Hepatology Research最新文献

{"title":"Liver Volumetry Enhances Prediction of Acute Pancreatitis in Acute Liver Failure: A Nationwide Registry Study.","authors":"Keisuke Kakisaka, Nobuaki Nakayama, Tokio Sasaki, Kotaro Kumagai, Hidekatsu Kuroda, Ryuzo Abe, Taro Takami, Kazuaki Chayama, Masahito Shimizu, Takuya Genda, Shuji Terai, Kazuaki Inoue, Atsushi Tanaka, Takayuki Matsumoto, Satoshi Mochida","doi":"10.1111/hepr.70054","DOIUrl":"https://doi.org/10.1111/hepr.70054","url":null,"abstract":"<p><strong>Background and aim: </strong>Acute pancreatitis is a recognized complication of acute liver failure (ALF), but its incidence and predictive factors remain poorly defined. Current risk stratification relies primarily on conventional laboratory markers with limited discriminatory ability for pancreatic complications. This study aimed to determine the incidence and prognostic impact of acute pancreatitis in ALF patients and evaluate whether liver volumetry improves prediction beyond conventional markers.</p><p><strong>Methods: </strong>This cross-sectional retrospective study utilized data from a nationwide survey-based registry conducted by the Intractable Hepato-Biliary Disease Study Group of Japan (2011-2021). We analyzed 142 ALF patients with available liver volumetry data and 90-day outcome information. Patients with pre-existing acute pancreatitis were excluded. Predictive models were developed comparing conventional markers (MELD score) versus an enhanced model incorporating computed tomography liver volume to standard liver volume ratio (CTLV/SLV). Model performance was evaluated using ROC analysis, net reclassification index, and clinical validation.</p><p><strong>Results: </strong>Acute pancreatitis developed in 19 patients (13.4%), typically within the first 8 weeks (84.3% of cases). Logistic regression identified acute pancreatitis as an independent risk factor for poor prognosis (β = 0.2556, p = 0.031). The CTLV/SLV ratio was significantly lower in patients developing pancreatitis (0.80 vs. 1.07, p < 0.001). The enhanced model (MELD + CTLV/SLV) achieved superior discrimination (AUC 0.810) compared to MELD alone (AUC 0.704), with 81% relative risk reduction in the low-risk category.</p><p><strong>Conclusion: </strong>Incorporating liver volumetry significantly improves acute pancreatitis prediction in ALF patients, enabling more precise risk stratification and potentially optimizing clinical management strategies.</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250831","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":"Refining Surgical Candidate Selection After Systemic Therapy in Advanced Hepatocellular Carcinoma.","authors":"Jinzhen Huang, Tao Cai, Nan He, Zeming Wu","doi":"10.1111/hepr.70052","DOIUrl":"https://doi.org/10.1111/hepr.70052","url":null,"abstract":"","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250817","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":"Efficacy and Safety of Hypofractionated Radiation Therapy Combined With Immunotherapy for Hepatocellular Carcinoma With Vp4 Portal Vein Tumor Thrombosis.","authors":"Masahiko Tameda, Hideaki Tanaka, Yutaka Toyomasu, Mizuki Kawachi, Hirono Owa, Mone Tsukimoto, Yasuyuki Tamai, Naoto Fujiwara, Ryuta Shigefuku, Suguru Ogura, Yoshihito Nomoto, Hayato Nakagawa","doi":"10.1111/hepr.70051","DOIUrl":"https://doi.org/10.1111/hepr.70051","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) with Vp4 portal vein tumor thrombosis (PVTT) has an extremely poor prognosis, and evidence for effective systemic therapy is limited. Preclinical studies suggest that hypofractionated radiation therapy (HFRT) may enhance immune checkpoint inhibitor (ICI) efficacy through immunogenic cell death and modulation of the tumor microenvironment.</p><p><strong>Methods: </strong>We conducted a retrospective feasibility study of HFRT combined with ICIs for unresectable HCC. Patients receiving atezolizumab plus bevacizumab (Atz/Bev) or durvalumab plus tremelimumab (Dur/Tre) as first-line therapy between October 2020 and March 2025 were analyzed. Since July 2022, those with Vp4 PVTT received HFRT (5 Gy × 5) targeting PVTT with ICIs. Outcomes were compared among Vp4 patients with HFRT, Vp4 patients without HFRT, and patients without Vp4 invasion (non-Vp4).