Journal of Clinical and Experimental Hepatology最新文献

{"title":"Comparative Study of Terlipressin and Noradrenaline as Vasopressors in Patients With Acute-on-chronic Liver Failure and Septic Shock: A Randomized Controlled Trial","authors":"Tarana Gupta,&nbsp;Anjali Saini,&nbsp;Vaibhav Gaur,&nbsp;Ashank Goel","doi":"10.1016/j.jceh.2024.102494","DOIUrl":"10.1016/j.jceh.2024.102494","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis is the most common acute insult in patients with acute-on-chronic liver failure (ACLF), and circulatory failure portends a poor prognosis in them.</div></div><div><h3>Aim</h3><div>This study aimed to compare terlipressin and noradrenaline as first-line vasopressors in patients with ACLF and septic shock.</div></div><div><h3>Methods</h3><div>This prospective, open-label, randomized controlled study was conducted from January 2021 to June 2022 at a tertiary care center. All patients presenting with ACLF as per the chronic liver failure consortium acute on chronic liver failure in cirrhosis study and septic shock were screened. Shock was defined as a mean arterial pressure (MAP) &lt;65 mmHg/systolic blood pressure &lt;90 mmHg. Patients with septic shock nonresponsive to crystalloids/colloids were randomized to receive terlipressin (group I) at 2.6 μg/kg/min and noradrenaline (group II) at 0.1 μg/kg/min. The primary outcome was an MAP &gt;65 mmHg at 6 h. The secondary outcomes were 3-, 7-, 14-, and 28-day mortality, duration of hospital stay, cumulative dose of drug, and new events such as upper gastrointestinal bleed, acute kidney injury, jaundice, and hepatic encephalopathy within 28 days.</div></div><div><h3>Results</h3><div>A total of 70 patients were randomized to group I (n = 35) and group II (n = 35). According to per-protocol analysis, a higher number of patients achieved an MAP &gt; 65 mmHg at 6 h in group II (n = 23/31, 74%) than in group I (5/34, 14%) (<em>P</em> &lt; 0.001). The 3-and 7-day mortality was significantly higher in group I than in group II, with no difference at 14 and 28 days. The 28-day mortality was highest in ACLF grade-3 in both group II (22/25, 88%) and group I (15/20, 75%).</div></div><div><h3>Conclusion</h3><div>Terlipressin did not prove to be noninferior to norepinephrine, and therefore, norepinephrine should be the first-line vasopressor in ACLF patients with septic shock. The mortality rate was highest in ACLF grade-3 patients in both the groups, irrespective of the initial response to vasopressors. This indicates that holistic management of these patients is most important.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102494"},"PeriodicalIF":3.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143157027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portal Hypertension as the First Manifestation of Primary Amyloidosis","authors":"Shrey Bhatt,&nbsp;Venkatesh Vaithiyam,&nbsp;Ravi Teja Reddy,&nbsp;Payila S. Raghava Aneesh,&nbsp;Sanjeev Sachdeva,&nbsp;Ajay Kumar,&nbsp;Ashok Dalal,&nbsp;Sarika Singh,&nbsp;Surbhi Goyal,&nbsp;Puja Sakhuja","doi":"10.1016/j.jceh.2025.102502","DOIUrl":"10.1016/j.jceh.2025.102502","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102502"},"PeriodicalIF":3.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Serological Immune Response to Hepatitis B Vaccine Following Rapid or Standard Regimen in People Who Inject Drugs","authors":"Nalinikanta Rajkumar ,&nbsp;Ajay K. Mishra ,&nbsp;Lokeshwar Khumukcham ,&nbsp;Harshita Katiyar ,&nbsp;Dhabali Thangjam ,&nbsp;Rajani Singh ,&nbsp;Giten Khwairakpam ,&nbsp;Amit Goel","doi":"10.1016/j.jceh.2025.102501","DOIUrl":"10.1016/j.jceh.2025.102501","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>The standard regimen of hepatitis B vaccination, i.e., three doses at 0, 1, and 6 months, protects 90–95% of vaccine recipients. Compliance for three doses, administered over six months, is particularly low among people who inject drugs (PWIDs). To prevent hepatitis B virus (HBV) infection, the World Health Organization has recommend to vaccinate PWIDs with an accelerated regimen, i.e., in a 0-, 7-, and 21-day schedule. We compared the serological immune response with standard and accelerated vaccination regimens in PWIDs.