Hepatology International最新文献

{"title":"Hepatic immune-related adverse event increased the overall survival of patients with malignancies treated with immune checkpoint inhibitors.","authors":"Kaori Matsumoto, Tatsuo Kanda, Junichiro Wakatsuki, Young-Jin Kim, Ritsuko Yokouchi, Naho Sato, Yuko Hasegawa, Kenji Amemiya, Yosuke Hirotsu, Sumio Hirose, Yushi Imai, Shinya Takaoka, Hiroyuki Amano, Yukiko Asakawa, Kouwa Nagasaka, Yoshiki Asahina, Yuichiro Kojima, Shodai Toyama, Hitoshi Mochizuki, Shuntaro Obi, Masao Omata","doi":"10.1007/s12072-025-10825-3","DOIUrl":"https://doi.org/10.1007/s12072-025-10825-3","url":null,"abstract":"<p><strong>Background and aim: </strong>Associations between the occurrence of abnormal liver function tests, an immune-related adverse event (irAE) caused by immune checkpoint inhibitors (ICIs), and treatment efficacy are unclear. We investigated the association between the incidence of these hepatic irAE occurrences and treatment response in patients treated with ICIs.</p><p><strong>Methods: </strong>We studied 924 patients treated with ICIs to determine the relationship between the incidence of irAEs and overall survival (OS) with and without the continuation of ICIs due to hepatic irAEs.</p><p><strong>Results: </strong>Of 924 treated, 338 (36.6%) developed all types of irAEs. Median OS for patients with and without irAEs were 34.3 months (n = 338) and 13.1 months (n = 586), respectively (p = 2.49 × 10^-14). Of 924, 62 (6.7%) patients developed hepatic irAE; 31 discontinued and 31 continued ICI. Of interest, median OS with and without the continuation of ICI therapy due to hepatic irAEs was 54.3 months and 11.5 months, respectively (p = 0.00589). We further compared the difference of liver function tests among the two groups. Although aminotransferases are higher among discontinued group, stigmata of impending hepatic failure were no different among these two groups.</p><p><strong>Conclusions: </strong>In patients who developed hepatic irAEs, OS was longer in the continued treatment group than in the discontinued treatment group. Most patients who developed hepatic irAEs and stopped the treatment had higher aminotransferase, but often lacks the stigmata of impending hepatic failure such as prothrombin time prolongation or gradual elevation of total bilirubin. Multi-disciplinary cooperation, including hepatologists, may be important for OS improvement by the prolonged use of ICIs.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diverse approaches and sources to derive antitumor T cell for liver cancer: a single-cell sequence based research.","authors":"Ai-Xian Zhang, Jia-Rui Chen, Ai-Rong Yang, Bo Yang, Zhao-Yi Lin, Bo-Yuan Liu, Tao Zeng, Pei-Ying Wang, Xue-Ying Wu, Yang Zhou, Heng-Hui Zhang, Xiu-Ping Zhang, Ming-Gen Hu","doi":"10.1007/s12072-025-10818-2","DOIUrl":"https://doi.org/10.1007/s12072-025-10818-2","url":null,"abstract":"<p><strong>Introduction: </strong>Despite advancements in adoptive cell therapy (ACT) for hematologic tumors, its role in solid tumors still lacks satisfactory performance, especially in Primary Liver Cancer (PLC). Therefore, further studies are needed on potential ACT sources for PLC.</p><p><strong>Methods: </strong>Primary liver cancer patients who had not previously received treatment were prospectively enrolled in this research. Tumor tissues combined with lymph node and blood samples were acquired during surgery. Two different antigen-specific T-cell induction approaches were used to form cytotoxic T-cell groups from PBMCs, and antitumor T cells from tumor tissues combined with TDLNs were derived. A single-cell RNA sequence coupled with a T-cell receptor sequence was used to identify the cell subsets based on the molecular and functional properties of diverse antitumor T-cell induction approaches and sources.</p><p><strong>Results: </strong>Three primary liver cancer patients were included in the present study. A total of 79,300 cell transcriptomes in 19 clusters were isolated from the clinical samples. After two different induction approaches, substantial amplification of immune cells occurred in both the CTL and CTL2 groups, with highly consistent T-cell subtypes, and selective amplification of antitumor T-cell clones in the two groups was also detected. The three-aspect comparison, which was based on the proliferation score, effect score and cytokine expression, indicated that the immunological effect of the mRNA approach was comparable to that of the multiantigen peptide approach. Finally, the antigen-specific expanded T-cell clones found in CTL, CTL2 and TAL-T cells indicated the potential of tumors combined with lymph nodes as sources for ACT.