</p><p><strong>Results: </strong>Eight Vp4 patients received HFRT plus ICIs (Atz/Bev, n = 5; Dur/Tre, n = 3). The best responses of the main intrahepatic lesions by RECIST 1.1 were complete response (CR) in 1 (12.5%), partial response (PR) in 6 (75%), and stable disease in 1 (12.5%), yielding a high objective response rate (ORR) of 87.5%. By mRECIST, CR was achieved in 3 patients (37.5%). Overall survival in Vp4 patients with HFRT was comparable to non-Vp4 patients and significantly better than Vp4 patients without HFRT. No gastrointestinal bleeding or perforation occurred, and ALBI scores were preserved at 12 weeks.</p><p><strong>Conclusions: </strong>HFRT combined with ICIs is feasible, well tolerated, and may improve outcomes in HCC with Vp4 PVTT. Prospective studies are warranted to confirm efficacy and determine optimal treatment protocols.</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250799","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":"Caution Regarding Short-Term Increases in Ammonia Levels Following Splenic Artery Embolization.","authors":"Tsuyoshi Ishikawa, Aika Kirihara, Natsuko Nishiyama, Maho Egusa, Tsuyoshi Fujioka, Daiki Kawamoto, Ryo Sasaki, Tatsuro Nishimura, Norikazu Tanabe, Takuro Hisanaga, Issei Saeki, Toshihiko Matsumoto, Taro Takami","doi":"10.1111/hepr.70050","DOIUrl":"https://doi.org/10.1111/hepr.70050","url":null,"abstract":"<p><strong>Aim: </strong>The effects of partial splenic embolization (PSE) on hepatic encephalopathy, a portal hypertension-related disease, are not well established. This study aimed to investigate changes in ammonia levels by PSE and to identify determinants of postprocedural changes in patients with or without portosystemic shunts (PSSs).</p><p><strong>Methods: </strong>The present retrospective study included 136 patients with hypersplenism who underwent PSE at our hospital. The patients were divided into the PSS (-) group, comprising 90 patients without PSSs with a diameter of ≥ 8 mm, and the PSS (+) group, comprising 46 patients with PSSs with a diameter of ≥ 8 mm. Ammonia levels were evaluated, and biochemical and imaging findings were assessed before and at 1 month after PSE.</p><p><strong>Results: </strong>Overall, PSE significantly increased ammonia levels despite postprocedural hepatic function amelioration and hepatic venous pressure gradient reduction. Increased ammonia levels were observed postoperatively in 73.3% and 63.0% of patients in the PSS (-) and PSS (+) groups, respectively. The procedure induced a significant increase in ammonia levels in the PSS (-) group; in contrast, the increase was not statistically significant in the PSS (+) group. Preprocedural Child-Pugh scores of < 8 and splenic non-infarction volume of ≥ 120.32 cm³ in the PSS (-) group, as well as preprocedural splenic artery diameter-to-common hepatic artery diameter ratios of < 1.4 and concomitant splenic vein-derived shunt vessels in the PSS (+) group, were significant and independent determinants of postprocedural ammonia-level increase.</p><p><strong>Conclusions: </strong>PSE generally poses a high risk of short-term increase in ammonia levels, particularly in patients without PSSs.</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244216","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":"Effect of General Anesthesia on Liver and Spleen Stiffness for Predicting High-Risk Varices in Biliary Atresia.","authors":"Shinya Yokoyama, Takashi Honda, Yoji Ishizu, Norihiro Imai, Takanori Ito, Kenta Yamamoto, Chiyoe Shirota, Takahisa Tainaka, Satoshi Makita, Masanao Nakamura, Hiroo Uchida, Hiroki Kawashima","doi":"10.1111/hepr.70049","DOIUrl":"https://doi.org/10.1111/hepr.70049","url":null,"abstract":"<p><strong>Aim: </strong>Liver and spleen stiffness (LS and SS) measurements in predicting high risk varices (HRVs) are reported useful in biliary atresia (BA). In children, inability to temporarily hold their breath may pose challenges in obtaining accurate measurements. This cross-sectional prospective study aimed to evaluate the diagnostic accuracy of LS and SS measurements obtained under general anesthesia during brief pauses in ventilation compared with those obtained in the awake state, in predicting HRVs.