Journal of Hepatology最新文献

{"title":"Is MASLD a real culprit for all-cause mortality? A meta-analysis and preliminary pathophysiology exploration in the real world.","authors":"Zheng Li, Zhiping Li, Dan Cao, Yue Hu","doi":"10.1016/j.jhep.2024.09.027","DOIUrl":"10.1016/j.jhep.2024.09.027","url":null,"abstract":"","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-Safe-C score: Assessing liver-related event risks in patients without cirrhosis after successful direct-acting antiviral treatment.","authors":"Huapeng Lin, Terry Cheuk-Fung Yip, Hye Won Lee, Xiangjun Meng, Jimmy Che-To Lai, Sang Hoon Ahn, Wenjing Pang, Grace Lai-Hung Wong, Lingfeng Zeng, Vincent Wai-Sun Wong, Victor de Lédinghen, Seung Up Kim","doi":"10.1016/j.jhep.2024.09.020","DOIUrl":"10.1016/j.jhep.2024.09.020","url":null,"abstract":"<p><strong>Background & aims: </strong>Direct-acting antivirals (DAAs) have considerably improved chronic hepatitis C (HCV) treatment; however, follow-up after sustained virological response (SVR) typically neglects the risk of liver-related events (LREs). This study introduces and validates the artificial intelligence-safe score (AI-Safe-C score) to assess the risk of LREs in patients without cirrhosis after successful DAA treatment.</p><p><strong>Methods: </strong>The random survival forest model was trained to predict LREs in 913 patients without cirrhosis after SVR in Korea and was further tested in a combined cohort from Hong Kong and France (n = 1,264). The model's performance was assessed using Harrell's C-index and the area under the time-dependent receiver-operating characteristic curve (AUROC).</p><p><strong>Results: </strong>The AI-Safe-C score, which incorporated liver stiffness measurement (LSM), age, sex, and six other biochemical tests - with LSM being ranked as the most important among nine clinical features - demonstrated a C-index of 0.86 (95% CI 0.82-0.90) in predicting LREs in an external validation cohort. It achieved 3- and 5-year LRE AUROCs of 0.88 (95% CI 0.84-0.92) and 0.79 (95% CI 0.71-0.87), respectively, and for hepatocellular carcinoma, a C-index of 0.87 (95% CI 0.81-0.92) with 3- and 5-year AUROCs of 0.88 (95% CI 0.84-0.93) and 0.82 (95% CI 0.75-0.90), respectively. Using a cut-off of 0.7, the 5-year LRE rate within a high-risk group was between 3.2% and 6.2%, mirroring the incidence observed in individuals with advanced fibrosis, in stark contrast to the significantly lower incidence of 0.2% to 0.6% in a low-risk group.</p><p><strong>Conclusion: </strong>The AI-Safe-C score is a useful tool for identifying patients without cirrhosis who are at higher risk of developing LREs. The post-SVR LSM, as integrated within the AI-Safe-C score, plays a critical role in predicting future LREs.</p><p><strong>Impact and implications: </strong>The AI-Safe-C score introduces a paradigm shift in the management of patients without cirrhosis after direct-acting antiviral treatment, a cohort traditionally not included in routine surveillance protocols for liver-related events. By accurately identifying a subgroup at a comparably high risk of liver-related events, akin to those with advanced fibrosis, this predictive model facilitates a strategic reallocation of surveillance and clinical resources.</p>","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the accuracy, time and cost of GPT-4 and GPT-4o in liver disease diagnoses using cases from \"What is Your Diagnosis\".","authors":"Yusheng Guo, Tianxiang Li, Jiao Xie, Miao Luo, Chuansheng Zheng","doi":"10.1016/j.jhep.2024.09.016","DOIUrl":"10.1016/j.jhep.2024.09.016","url":null,"abstract":"","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning model to predict liver-related outcomes after the functional cure of chronic hepatitis B: Is cirrhosis driving the performance?","authors":"Guanglin Xiao, Hong Ren","doi":"10.1016/j.jhep.2024.09.017","DOIUrl":"https://doi.org/10.1016/j.jhep.2024.09.017","url":null,"abstract":"","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communicating the complexity of the transplant benefit score.","authors":"Philip Berry, Sreelakshmi Kotha","doi":"10.1016/j.jhep.2024.09.018","DOIUrl":"https://doi.org/10.1016/j.jhep.2024.09.018","url":null,"abstract":"","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression of concern to “Nitric oxide mimics transcriptional and post-translational regulation during α-Tocopherol cytoprotection against glycochenodeoxycholate-induced cell death in hepatocytes” [J Hepatol. 