</p><p><strong>Conclusions: </strong>Diverse antitumor T-cell induction approaches and sources were compared, revealing multiple effective options for antitumor T-cell derivation as a source of ACT for liver cancer.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mindin orchestrates the macrophage-mediated resolution of liver fibrosis in mice.","authors":"Yong-Dong Huang, Xian-Ling Zhao, Ying Lin, Xiao-Mei Ouyang, Xiao-Shen Cheng, Lai-Ying Liang, Ya-Ni Huo, Gui-Jing Xie, Jun-Hui Lin, Amarsanaa Jazag, Bayasi Guleng","doi":"10.1007/s12072-025-10813-7","DOIUrl":"https://doi.org/10.1007/s12072-025-10813-7","url":null,"abstract":"<p><strong>Background & aims: </strong>Liver disease that progresses to cirrhosis is an enormous health problem worldwide. The extracellular matrix protein Mindin is known to have immune functions, but its role in liver homeostasis remains largely unexplored. We aimed to characterize the role of Mindin in the regulation of liver fibrosis.</p><p><strong>Approach & results: </strong>Mindin was upregulated in mice with carbon tetrachloride (CCl₄) or thioacetamide (TAA)-induced liver fibrosis, and was primarily expressed in hepatocytes. Global Mindin knockout mice were generated, which were susceptible to liver fibrosis. Notably, Mindin failed to activate hepatic stellate cells directly; however, it played a role in promoting the recruitment and phagocytosis of macrophages, and caused a phenotypic switch toward restorative macrophages during liver fibrosis. Furthermore, Mindin was found to bind to the αM-I domain of CD11b/CD18 heterodimeric receptors. To further explore this mechanism, we created Mindin and CD11b double-knockout (DKO) mice. In DKO mice, phagocytosis was further reduced, and liver fibrosis was markedly exacerbated.</p><p><strong>Conclusions: </strong>Mindin promotes the resolution of liver fibrosis and the Mindin/CD11b axis might represent a novel target for the macrophage-mediated regression of liver fibrosis.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential combination with ropeginterferon alfa-2b and anti-PD-1 treatment as adjuvant therapy in HBV-related HCC: a phase 1 dose escalation trial.","authors":"Albert Qin, Ming-Chih Ho, Chan-Yen Tsai, Chun-Jen Liu, Pei-Jer Chen","doi":"10.1007/s12072-025-10824-4","DOIUrl":"https://doi.org/10.1007/s12072-025-10824-4","url":null,"abstract":"<p><strong>Background/purpose: </strong>Post-operative recurrence is a major clinical challenge with hepatocellular carcinoma (HCC). While currently unapproved, anti-programmed cell death 1 (PD-1) and anti-vascular endothelial growth factor combination adjuvant therapy showed promise. We initiated a phase I trial using sequential treatment with ropeginterferon alfa-2b (ropeg), a novel interferon-based antiviral and antitumor agent, followed by anti-PD-1 therapeutic antibody nivolumab as an adjuvant therapy for hepatitis B virus (HBV)-related HCC.</p><p><strong>Methods: </strong>Patients who underwent surgical resection of HBV-related HCC with curative intent received sequential therapy with six doses of ropeg every two weeks at 450 μg, followed by three doses of nivolumab escalating from 0.3 to 0.75 mg/kg every two weeks. Safety, HBV surface antigen (HBsAg) loss or decrease, anti-HBV surface (HBs) antibodies, cancer recurrence, and survival were evaluated.</p><p><strong>Results: </strong>Fifteen eligible patients were enrolled. Most adverse events (AEs) were mild or moderate and no severe or serious AEs were observed. Alanine transaminase flares, including one grade 3 event as dose-limiting toxicity, were noted in five cases and the final recommended dose for anti-PD1 was determined at 0.75 mg/kg. Interestingly, all five cases had HBsAg clearance or reduction. All patients in the study were alive without cancer recurrence during a median follow-up of 1024 days with six patients surviving > 4 years and three for > 5 years.