Hepatology Communications最新文献

{"title":"The global epidemiology of hepatocellular carcinoma.","authors":"Muhammad Ali Butt, Elizabeth S Aby, Jose D Debes","doi":"10.1097/HC9.0000000000000932","DOIUrl":"10.1097/HC9.0000000000000932","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) remains a major global cause of cancer morbidity and mortality, with marked geographic heterogeneity in incidence and outcomes. The highest age-standardized incidence and mortality rates persist in East Asia and across much of Africa. In contrast, Europe and North America exhibit moderate incidence, while Latin America and Oceania represent intermediate-burden regions with important subregional heterogeneity, with higher mortality concentrated in underserved, rural, Indigenous, and remote populations. Globally, the etiologic landscape of HCC is shifting from predominantly infection-related toward metabolic dysfunction and alcohol-associated liver disease. Rural-urban disparities further exacerbate global HCC burden through gaps in vaccination coverage, antiviral access, diagnostic infrastructure, and specialty care, leading to later-stage presentation and poorer outcomes. In this review, we describe the epidemiological changes in HCC across different areas of the world, focusing on region-specific issues and identifying key aspects of epidemiological transition.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 5","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molnupiravir is effective against hepatitis E virus infection in an animal model.","authors":"Shusheng Wu, Nicholas Foo-Siong Chew, Xiaodan Ma, Jianwen Situ, Estie Hon-Kiu Shun, Can Li, Jonathan Daniel Ip, Siu-Fung Stanley Ho, Anna Jinxia Zhang, James Yiu-Hung Tsoi, Wan-Mui Chan, Weihui Ma, Yonghao Liang, Weiwei Mao, Karina Wing Yee Chen, Feifei Yin, Kelvin Kai-Wang To, Shuofeng Yuan, Jasper Fuk-Woo Chan, Longchao Zhu, Yaowei Huang, Siddharth Sridhar","doi":"10.1097/HC9.0000000000000944","DOIUrl":"10.1097/HC9.0000000000000944","url":null,"abstract":"<p><strong>Background: </strong>There are few treatment options for patients with chronic hepatitis E unresponsive to ribavirin. Drug repurposing is required to identify new treatments. Molnupiravir, a nucleoside analogue, is approved for the treatment of coronavirus disease 2019 (COVID-19). This study evaluated the activity of molnupiravir against hepatitis E virus (HEV) in cell culture and animal models.</p><p><strong>Methods: </strong>Cytotoxicity and antiviral efficacy of molnupiravir, ribavirin, and sofosbuvir were investigated using infectious cDNA clones and wild-type HEV isolates in PLC/PRF/5 cells and primary rat hepatocytes. Immunosuppressed rats were infected with HEV and treated with molnupiravir and ribavirin. The effectiveness of molnupiravir in clearing HEV in serum, feces, and liver tissue was compared with that of untreated and ribavirin-treated animals. Mutations arising in virus populations during treatment were assessed using next-generation sequencing.</p><p><strong>Results: </strong>The antiviral effect of molnupiravir was comparable to that of ribavirin and superior to that of sofosbuvir against HEV strains in vitro, with decreased HEV RNA in supernatant (p<0.05) and cytoplasmic viral protein expression. No additive effect with sofosbuvir was observed. Rats (n=14 per group) treated with 400 mg/kg/d molnupiravir cleared viremia within 4 weeks of treatment, and 9/14 of these animals also cleared viral shedding in stool. Mean viremia and fecal viral loads were reduced compared with untreated and ribavirin-treated animals (p≤0.005). Partial effectiveness was apparent at the lower 250 mg/kg/d molnupiravir dose. Molnupiravir-treated rats had improved liver histology compared with control animals. Frequent transition mutations were observed in HEV from molnupiravir-treated animals.</p><p><strong>Conclusions: </strong>Molnupiravir limits HEV infection in cell culture and animal models. Molnupiravir could be an alternative for ribavirin-refractory chronic hepatitis E.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 5","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD14+CD16- monocytes exhibit NF-κB hyperactivation in biliary atresia: Clinical association and murine therapeutic validation.","authors":"Jiaming Chang, Sizhe Liu, Xiaobin Wu, Qiying Xu, Mengyue Li, Zhipeng Guo, Hui Chen, Hezhen Wang, Lili Xu, Jingru Yan, Ming Fu, Boyuan Tao, Yan Chen, Huimin Xia, Ruizhong Zhang, Juan He, Zhe Wen","doi":"10.1097/HC9.0000000000000941","DOIUrl":"10.1097/HC9.0000000000000941","url":null,"abstract":"<p><strong>Background: </strong>Classical CD14+CD16- monocytes are elevated in biliary atresia (BA); however, their specific role in bile duct injury and the underlying regulatory mechanisms remain unclear. This study aimed to define their contribution to BA pathogenesis, focusing on the NF-κB signaling pathway.