Liver International最新文献

{"title":"Time Zero Asymmetry in Survival Analysis of PD-1 Sequencing in uHCC","authors":"Mengjian Lu, Luojie Liu","doi":"10.1111/liv.70915","DOIUrl":"10.1111/liv.70915","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 11","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111243","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":"Correction to ‘Post-TIPS Dynamics of Von Willebrand Factor for Risk Stratification After TIPS Placement’","authors":"","doi":"10.1111/liv.70906","DOIUrl":"10.1111/liv.70906","url":null,"abstract":"<p>\u0000 <span>M. Hintersteininger</span>, <span>S. J. Gairing</span>, <span>K. Kirsch</span>, et al., “ <span>Post-TIPS Dynamics of Von Willebrand Factor for Risk Stratification After TIPS Placement</span>,” <i>Liver International</i> <span>46</span>, no. <span>7</span> (<span>2026</span>): e70736, https://doi.org/10.1111/liv.70736.\u0000 </p><p>In the published article, the cumulative incidence curves in Figure 3 are labelled incorrectly. The blue line should represent the relative VWF decrease &lt; 5% at M3 cohort and the red line the relative VWF decrease ≥ 5% at M3 cohort. The corrected Figure 3 appears below.</p><p>We apologize for this error.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 11","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111676","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":"Age-Specific Associations of Polygenic Risk Scores With Advanced Fibrosis and Histological Activity in Biopsy-Proven MASLD","authors":"Samer Gawrieh,&nbsp;Jingyi Tan,&nbsp;Xiuqing Guo,&nbsp;Linus Schwantes-An,&nbsp;Marco Abreu,&nbsp;Callie J. Zaborenko,&nbsp;Eduardo Vilar-Gomez,&nbsp;Jeffrey B. Schwimmer,&nbsp;Jerome I. Rotter,&nbsp;Naga Chalasani","doi":"10.1111/liv.70907","DOIUrl":"10.1111/liv.70907","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>The genetic susceptibility to MASLD histological severity remains incompletely defined. We assessed the associations between recently developed genome-wide association studies–derived polygenic risk scores (PRSs) and advanced fibrosis in MASLD. We also evaluated PRSs' associations with histological activity and selected PRSs' predictive ability for advanced fibrosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed 2149 adults and 900 children with biopsy-proven MASLD from the NASH Clinical Research Network studies. Genotyping was performed by the Regeneron Genetics Center using whole-exome sequencing with targeted genotyping. Associations between seven published PRSs (Chen, Emdin, Whitfield, Schwantes-An, Vujkovic, and Ghouse) and MASLD histological features were examined using linear and logistic regression models. Penalized regression models were used to select top PRSs associated with MASLD traits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Schwantes-An PRS in adults (OR 1.29, 95% CI 1.17–1.42, <i>p</i> &lt; 0.01) and the Chen PRS in children (OR 1.46, 95% CI 1.17–1.82, <i>p</i> &lt; 0.01) were associated with higher risk of advanced fibrosis versus other PRSs. The Chen PRS in adults (OR 1.29, 95% CI 1.18–1.41, <i>p</i> &lt; 0.01) and Schwantes-An PRS in children (OR 1.39, 95% CI 1.20–1.61, <i>p</i> &lt; 0.05) were associated with higher risk with MASLD activity. Although highest PRSs quartiles were associated with advanced fibrosis risk versus bottom quartiles, neither PRS had good diagnostic discrimination for advanced fibrosis (AUROC &lt; 60%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this large biopsy-proven MASLD cohort, two distinct PRSs were associated with disease histological severity and activity in adults versus children. Findings suggest current PRSs may improve personalized risk stratification for advanced fibrosis but not its diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 11","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111638","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":"Serum Hepatocyte Growth Factor Predicts