</p><p><strong>Methods: </strong>Among patients with BA aged 15 years or younger who underwent esophagogastroduodenoscopy under general anesthesia for evaluation of varices, 43 patients with LS and SS measured both in the awake and anaesthetized states were enrolled. HRVs were defined as large esophagogastric varices or esophagogastric varices of any size with red color signs.</p><p><strong>Results: </strong>The median age was 4 years. Nineteen patients had HRVs. In the HRVs group compared with the non-HRVs group, awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS were significantly higher: 2.23 versus 1.71, 4.40 versus 3.45, 2.56 versus 1.73, and 4.13 versus 3.62 m/s, respectively. The area under the curve for awake-LS, awake-SS, anesthesia-LS, and anesthesia-SS were 0.784, 0.794, 0.814, and 0.698, respectively. Awake-LS and anesthesia-LS showed a strong positive correlation (ρ = 0.894), whereas awake-SS and anesthesia-SS showed a weak correlation (ρ = 0.468).</p><p><strong>Conclusions: </strong>As anesthetics and mechanical ventilation affect abdominal hemodynamics, SS measurements obtained under general anesthesia deviated from those obtained during the awake state. Further research is needed to determine whether mild sedation could help optimize measurement conditions.</p><p><strong>Trial registration: </strong>This study was registered on the University Hospital Medical Information Network (UMIN000033123).</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228374","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":"Employment Status of Patients With Liver Disease: A Nationwide Questionnaire Survey in Japan.","authors":"Yoshio Tokumoto, Yoichi Hiasa, Yoshihito Uchida, Takashi Oono, Atsushi Yukimoto, Takao Watanabe, Ryo Sasaki, Sachiko Tatsuki, Hironori Tanaka, Takako Inoue, Mika Horino, Akira Hirose, Tadashi Ikegami, Jun Inoue, Hiroshi Isoda, Hirokazu Takahashi, Yoshihisa Arao, Isao Hidaka, Hiroki Tojima, Satoru Kakizaki, Tetsuro Shimakami, Masayuki Tatemichi, Tatehiro Kagawa, Koji Ogawa, Masatsugu Ohara, Ritsuzo Kozuka, Masaru Enomoto, Mizuki Endo, Yuichiro Eguchi, Kenji Nagata, Masaaki Korenaga","doi":"10.1111/hepr.70048","DOIUrl":"https://doi.org/10.1111/hepr.70048","url":null,"abstract":"<p><strong>Aim: </strong>Patients with chronic liver disease often experience significant physical, psychological, and financial burdens. These burdens result from repeated long-term hospital visits or admissions caused by progression to decompensated cirrhosis or hepatocellular carcinoma. Patients with viral liver disease may fear discrimination or social prejudice. This study aimed to clarify the employment status of patients with liver disease in Japan and provide basic data to promote support for balancing treatment and work responsibilities.</p><p><strong>Methods: </strong>A cross-sectional questionnaire survey on employment was conducted among patients attending 22 hospitals across Japan.</p><p><strong>Results: </strong>Of the 4022 respondents, 2183 were analyzed, including 1694 (77.6%) participants with liver disease. Patients with liver disease were predominantly male and in their 60 s. Disclosure of health information to the workplace was significantly lower among patients with viral liver disease (80.8%) than among those without liver disease or with nonviral liver disease. The intention to continue working after diagnosis was significantly higher among patients with malignancies than among those without. However, this intention did not significantly differ between liver disease and non-liver disease groups. The awareness rate of the support system for balancing treatment and work program was 27.1%, with no significant difference observed between the liver disease and malignancy groups. Awareness was significantly higher in large workplaces, where full-time occupational health physicians are mandated.