</p><p><strong>Conclusions: </strong>This phase I trial supports the safety and clinical efficacy of sequential treatment with ropeg and nivolumab in post-resection HBV-related HCC. This regimen holds promise for further adjuvant therapy trials in HCC, both HBV-related and other types.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimates of the global prevalence of occult hepatitis B virus infection in population under 18 years old: a systematic review and meta-analysis.","authors":"Yuchen Pan, Zhifang Jia, Yangyu Zhang, Yanhua Wu, Jing Jiang","doi":"10.1007/s12072-025-10816-4","DOIUrl":"https://doi.org/10.1007/s12072-025-10816-4","url":null,"abstract":"<p><strong>Objective: </strong>Occult hepatitis B virus infection (OBI) is defined by the presence of hepatitis B virus (HBV) DNA, while HBsAg (Hepatitis B surface antigen) remains undetectable. The infectivity of OBI and its potential ability to contribute to cirrhosis and hepatocellular carcinoma has been reported, with infection in children potentially leading to more severe outcomes. However, the global prevalence and disease burden remain unclear, and this study aimed to assess the prevalence of OBI in population under 18 years old.</p><p><strong>Methods: </strong>We conducted a systematic literature search in PubMed, Embase, Scopus, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Chinese databases for articles evaluating OBI in population under 18 years old. The prevalence of OBI was pooled after quality assessment.</p><p><strong>Results: </strong>A total of 49 studies was included, allowing a meta-analysis of 1,070,526 HBsAg-negative individuals. Data from 28 and 25 studies were extracted for analysis of the high- and low-risk population, respectively. The overall prevalence of OBI in population ≤ 18 years old was 2.1% [95% confidence interval (CI): 0.9%-3.8%] and 9.7% (95% CI: 4.9%-15.8%) in the low- and high-risk population, respectively. In the subgroup analysis of the high-risk population, the OBI prevalence in the African, Eastern Mediterranean, and Western Pacific regions was 21.5% (95% CI: 0.0%-69.9%), 26.8% (95% CI: 13.0%-43.4%), and 4.3% (95% CI: 1.5%-8.2%), respectively. The OBI prevalence was 6.3% (95% CI: 2.7%-11.1%) in children born to mothers infected with HBV, 20.5% (95% CI: 0.0%-66.6%) in population infected with HIV or HCV, and 37.8% (95% CI: 30.8%-45.1%) in population who received blood transfusion. The OBI prevalence was 6.0% (95% CI: 2.4%-11.0%) in participants whose mothers were infected with HBV and vaccinated with hepatitis B vaccine (HepB) and HBIG, 7.1% (95% CI: 0.0%-22.9%) in participants only vaccinated with HepB.</p><p><strong>Conclusion: </strong>The global prevalence of OBI among individuals under 18 years old, particularly in high-risk population, cannot be neglected. Given the stealthy transmission of OBI and its potential for serious clinical outcomes, OBI in population younger than 18 years old should be emphasized as a global health issue.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Model of baseline clinicopathological features predicts non-resolution of drug-induced liver injury at 6 months.","authors":"Chhagan Bihari, Shvetank Sharma, Apoorva Giri, Raj Pal Yadav, Sukriti Baweja, Archana Rastogi, Shiv Kumar Sarin","doi":"10.1007/s12072-025-10814-6","DOIUrl":"https://doi.org/10.1007/s12072-025-10814-6","url":null,"abstract":"<p><strong>Introduction: </strong>Chronicity in drug-induced liver injury (DILI) is assessed at 12 months, leading to a large time gap from its initial presentation. In this study, we developed a model that could predict biochemical non-resolution in DILI (DILI-NR) patients at 6 months using baseline clinicopathological data.</p><p><strong>Patients and methods: </strong>Cases of DILI with liver biopsies were enrolled between January 2016 and December 2021. BSEP, MDR3, and MRP2 were assessed immunohistochemically. DILI-NR was considered a biochemical non-resolution 6 months after the onset of DILI. A separate cohort of 126 patients was taken as a validation cohort.