</p><p><strong>Methods: </strong>Liver tissues and blood samples from patients with BA and controls were analyzed by single-cell RNA sequencing, flow cytometry, and immunofluorescence. A rhesus rotavirus-induced BA mouse model was used for anti-Ly6C monocyte depletion and NF-κB inhibition (dehydroxymethylepoxyquinomicin). Transcriptomic profiling and cytokine analysis revealed key molecular mechanisms.</p><p><strong>Results: </strong>Classical monocytes were significantly enriched near the damaged bile ducts in patients with BA and positively correlated with liver injury severity. These monocytes exhibited NF-κB hyperactivation, marked by the upregulation of TNF, IL-1β, Cxcl2, and NLRP3 inflammasome components. RNA-seq revealed BA-specific monocyte clusters with enriched NF-κB signatures. The depletion of classical monocytes (anti-Ly6C) in rhesus rotavirus-induced BA mice reduced biliary inflammation, restored bile duct patency, and improved survival. Pharmacological NF-κB inhibition (dehydroxymethylepoxyquinomicin) similarly attenuated inflammation and liver dysfunction and improved survival in rhesus rotavirus-induced BA mice.</p><p><strong>Conclusions: </strong>Classical CD14+CD16- monocytes are spatially enriched and exhibit NF-κB hyperactivation in BA. Targeting these cells or their NF-κB axis represents a promising therapeutic strategy to mitigate disease progression.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 5","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1RA plus SGLT2i combination therapy and liver fibrosis progression in MASLD with type 2 diabetes.","authors":"Jonggi Choi, Gabby Mitchell, Vy H Nguyen, Eric Przybyszewski, Jiunn Song, Allison Carroll, Megan Michta, Erik Almazan, Tracey G Simon, Raymond T Chung","doi":"10.1097/HC9.0000000000000949","DOIUrl":"10.1097/HC9.0000000000000949","url":null,"abstract":"<p><strong>Background and aim: </strong>The combined use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) may provide synergistic benefits for liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM). We evaluated the comparative effectiveness of GLP-1RA plus SGLT2i versus GLP-1RA monotherapy on liver fibrosis progression.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the Mass General Brigham healthcare network (2010-2024). Adults with MASLD and T2DM initiating GLP-1RA therapy were included if their baseline FIB-4 scores indicated low-risk (<1.3) or intermediate-risk (1.3-2.67) categories. Combination therapy was defined as concurrent SGLT2i use for ≥50% of the GLP-1RA treatment period. The primary outcome was fibrosis progression, defined as advancement to a high-risk FIB-4 category. The secondary outcome was hepatic complications (cirrhosis, hepatocellular carcinoma, liver transplantation, or decompensation). Propensity score matching (1:2) was performed to minimize confounding.</p><p><strong>Results: </strong>After matching, 879 combination therapy users were compared with 1690 monotherapy users. Combination therapy was associated with a significantly lower risk of fibrosis progression (3.10 vs. 4.01/100 person-years; HR 0.76, 95% CI 0.61-0.95) and a numerically lower incidence of hepatic complications (1.05 vs. 1.34/100 person-years; HR 0.76, 95% CI 0.53-1.09). Subgroup analyses showed consistent protective associations, with a significant benefit observed among patients with a BMI ≤35. Sensitivity analyses confirmed reduced fibrosis progression in both the ≥90-day and ≥180-day landmark analyses.</p><p><strong>Conclusions: </strong>GLP-1RA plus SGLT2i therapy was associated with reduced fibrosis progression compared with GLP-1RA monotherapy in MASLD and T2DM.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 5","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture risk under selective and non-selective PPAR agonists in primary biliary cholangitis.","authors":"Ulrich Beuers, Alexandra Rousseau, Stan F J van de Graaf, Christophe Corpechot","doi":"10.1097/HC9.0000000000000945","DOIUrl":"10.1097/HC9.0000000000000945","url":null,"abstract":"","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 5","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DAAs in pregnancy are the only potential intervention to decrease vertical transmission: Pregnancy DAA data support safety.","authors":"Catherine Chappell, Mia J Biondi, Tatyana Kushner","doi":"10.1097/HC9.0000000000000924","DOIUrl":"10.1097/HC9.0000000000000924","url":null,"abstract":"","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 5","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seladelpar in patients with primary biliary cholangitis and compensated cirrhosis: Efficacy and safety from RESPONSE and ASSURE studies.","authors":"Stuart