</div></div><div><h3>Methods</h3><div>PWIDs were vaccinated with three doses of hepatitis B vaccine as a part of routine preventive services in the past, which was not the part of our research work. Each of them had taken a conscious and informed decision to choose either the standard or accelerated regimen at the time of vaccination. For this cross-sectional observational study, anti-HBs (anti-HBs) titers were measured in vaccine recipients at ≥3 months after the administration of the third dose of vaccine. Vaccine-induced seroconversion was defined as presence of detectable anti-HBs titer, and seroprotection was defined as anti-HBs titer measuring ≥10 mIU/mL. Numerical and categorical data are expressed as median (interquartile range) and percentage (proportion), respectively; groups were compared using nonparametric tests.</div></div><div><h3>Results</h3><div>The study included 567 PWIDs (all men; age: 29 [24–38] years) vaccinated with either the accelerated (n = 356; 62.8%) or standard (n = 211; 37.2%) regimen. Participants’ ages were comparable (<em>P</em> = 0.99) in accelerated (29 [24–38.5] years) and standard (29 [24–37] years) groups. The interval between the last dose of vaccine and anti-HBs titer estimation was significantly longer in the accelerated group (487 [422–625]) than in the standard group (176 [105–211] days) (<em>P</em> &lt; 0.001). A higher proportion achieved seroconversion in the standard group than in the accelerated group (99.5% vs 91.9%; <em>P</em> &lt; 0.001). Among those who achieved seroconversion, a larger proportion in the standard group were seroprotected than in the accelerated group (99.5% vs. 92.1%; <em>P</em> &lt; 0.001). Anti-HBs titer was significantly higher in the standard group (2404 [412–12450] mIU/mL) than in the accelerated group (247 [57–1250] mIU/mL) (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Accelerated regimen of hepatitis B vaccination is well accepted among PWIDs and provides seroprotection to a large proportion of vaccine recipients, though the vaccine-induced antibody titers remain relatively lower. For high-risk groups such as PWIDs and other mobile population groups, an accelerated vaccination regimen may be a reasonable alternative to the standard vaccination schedule.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102501"},"PeriodicalIF":3.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Fascioliasis a Silent Menace: Case Report With Review of Literature","authors":"Rohan Grotra ,&nbsp;Rohan Malik ,&nbsp;Ashwin Varadarajan ,&nbsp;Devasenathipathy Kandasamy ,&nbsp;Rajni Yadav ,&nbsp;Sanchita Gupta","doi":"10.1016/j.jceh.2024.102493","DOIUrl":"10.1016/j.jceh.2024.102493","url":null,"abstract":"<div><div>Fascioliasis is a tropical zoonotic disease caused by liver flukes (<em>Fasciola hepatica</em> and <em>Fasciola gigantica</em>) mostly in sheep, goats, and cattle. It is a prevalent infection in developing countries like Bolivia, Peru, and Egypt, affecting both humans and livestock. It remains under-reported due to lack of awareness. Humans accidentally acquire it by consuming contaminated watercress or water contaminated with infective metacercaria. It affects the hepatobiliary system, manifesting as tender hepatomegaly, bile duct obstruction, liver fibrosis, and secondary cholangitis. Diagnosing fascioliasis is a challenge as it presents with nonspecific symptoms like prolonged fever, anorexia, ascites, and with limited availability of testing. Triclabendazole, currently the only approved drug, is unavailable in India. Fascioliasis has been reported only in reports from India. We here report a case of a 4-year-old patient who presented with fever and tender hepatomegaly. Hepatobiliary imaging showed infiltrative liver disease with small cystic lesions and periportal thickening. Liver biopsy showed microabscesses with eosinophilic infiltration. The patient was tested for Fasciola IgG antibody, which was positive. Triclabendazole was procured from Geneva for treatment. Through this report, we highlight this neglected parasitic infection that presented in a nonendemic region that needs improved diagnostic tools, increased awareness, and control measures to mitigate the disease.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102493"},"PeriodicalIF":3.