2011 Jul;55(1):133-44]","authors":"","doi":"10.1016/j.jhep.2024.09.022","DOIUrl":"https://doi.org/10.1016/j.jhep.2024.09.022","url":null,"abstract":"","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":25.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreases in cT1 and liver fat content reflect treatment-induced histological improvements in MASH.","authors":"Naim Alkhouri, Cayden Beyer, Elizabeth Shumbayawonda, Anneli Andersson, Kitty Yale, Timothy Rolph, Raymond T Chung, Raj Vuppalanchi, Kenneth Cusi, Rohit Loomba, Michele Pansini, Andrea Dennis","doi":"10.1016/j.jhep.2024.08.031","DOIUrl":"https://doi.org/10.1016/j.jhep.2024.08.031","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background & aims: &lt;/strong&gt;MRI biomarkers of liver disease are robust and reproducible alternatives to liver biopsy. Emerging data suggest that absolute reduction in iron corrected T1 (cT1) of ≥ 80 ms and relative reduction in liver fat content of 30% reflect histological improvement. We aimed to validate the associations of changes to these noninvasive biomarkers with histological improvement, specifically the resolution of steatohepatitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis of participants from three interventional clinical trials who underwent multiparametric MRI to measure liver cT1 and liver fat content (LFC) (LiverMultiScan) alongside biopsies at baseline and end of study. Responders were defined as those achieving resolution of steatohepatitis with no worsening in fibrosis. Differences in the magnitude of change in cT1 and LFC between responders and non-responders was assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Individual patient data from 150 participants were included. There was a significant decrease in liver cT1 (-119 ms vs. -49 ms) and liver fat content (-65% vs. -29%) in responders compared to non-responders (P &lt; .001) respectively. The diagnostic accuracy to identify responders was 0.72 (AUC) for both. The Youden's index for cT1 to separate responders from non-responders was -82 ms and for liver fat was a 58% relative reduction. Those achieving a ≥ 80 ms reduction in cT1 were 5-times more likely to achieve histological response (sens 0.68; spec 0.70). Those achieving a 30% relative reduction in liver fat were ∼4 times more likely to achieve a histological response (sens 0.77; spec 0.53).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;These results, from three combined drug trials, demonstrate that changes in multiparametric MRI markers of liver health (cT1 and PDFF) can predict histological response for steatohepatitis following therapeutic intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Impact and implications: &lt;/strong&gt;There is great interest in identifying suitable biomarkers that can be used to replace liver biopsy, or to identify those patients who would benefit from one, in both the clinical management of MASH and in drug development. We investigated the utility of two MRI-derived non-invasive tests, iron corrected T1 mapping (cT1) and liver fat content from proton density fat fraction (PDFF), to predict histological improvement in patients who had undergone experimental treatment for MASH. Using data from 150 people who participated in one of three clinical trials, we observed that a reduction in cT1 by over 80 ms and a relative reduction in PDFF of over 58% were the optimal thresholds for change that predicted resolution of steatohepatitis. PDFF as a marker of liver fat, and cT1 as a specific measure of liver disease activity, are both effective at identifying those who are likely responding to drug interventions and experiencing improvements in overall liver health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical trial number(s): &lt;/strong&gt;NCT02443","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: correspondence on \"Impact of pre-transplant immune checkpoint inhibitor use on post-transplant outcomes in HCC: A systematic review and individual patient