</p><p><strong>Results: </strong>DILI-NR was noted in 59/407 patients (14.5%). DILI-NR patients had significantly higher body mass index, lower hemoglobin, more severe disease at the presentation, autoantibody positivity, higher IgG, association with co-morbidities, and were more aged. Pathologically, DILI-NR had increased ductular reaction, duct damage, duct loss, ductular bile plugs, and autoimmune hepatitis-like morphology along with lesser expression of canalicular transporters. On multivariate logistic regression (LR) analysis and XGBoost analysis, BMI, hemoglobin, presence of autoantibodies, disease severity at baseline, and lower expression of any one transporter were associated with DILI-NR (AUROC = 0.92). After calibrating the model on the test cohort, the LR model showed AUROC of 0.89 with an accuracy of 87.3% and precision of 91.5%, confirming the effectiveness of the model.</p><p><strong>Conclusion: </strong>The model encompassing hemoglobin, BMI, presence of autoantibodies, disease severity, and reduced expression of canalicular proteins at baseline predicts the biochemical non-resolution of DILI at six months.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carvedilol and traditional nonselective beta blockers for the secondary prophylaxis of variceal hemorrhage and portal hypertension related complications among patients with decompensated cirrhosis: a systematic review and network meta-analysis.","authors":"Warunee Mingpun, Agnieszka Sobanska, Mantiwee Nimworapan, Maneerat Chayanupatkul, Teerapon Dhippayom, Piyameth Dilokthornsakul","doi":"10.1007/s12072-025-10812-8","DOIUrl":"https://doi.org/10.1007/s12072-025-10812-8","url":null,"abstract":"<p><strong>Background: </strong>Carvedilol has limited research on decompensated cirrhosis. This study compared the effects of carvedilol, traditional nonselective beta blockers (NSBBs), including propranolol and nadolol, and other interventions in patients using carvedilol or traditional NSBBs for secondary prophylaxis of variceal hemorrhage (VH) and portal hypertension (PH)-related complications.</p><p><strong>Methods: </strong>A systematic search of databases, including PubMed, Embase, Cochrane Library, and Scopus, was conducted through October 2023. Randomized controlled trials (RCTs) evaluating carvedilol or traditional NSBBs for secondary prophylaxis of VH were included. The outcomes were the occurrence of VH and portal PH-related complications, including new or worsening ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome. A network meta-analysis was performed using a random-effects model.</p><p><strong>Results: </strong>A total of 60 RCTs involving 5,600 patients with a median Child Pugh score of 8.0 (range 6.8-10) were included. The risk of carvedilol plus variceal band ligation (VBL) on VH was lower than placebo (relative risk (RR) 0.24; 95% confidence interval (CI): 0.10-0.57), and the risk of carvedilol on new or worsening ascites was lower than placebo (RR = 0.10, 95%CI; 0.01-0.93). Traditional NSBBs plus VBL also had preventive effects on VH compared to placebo (RR = 0.31, 95%CI; 0.18-0.54). However, there were no differences between carvedilol and traditional NSBBs in other outcomes.</p><p><strong>Conclusion: </strong>Carvedilol can prevent PH-related complications, including VH and new or worsening ascites, in cirrhosis patients with a history of VH. No significant differences were observed between the effects of carvedilol and traditional NSBBs, both combined with VBL.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interplay between lymphatic system and portal hypertension: a comprehensive review.","authors":"Pinky Juneja, Rajni Yadav, Dinesh M Tripathi, Savneet Kaur","doi":"10.1007/s12072-025-10815-5","DOIUrl":"https://doi.org/10.1007/s12072-025-10815-5","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of portal hypertension revolves around numerous structural and functional changes in the intra- and extra-hepatic vascular compartments. In recent years, a dysfunction of the lymphatic system has garnered increasing attention as one of the key sequelae of portal hypertension.</p><p><strong>Purpose and methods: </strong>The review comprehensively deliberates about the anatomical and functional attributes of the hepatic lymphatic system during portal hypertension. Along with liver lymphatic system, important modifications that occur in extrahepatic lymphatics during advanced liver disease are discussed.