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Banding Down the Hurdles: Evaluating Endoscopic Variceal Ligation for Rectal Varices","authors":"Umesh Jalihal ,&nbsp;Madduri Pavan Kumar ,&nbsp;Irshad Ali H ,&nbsp;B.S. Puneeth ,&nbsp;Dave Manan Dilipbhai ,&nbsp;Anil Jain ,&nbsp;Bharath Gowda S ,&nbsp;Manoj Gowda A","doi":"10.1016/j.jceh.2024.102499","DOIUrl":"10.1016/j.jceh.2024.102499","url":null,"abstract":"<div><div>Portal hypertension can lead to the formation of rectal varices. Rectal varices are a common manifestation of portal hypertension but tend to bleed less frequently than esophageal or gastric varices. It has been observed that rectal varices can result in significant lower gastrointestinal (GI) bleeding and pose unique therapeutic challenges. This case series evaluates the efficacy and safety of endoscopic variceal ligation (EVL) in treating rectal varices in five patients who presented with lower GI hemorrhage to our center. While Endoscopic Ultrasound (EUS) or Computed Tomography (CT) could provide additional diagnostic insights, these modalities were not routinely used in this series because of the straightforward clinical and endoscopic diagnosis. All patients underwent a successful EVL procedure with complete variceal obliteration. There were no postprocedural complications noted. Six months after the initial course of treatment, a follow-up endoscopy was performed. Overall, one patient required three sessions of EVL, whereas two other patients needed two more sessions. None of the patients had any residual varices at the 5-year follow-up. These findings demonstrate that EVL is an effective treatment modality for rectal varices, particularly in resource-constrained environments. Ongoing endoscopic surveillance is crucial because recurrence is a possibility as seen in many studies. Although our results lend support to the use of EVL, more studies with larger patient populations and longer periods of follow-up are required to validate these findings and improve treatment regimens.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102499"},"PeriodicalIF":3.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing ‘ALD-Met’: Bridging the Gap Between ‘MetALD’ and ‘ALD’ for Heavy Drinkers With Metabolic Dysfunction","authors":"Ashish Kumar","doi":"10.1016/j.jceh.2024.102500","DOIUrl":"10.1016/j.jceh.2024.102500","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102500"},"PeriodicalIF":3.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Interleukin-6 Levels may be a Key Determinant of 6-week Further Decompensation Risk in Patients With Cirrhosis and Acute Variceal Bleed: A Proof of Concept Study","authors":"Rajat Bansal ,&nbsp;Samagra Agarwal ,&nbsp;Deepak Gunjan ,&nbsp;Rajni Yadav ,&nbsp;Sanchit Sharma ,&nbsp;Anoop Saraya","doi":"10.1016/j.jceh.2024.102496","DOIUrl":"10.1016/j.jceh.2024.102496","url":null,"abstract":"<div><h3>Background and aims</h3><div>Limited data exist on the role of systemic inflammation and gut barrier dysfunction in acute variceal bleed (AVB). We studied inflammatory markers and changes in the intestinal barrier in patients with AVB and assessed if these can be used to identify a higher risk subgroup with regard to outcomes.</div></div><div><h3>Methods</h3><div>In this prospective observational study, patients with cirrhosis and AVB presenting at a tertiary care center were stratified by whether or not they developed acute decompensation (AD) over 6 weeks follow-up. Utility of systemic inflammatory markers (interleukin-6 [IL-6], C-reactive protein), endotoxinemia (serum IgM/IgG anti-endotoxin antibodies), and duodenal epithelial tight junction proteins (TJPs) by immunohistochemistry (IHC) for tight-junction proteins (claudin-2,-4, zonula occludens-1(ZO-1), junctional adhesion molecule (JAM)) was assessed to predict the outcomes. These parameters were compared with a pre-existing cohort of patients with cirrhosis and no recent variceal bleed and with those without cirrhosis (dyspepsia with no endoscopic pathology). A nomogram was developed from multivariate model to predict 6-wk AD in patients with AVB.