</p><p><strong>Conclusion: </strong>Workers with viral liver disease may hesitate to disclose their condition owing to fear of discrimination or prejudice. Therefore, raising awareness of support systems that protect all workers with illnesses, while considering stigma and discrimination, is essential.</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228439","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":"Pre-Treatment Liver Stiffness Is a Stronger Predictor of Hepatocellular Carcinoma Development Than Post-Treatment Liver Stiffness After Hepatitis C Virus Eradication.","authors":"Takuma Nakatsuka, Ryo Nakagomi, Keisuke Mabuchi, Yuki Matsushita, Tomoharu Yamada, Kazuya Okushin, Tatsuya Minami, Masaya Sato, Koji Uchino, Yotaro Kudo, Mitsuhiro Fujishiro, Kazuhiko Koike, Ryosuke Tateishi","doi":"10.1111/hepr.70047","DOIUrl":"https://doi.org/10.1111/hepr.70047","url":null,"abstract":"<p><strong>Introduction: </strong>Liver stiffness measurement (LSM) values decrease after hepatitis C virus eradication. However, whether this reduction translates into a reduced risk of hepatocellular carcinoma (HCC) development in patients who achieve sustained virological response (SVR) remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 501 patients with chronic hepatitis C who achieved SVR after direct-acting antiviral (DAA) treatment. LSM and FIB-4 levels were measured before DAA treatment and at multiple follow-up points. Time-dependent Cox proportional hazards models evaluated the association between these time-dependent markers and HCC development.</p><p><strong>Results: </strong>LSM and FIB-4 significantly decreased after DAA treatment in 80.4% and 70.8% of patients, respectively. During a mean follow-up of 5.7 years, 28 patients developed HCC, and in 57% of them, LSM was reduced to < 10 kPa and FIB-4 to < 3.25 at HCC diagnosis. Multivariable analysis revealed higher pre-treatment LSM (adjusted hazard ratio [aHR], 8.10; 95% confidence interval [CI], 1.82-35.95) and higher pre-treatment FIB-4 (aHR, 1.29; 95% CI, 1.11-1.51) as independent predictors of HCC, while post-treatment values at any time point showed no significant association. Patients with LSM < 10 kPa at HCC diagnosis showed better liver function and less fibrosis, but more metabolic risk factors and excessive alcohol consumption than those with LSM ≥ 10 kPa.</p><p><strong>Conclusion: </strong>Pre-treatment LSM and FIB-4 were stronger predictors of post-SVR HCC risk than post-treatment values. Patients with higher pre-treatment values remained at an increased risk of HCC development even if these values decreased after DAA treatment, emphasizing the importance of continued HCC surveillance in this group.</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199099","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":"Identification and Characterization of Three Novel Biomarkers for Mixed/Cholestatic Drug-Induced Liver Injury.","authors":"Kosuke Saito, Tatehiro Kagawa, Keiji Tsuji, Yuji Kumagai, Ken Sato, Shotaro Sakisaka, Naoya Sakamoto, Mitsuhiko Aiso, Shunji Hirose, Nami Mori, Toshio Uraoka, Kazuhide Takata, Koji Ogawa, Kazuhiko Mori, Motonobu Sato, Takayoshi Nishiya, Kazuhiko Takamatsu, Noriaki Arakawa, Takashi Izumi, Ruri Kikura-Hanajiri, Yasuo Ohno, Yoshiro Saito, Hajime Takikawa","doi":"10.1111/hepr.70043","DOIUrl":"https://doi.org/10.1111/hepr.70043","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to identify and establish novel biomarkers for human drug-induced liver injury (DILI).</p><p><strong>Methods: </strong>Patients with DILI (N = 52) or other liver diseases (N = 486) and healthy participants (N = 60) were recruited from the hospitals enrolled in this study. Metabolomics was conducted using serum samples from patients with DILI and healthy participants to screen for candidate DILI biomarkers. Subsequently, the serum concentrations of the candidate biomarkers were determined using a validated assay to characterize their properties and evaluate their ability to differentiate the patients with DILI from those who recovered from DILI and those with other liver diseases.