</p><p><strong>Results: </strong>During progression of liver disease, elevated portal pressures cause increased sinusoidal blood and enhanced lymph flow, leading to dilation and proliferation of hepatic lymphatic vessels. In advanced liver disease, portal and central lymphatic systems also undergo profound changes to accommodate increased lymph flows. These changes in lymphatic system seem to have evolved as compensatory mechanisms to alleviate enhanced portal pressures. However, further increase in the splanchnic lymph production causes a complete failure of the drainage capacity of local and central lymphatic vessels, leading to maldistribution of extracellular fluid along with immune system anomalies aggravating ascites and pathological bacterial translocation.</p><p><strong>Conclusion: </strong>Lymphatic dysfunction plays a crucial role in the progression and complications of portal hypertension. Development of routine imaging techniques for lymphatic vessels in clinics,  protocols for measuring lymphovenous pressure gradient and in vitro and in vivo experimental studies are requisite to further our understanding in this field. Targeting lymphatic dysfunction could offer promising therapeutic options for managing cirrhosis, portal hypertension and related complications.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to \"Metabolic (dysfunction)-associated fatty liver disease metrics and contributions: Correspondence\".","authors":"Maito Suoh, Saeed Esmaili, Mohammed Eslam, Jacob George","doi":"10.1007/s12072-025-10811-9","DOIUrl":"https://doi.org/10.1007/s12072-025-10811-9","url":null,"abstract":"","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating prior decompensation into ACLF definition to enhance clinical management.","authors":"Meiqian Hu, Jinjin Luo, Yu Wu, Jing Zhang, Peng Li, Xi Liang, Jiaojiao Xin, Dongyan Shi, Heng Yao, Shiwen Ma, Taoying Wei, Qiuzhi Wang, Xiao Wu, Yuheng Kong, Xingping Zhou, Jiaxian Chen, Hui Yang, Wen Hu, Bingqi Li, Feiyang Sun, Qingyang Ruan, Yu Chen, Jun Li, Jing Jiang","doi":"10.1007/s12072-025-10805-7","DOIUrl":"https://doi.org/10.1007/s12072-025-10805-7","url":null,"abstract":"<p><strong>Background: </strong>Acute-on-chronic liver failure (ACLF) is a complicated syndrome associated with high short-term mortality and reversibility. Whether the prior decompensation should be included in the definition of ACLF is controversial.</p><p><strong>Methods: </strong>A total of 532 patients with decompensation (prior or first) of chronic liver disease were retrospectively enrolled and analyzed from January 2018 to June 2023. Clinical data were used to identify the characteristics and determine prognosis.</p><p><strong>Results: </strong>Of the 532 patients, 99 patients did not meet APASL-ACLF criteria due to the existence of prior decompensation and 433 patients met the Asian Pacific Association for the Study of the Liver (APASL)-ACLF criteria. The two groups had similar characteristics including prognosis scores (Chinese Group on the Study of Severe Hepatitis B (COSSH)-ACLF II score: 7.59 vs. 7.67, p = 0.934; Chronic Liver Failure (CLIF) Consortium ACLF score: 42.90 vs. 44.81, p = 0.273), the distribution of patients with APASL ACLF research consortium score (AARC score) (5-7: 19.2%/12.0%; 8-10: 56.6%/55.0%; 11-15: 24.2%/33.0%, p > 0.05) and the 28-/90-day mortality rates (30.5%/43.2% vs. 36.3%/43.1%, p = 0.267/0.978). In all integrated ACLF patients, Receiver Operating Characteristic (ROC) curve analysis and decision curve analysis (DCA) showed that COSSH-ACLF IIs had higher prognostic efficiency and clinical net benefit than AARC score and CLIF-C ACLFs for 28-/90-day mortality.</p><p><strong>Conclusion: </strong>Prior decompensated patients exhibited clinical characteristics and high short-term mortality similar to those of first decompensated patients. The COSSH-ACLF IIs demonstrated the highest prognostic efficiency for all integrated ACLF patients. Including prior decompensation in the ACLF definition can help to simplify and improve clinical management.</p>","PeriodicalId":12901,"journal":{"name":"Hepatology International","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}