C Gordon, Alejandra Villamil, Ira M Jacobson, Eric J Lawitz, Ziad Younes, Marina G Silveira, Christopher L Bowlus, Joost P H Drenth, John M Vierling, Ulrike Morgera, Adam Vasura, George Dalekos, Andrea Galli, Mordechai Rabinovitz, Jeong Heo, Frederik Nevens, Cynthia Levy, Yan Zhou, Susheela Carroll, Daria B Crittenden","doi":"10.1097/HC9.0000000000000918","DOIUrl":"10.1097/HC9.0000000000000918","url":null,"abstract":"<p><strong>Background: </strong>Treatment options are limited for patients with primary biliary cholangitis (PBC) and cirrhosis. Seladelpar, a first-in-class delpar (selective PPAR-δ agonist), had generally similar efficacy and safety among patients with versus without compensated cirrhosis in the phase 3 RESPONSE study. Here we provide additional data on seladelpar in patients with compensated cirrhosis from the phase 3 program.</p><p><strong>Methods: </strong>In RESPONSE, patients with PBC and an inadequate response or intolerance to UDCA were randomized 2:1 to seladelpar 10 mg or placebo for 1 year. Upon completion, patients rolled over into the open-label (seladelpar 10 mg) phase 3 ASSURE study, which also enrolled patients from earlier seladelpar legacy PBC studies. Here, we assessed the composite endpoint [alkaline phosphatase (ALP) <1.67×upper limit of normal (ULN), ALP decrease ≥15%, and total bilirubin ≤ULN], other laboratory changes, and safety in all patients with cirrhosis from RESPONSE and an interim analysis of the ongoing ASSURE study through January 2024.</p><p><strong>Results: </strong>Twenty-seven patients with compensated cirrhosis enrolled in RESPONSE (18 seladelpar, 9 placebo). At month 12, 38.9% and 22.2% of patients in the seladelpar and placebo groups, respectively, met the composite endpoint; mean percent change from baseline in ALP was -37.1% and -10.1%, respectively. Upon rollover to ASSURE (13 seladelpar, 6 placebo), ALP declines were maintained for up to 18 months. An additional 35 patients with compensated cirrhosis in ASSURE from legacy studies had similar reductions in ALP with up to 2 years of treatment. Bilirubin remained overall stable. No treatment-related serious adverse events occurred. Variceal bleeding and/or ascites developed in 3 patients after ≥9 months.</p><p><strong>Conclusions: </strong>Seladelpar decreased markers of cholestasis and was overall safe and well-tolerated in patients with PBC and compensated cirrhosis.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 5","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD8 TRM-like T cells expressing perforin and IFN-γ define a pediatric activated T-cell acute liver failure endotype.","authors":"Tamir Diamond, Catherine A Chapin, Caroline J Diorio, Sarah McCuaig, Michelle Lau, Niansheng Chu, Nora M Gibson, Portia A Kreiger, Simon Horslen, Kathleen M Loomes, Anna M Banc-Husu, Jaime Chu, M Kyle Jensen, Daniel H Leung, Amrita Narang, Beth A Carter, Scott Elisofon, Ryan Fischer, Steven J Lobritto, Mike Leonis, Anna L Peters, Norberto Rodriguez-Baez, Rene Romero, Philip Rosenthal, David Rudnick, James Squires, Shikha Sundaram, Kyla M Tolliver, Pamela Valentino, Valerie Durkalski, Estella M Alonso, Edward M Behrens","doi":"10.1097/HC9.0000000000000926","DOIUrl":"10.1097/HC9.0000000000000926","url":null,"abstract":"<p><strong>Background: </strong>Activated T-cell pediatric acute liver failure (TC-PALF) is the most common cause of non-acetaminophen PALF, with poor transplant-free survival. Livers in TC-PALF are infiltrated by effector cytotoxic T lymphocytes with markers of tissue-resident memory function (CD8 Trm) and an interferon gamma (IFNγ) transcriptional signature. The PALF-Immune Response Network (PALF-IRN) and the prospective TReatment for ImmUne-Mediated PathopHysiology (TRIUMPH) clinical trial (NCT04862221) aim to characterize the TC-PALF immune pathology and utility of T-cell directed therapy to improve transplant-free survival.</p><p><strong>Methods: </strong>TRIUMPH patients with TC-PALF were compared with healthy children and disease controls utilizing multiparameter flow cytometry and 3' single-cell RNA sequencing from peripheral blood mononuclear cells. TC-PALF patient serum was compared with healthy children and those with PALF from other causes, utilizing the Olink Inflammation I 384 protein assay.</p><p><strong>Results: </strong>Two distinct endotypes of TC-PALF were identified, which differed in flow cytometry CD8+ Perforin1 (Prf) expression and liver biopsy staining of Prf. TC-PALF patients with high CD8+ Prf (TC-PALF High Prf) had monocytosis, with a unique circulating CD8 IFNγ+ Trm-like population and IFNγ-responsive CD14/CD16 monocyte ligand-receptor interaction. TC-PALF patients with normal CD8+ Prf expression had hypergammaglobulinemia, an increase in class-switched B-cells, and a decrease in serum inflammatory proteins associated with myeloid activation.