-948"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and predictive model for transjugular intrahepatic portosystemic shunt dysfunction in cirrhotic patients.","authors":"Yongbing Zhao, Tingwei Xiong, Sijie Hu, Hao Zhou, En Liu, Zhengguo Xu, Rui Xie","doi":"10.1097/MEG.0000000000003203","DOIUrl":"10.1097/MEG.0000000000003203","url":null,"abstract":"<p><strong>Background: </strong>Transjugular intrahepatic portosystemic shunt (TIPS) has been widely adopted for the management of decompensated portal hypertension in cirrhotic patients. However, TIPS dysfunction remains a critical clinical challenge. This study aimed to identify risk factors for TIPS dysfunction and develop a predictive model to assess this complication.</p><p><strong>Methods: </strong>A retrospective study was conducted involving cirrhotic patients who underwent TIPS between 2017 and 2024. Among 1052 initially screened patients, 676 were finally included in the analysis. TIPS dysfunction was diagnosed using ultrasound and angiographic evaluations. The dataset was randomly divided into a training set and a validation set at a ratio of 7 : 3. A stepwise logistic regression analysis was performed in the training set to establish a predictive model. Ten-fold cross-validation was used for internal validation, and the validation set was applied for external validation. The predictive discrimination was evaluated using the receiver operating characteristic curve, and the calibration curve was used to assess the consistency. Shapley Additive Explanations analysis was conducted to interpret the model.</p><p><strong>Results: </strong>Independent risk factors for TIPS dysfunction included age, main portal vein thrombosis, platelets, D value, angle β, and the angle between the selected hepatic vein and inferior vena cava. The model showed good predictive performance with an area under the curve of 0.896 (sensitivity 0.804, specificity 0.844, and accuracy 93.2%) for training set and 0.905 (sensitivity 0.870, specificity 0.826, and accuracy 86.5%) for validation set. The calibration curve from the 10-fold cross-validation in the training set also showed good agreement between prediction and observation. Shapley Additive Explanations analysis showed that Beta value is the most important feature affecting prediction, and allows the estimation of the specific risk of TIPS dysfunction for each individual in the model.</p><p><strong>Conclusion: </strong>This study developed a valid predictive model for assessing risk factors for TIPS dysfunction in cirrhotic patients. Recognition of these risk factors and optimized TIPS shunt management may contribute to improved outcomes in patients undergoing TIPS procedures.</p>","PeriodicalId":11999,"journal":{"name":"European Journal of Gastroenterology & Hepatology","volume":" ","pages":"977-985"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}