data meta-analysis\".","authors":"Mohammad Saeid Rezaee-Zavareh, Zhiyong Guo, Ju Dong Yang","doi":"10.1016/j.jhep.2024.09.019","DOIUrl":"10.1016/j.jhep.2024.09.019","url":null,"abstract":"","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poor long-term outcome in patients with porto-sinusoidal vascular disease (PSVD): fact or disease misclassification?","authors":"Shiv K Sarin, Ansgar W Lohse, Patrick S Kamath","doi":"10.1016/j.jhep.2024.09.015","DOIUrl":"10.1016/j.jhep.2024.09.015","url":null,"abstract":"","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring algorithms to select candidates for non-selective beta-blockers in cirrhosis: a post-hoc analysis of the PREDESCI trial.","authors":"Elton Dajti, Càndid Villanueva, Annalisa Berzigotti, Anna Brujats, Agustín Albillos, Joan Genescà, Juan C Garcia-Pagán, Antonio Colecchia, Jaume Bosch","doi":"10.1016/j.jhep.2024.09.014","DOIUrl":"https://doi.org/10.1016/j.jhep.2024.09.014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background & aims: &lt;/strong&gt;Whether non-invasive tests (NITs) can accurately select patients with cirrhosis requiring non-selective beta-blockers (NSBB) for clinically significant portal hypertension (CSPH) and prevention of decompensation is unclear. Our aim was to test the performance of NIT-based algorithms for CSPH diagnosis using the prospective PREDESCI cohort. We investigated a new algorithm combining NITs with endoscopy to improve performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We included patients with compensated cirrhosis and available liver elastography who were screened during the trial. The performance of models based on liver stiffness measurement (LSM) and platelet count was evaluated. An algorithm considering endoscopy for patients with inconclusive results (the \"grey zone\") was then developed and validated in an independent cohort of 195 patients in whom also spleen stiffness was available.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 170 patients from the PREDESCI cohort. An LSM≥25 kPa alone (Baveno VII criteria) or an LSM&gt;20 kPa plus thrombocytopenia (AASLD criteria) ruled-in CSPH with positive predictive value of 88 and 89%, respectively. However, 37%-47% patients fell into the grey zone while at high-risk of decompensation or death. Performing endoscopy in inconclusive cases identified patients with varices that, when re-classified as high-risk for CSPH, significantly reduced the grey zone to 22%. In this algorithm, 86% of CSPH patients were correctly classified as high-risk. The diagnostic performance was confirmed in the external validation cohort, where combining Baveno VII criteria with spleen stiffness showed similar accuracy to the model using endoscopy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Algorithms based only on LSM and platelet count are suboptimal to identify NSBB treatment candidates. Performing endoscopy in patients with indeterminate findings from NITs improved diagnostic performance and risk stratification. Endoscopy may be substituted by spleen stiffness for stratifying the risk in the grey zone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Impact and implications: &lt;/strong&gt;The PREDESCI trial demonstrated that non-selective beta-blockers prevent decompensation in CSPH patients. Still it is unclear whether we can select treatment candidates using non-invasive tests to assess the presence of CSPH without measuring HVPG. In the prospective cohort of patients screened during the trial, we showed that algorithms based on liver stiffness and platelet count had suboptimal performance, mainly due to a high rate of indeterminate results. Performing endoscopy in the grey zone patients allowed to significantly increase the number of patients with CSPH and improved the risk stratification for decompensation or death on long-term follow-up. These findings were validated in an independent cohort. In addition, a model using spleen stiffness instead of endoscopy showed similar diagnostic performance in the external validation cohort, suggesting that","PeriodicalId":15888,"journal":{"name":"Journal of Hepatology","volume":null,"pages":null},"PeriodicalIF":26.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}