</p><p><strong>Conclusions: </strong>TC-PALF high Prf patients have a unique circulating CD8+ IFNγ+ Trm-like population accompanied by monocyte proliferation and activation. Further understanding of the role of IFNγ in TC-PALF High Prf may provide a therapeutic target for this endotype to improve transplant-free survival.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-stratified surveillance for hepatocellular carcinoma.","authors":"Thomas Hunold, Neehar D Parikh","doi":"10.1097/HC9.0000000000000943","DOIUrl":"10.1097/HC9.0000000000000943","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with most cases arising in patients with cirrhosis or chronic hepatitis B. Current guidelines recommend semi-annual ultrasound with or without alpha-fetoprotein (AFP) testing for all at-risk individuals; however, this one-size-fits-all approach has important limitations, including suboptimal sensitivity, frequent false-positive results, poor adherence, and failure to account for substantial heterogeneity in individual HCC risk. Risk-stratified surveillance has emerged as a potential strategy to better balance surveillance benefits and harms by tailoring surveillance intensity and modality to patient-specific risk. We summarize and critically evaluate existing HCC risk stratification models, including clinical, biomarker-based, and imaging-based or elastography-based approaches. Although several models demonstrate promising performance, many lack robust external validation, underrepresent patients with metabolic and alcohol-associated liver disease, and inadequately account for competing risks such as non-liver-related mortality. We further discuss key challenges to implementing risk-stratified surveillance in clinical practice. Overall, while risk-stratified HCC surveillance has several promising characteristics over current paradigms, prospective validation and implementation studies are needed before widespread adoption. Aligning surveillance strategies with individualized risk has the potential to improve outcomes in patients at risk for HCC.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain, uncertainty, and lack of clinical support drive emergency department utilization in cirrhosis: A qualitative study.","authors":"Swetha Parvataneni, Nicholas E Harrison, Bridget Hawryluk, Courtney Moore, Anurag Harishchandrakar, Eric S Orman, William E Bennett, Archita P Desai","doi":"10.1097/HC9.0000000000000936","DOIUrl":"10.1097/HC9.0000000000000936","url":null,"abstract":"<p><strong>Background: </strong>Individuals with cirrhosis frequently require Emergency Department (ED) care, with some experiencing repeated ED use, yet little is known about the patient and caregiver perspectives driving decisions to visit the ED. We aimed to explore perspectives of including high ED utilizers with cirrhosis and their caregivers to identify drivers of ED use and opportunities to optimize care.</p><p><strong>Methods: </strong>Using human-centered design methods, we conducted an in-person group engagement session with 7 adults with cirrhosis and their caregivers, recruited from recent ED encounters. A custom board-game activity facilitated the discussion. Data were analyzed using snippet extraction, affinity mapping, and affinity concept modeling.</p><p><strong>Results: </strong>Seven major themes emerged: (1) Mindset around symptoms, which includes fear, uncertainty, and caregiver burden. (2) Informational needs, including reliance on variable-quality online resources and lack of trusted education. (3) Day-to-day cirrhosis management, particularly challenges related to medications and symptom monitoring. (4) Symptom-driven ED triggers, with some prompting, urgent visits. (5) Decision-making factors, including limited alternatives to ED care and prior experiences, and mismatched patient-caregiver thresholds for seeking care. (6) Expectations of ED care, focused on pain relief and return to baseline health. (7) Challenges during ED care, including long wait times, misdiagnosis concerns, and stigma related to pain treatment. Concept modeling revealed that ED decision-making is a dynamic journey shaped by symptom severity, emotional states, logistical considerations, and evolving patient-caregiver-provider roles.</p><p><strong>Conclusions: </strong>Pain, uncertainty about symptom severity, and lack of accessible real-time clinical support were major drivers of ED utilization in cirrhosis. Interventions addressing these specific needs may reduce avoidable ED use. These findings provide a patient-informed foundation for care delivery redesign in cirrhosis.</p>","PeriodicalId":12978,"journal":{"name":"Hepatology Communications","volume":"10 4","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}