</p><p><strong>Results: </strong>Three metabolites, pyroglutamylglycine (pyroGluGly), phenylalanine (Phe), and phenylalanyltryptophan (PheTrp), were identified as candidate DILI biomarkers. The serum concentrations of pyroGluGly, Phe, and PheTrp demonstrated a high and similar differentiating ability (area under the receiver-operating characteristic curve [ROC-AUC] > 0.9) in patients with mixed and cholestatic DILI compared with those in patients who recovered from DILI, suggesting that these three metabolites are biomarkers for mixed/cholestatic DILI. All or some of them demonstrated a substantially high differentiating ability (ROC-AUC > 0.8) in patients with mixed/cholestatic DILI compared with patients with other liver diseases, except for obstructive jaundice.</p><p><strong>Conclusions: </strong>We identified novel DILI biomarkers that can be used to clinically assess patients with mixed/cholestatic DILI and to differentiate these patients from recovered patients and those with other liver diseases.</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185736","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":"Which Cells Play a Protective Role in Primary Biliary Cholangitis: Dendritic Cells or Others?","authors":"Zhencheng Zhang, Zaixing Yang","doi":"10.1111/hepr.70045","DOIUrl":"https://doi.org/10.1111/hepr.70045","url":null,"abstract":"","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182002","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":"Altered Serum Bile Acid Pattern as an Independent Factor for Covert and Overt Hepatic Encephalopathy in Patients With Cirrhosis.","authors":"Takao Miwa, Hajime Ueda, Teruo Miyazaki, Akira Honda, Tadashi Ikegami, Shinji Unome, Tatsunori Hanai, Yohei Shirakami, Masahito Shimizu","doi":"10.1111/hepr.70036","DOIUrl":"https://doi.org/10.1111/hepr.70036","url":null,"abstract":"<p><strong>Aim: </strong>Bile acid (BA) signaling plays an important role in the pathogenesis of hepatic encephalopathy (HE), including covert (CHE) and overt HE (OHE). However, few studies have examined its clinical impact in patients with cirrhosis.</p><p><strong>Methods: </strong>This retrospective study included patients with cirrhosis who underwent CHE assessment using a computer-aided neuropsychiatric test. BAs were quantified using liquid chromatography-tandem mass spectrometry. Patients were divided into high and low groups according to their BA levels. Independent factors, namely CHE, OHE development, and mortality, were assessed using logistic, Fine-Gray competing risk, and Cox proportional hazards regression models.</p><p><strong>Results: </strong>Among the 189 patients, the median age was 71 years, 74.1% were male, and 28.0% were diagnosed with CHE. During a median follow-up period of 3.1 years, 15.9% (n = 30) developed OHE, and 33.3% (n = 63) died. Considering mortality as a competing risk, multivariable analysis identified a high conjugated primary BA level (subdistribution hazard ratio [HR] 3.44; 95% confidence interval [CI] 1.08-10.97) as an independent factor for OHE development. Additionally, a high non-conjugated primary BA level (odds ratio 2.18; 95% CI 1.06-4.46) was an independent factor of CHE. Furthermore, a high conjugated primary BA level (HR 2.06; 95% CI 1.11-3.83) was an independent predictor of mortality.</p><p><strong>Conclusions: </strong>Elevated serum conjugated primary BA levels are an independent factor for OHE development and mortality in patients with cirrhosis. Additionally, elevated non-conjugated primary BA levels were an independent factor for CHE in these patients.</p>","PeriodicalId":12987,"journal":{"name":"Hepatology Research","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182060","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}