</div></div><div><h3>Results</h3><div>Patients with AVB(n = 66) (age:46.4 ± 11.7 years; etiology: alcohol/NASH/HBV/HCV [48.5%/12.1%/12.1%/7.6%]) were included. Twenty-four (36.3%) patients developed 6-wk AD. Patients with 6-wk AD had higher serum IL-6 (median: 156.14 pg/ml [IQR: 136.12–170.52] vs 58.28 pg/ml [31.70–110.67]; <em>P</em> &lt; 0.001) and Child score (median: 9 [6.75–10.25] vs 7 [6–9]; <em>P</em> = 0.042) at baseline. Serum endotoxinemia and duodenal epithelial TJP were similar. A nomogram combining CTP and IL-6 was generated that predicted 6-wk AD with optimism-corrected c-statistic of 0.87. Comparison with non-bleeder cirrhosis (n = 52) (7.57 [5.48–9.87]) and dyspepsia controls (n = 53) (5.72 [4.40–6.45]; <em>P</em> &lt; 0.001) also identified significant elevation of serum IL-6, not entirely explainable by derangements in TJP and bacterial translocation markers.</div></div><div><h3>Conclusion</h3><div>6-wk AD rates in patients with cirrhosis and AVB can be predicted using combination of Child score and serum IL-6.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102496"},"PeriodicalIF":3.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issue Highlights","authors":"","doi":"10.1016/S0973-6883(24)01144-7","DOIUrl":"10.1016/S0973-6883(24)01144-7","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 1","pages":"Article 102477"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MASLD, MLA Pesarattu and Other Developments","authors":"Anil C. Anand","doi":"10.1016/j.jceh.2024.102465","DOIUrl":"10.1016/j.jceh.2024.102465","url":null,"abstract":"","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 1","pages":"Article 102465"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of the ASAP Score for Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma: A Multicenter Analysis of 1,239 Patients","authors":"Tian Yang ,&nbsp;Dong-Xu Yin ,&nbsp;Yong-Kang Diao ,&nbsp;Ming-Da Wang ,&nbsp;Xian-Ming Wang ,&nbsp;Yong-Yi Zeng ,&nbsp;Zhong Chen ,&nbsp;Han Liu ,&nbsp;Fu-Jie Chen ,&nbsp;Yu-Chen Li ,&nbsp;Jia-Hao Xu ,&nbsp;Han Wu ,&nbsp;Lan-Qing Yao ,&nbsp;Xin-Fei Xu ,&nbsp;Chao Li ,&nbsp;Li-Hui Gu ,&nbsp;Alfred W. Chieh Kow ,&nbsp;Timothy M. Pawlik ,&nbsp;Feng Shen","doi":"10.1016/j.jceh.2024.102497","DOIUrl":"10.1016/j.jceh.2024.102497","url":null,"abstract":"<div><h3>Background and aims</h3><div>The ASAP score, which incorporates age, sex, alpha-fetoprotein (AFP), and protein induced by vitamin K absence-II, has demonstrated promise for early detection of hepatocellular carcinoma (HCC). However, its prognostic value after HCC treatment remains unknown. The current study sought to evaluate the prognostic value of the ASAP score to predict recurrence and survival following curative hepatic resection for HCC.</div></div><div><h3>Methods</h3><div>This study using prospectively collected data included HCC patients who underwent curative-intent hepatic resection. The ASAP score was calculated preoperatively, and X-tile analysis was used to determine the optimal cutoff value. Univariate and multivariate analyses were performed to identify independent risk factors associated with recurrence and overall survival (OS).</div></div><div><h3>Results</h3><div>Among 1239 patients in the analytic cohort, the optimal ASAP score cutoff was 4.8; patients were divided into low (n = 749) and high (n = 490) ASAP score subgroups. Patients with high ASAP scores had a higher incidence of 5-year recurrence (73.9% vs 51.0%, <em>P</em> &lt; 0.001) and worse OS (31.7% vs 60.1%, <em>P</em> &lt; 0.001) versus individuals with low scores. Multivariate analysis identified ASAP score ≥4.8 as an independent risk factor of both recurrence (hazard ratio [HR] 1.976, 95% confidence interval [CI]: 1.633–2.390, <em>P</em> &lt; 0.001) and OS (HR 1.407, 95% CI 1.170–1.691, <em>P</em> &lt; 0.001) after controlling for established clinicopathological factors.</div></div><div><h3>Conclusion</h3><div>Preoperative ASAP score was independently associated with recurrence and survival after HCC resection. The clinical utility of the ASAP score may be applicable to both diagnosis and prognosis, potentially improving postoperative surveillance and management strategies for HCC patients.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 3","pages":"Article 102497"},"PeriodicalIF":3.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}