Outcomes in Non-Acetaminophen Drug-Induced Acute Liver Failure","authors":"Tao Wang,&nbsp;Silvia M. Bacot,&nbsp;Kamai Patterson,&nbsp;Devira Friedman,&nbsp;Caroline Taylor,&nbsp;Huixiao Hong,&nbsp;Jie Liu,&nbsp;Mark I. Avigan,&nbsp;Paul Hayashi,&nbsp;Jody A. Rule,&nbsp;William M. Lee,&nbsp;Jorge Rakela,&nbsp;Gerald M. Feldman,&nbsp;Minjun Chen","doi":"10.1111/liv.70895","DOIUrl":"10.1111/liv.70895","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Regenerative capacity and inflammatory responses are key determinants of outcome in acute liver failure (ALF). However, their prognostic significance in non-acetaminophen drug-induced liver injury with acute liver injury or ALF (non-APAP-DILI-ALI/ALF) remains poorly defined. We aimed to identify biomarkers of regeneration and inflammation associated with clinical outcomes in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated clinical laboratory parameters and circulating biomarkers in 79 patients with non-APAP-DILI-ALI/ALF (20 with ALI, 59 with ALF) and 19 healthy donors. We used multivariable logistic regression to identify independent predictors of 21-day transplant-free survival among these patients. These predictors were used to create a composite model that was compared with the Model for End-Stage Liver Disease (MELD) score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Markers reflecting hepatic synthetic dysfunction (TBIL, INR, MELD) were strongly associated with the outcomes, whereas aminotransferases were not. HGF levels were markedly elevated in non-APAP-DILI-ALI/ALF patients versus healthy donors (5070 ± 4001 vs. 276 ± 581 pg/mL; <i>p</i> &lt; 0.001), increased with injury severity, and were highest in patients who died or underwent transplantation (6421 ± 4359 vs. 4102 ± 3456 pg/mL; <i>p</i> = 0.009). Among inflammatory mediators, only interleukin-6 showed a modest association with outcome. We developed an H-Score based on the three variables independently associated with survival on multivariable analysis: HGF (odds ratio, 1.0002; <i>p</i> = 0.048), TBIL and INR. The H-Score outperformed MELD overall (area under the curve, 0.819 vs. 0.713) and in ALF only patients (0.811 vs. 0.643; <i>p</i> = 0.040).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HGF provides independent prognostic value beyond standard measures in non-APAP-DILI-ALF. The H-Score may improve risk stratification over the MELD score and warrants validation in a prospective cohort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 11","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111691","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":"Multicenter Evaluation of Large Language Models Versus Hepatologists for Prognostic Prediction in Drug-Induced Liver Injury.","authors":"Haoshuang Fu, Yanan Du, Gangde Zhao, Yuelin Xiao, Shuying Song, Xinya Zang, Tianhui Zhou, Yan Zhuang, Ruidong Mo, Rongtao Lai, Qing Xie","doi":"10.1111/liv.70879","DOIUrl":"10.1111/liv.70879","url":null,"abstract":"<p><strong>Background & aims: </strong>Drug-induced liver injury (DILI) would progress to chronicity or death. Large language models (LLMs) may enhance clinical decision-making, yet their utility relative to physicians in DILI remains unclear. Therefore, we evaluated their performance in predicting DILI outcomes.</p><p><strong>Methods: </strong>We enrolled 943 DILI patients from three centers as internal and external cohorts. Based on 12-month follow-up, outcomes were classified as recovery, 6/12-month chronicity, and death. LLMs (Gemini-2.5 Pro, GPT-5.1, DeepSeek-3.2), hepatologists (Junior, middle, senior), and models (Hy's Law, nHy's Law, MELD Score) estimated probabilities of outcomes. LLM-Rules (VOTE, OR, AND) were applied to enhance stability. Model performance was assessed.</p><p><strong>Results: </strong>For 6-month chronicity, the senior achieved highest AUROC (0.61) with an accuracy of 70%. Gemini-2.5 Pro and GPT-5.1 yielded AUROCs of 0.60 and 0.59, respectively, outperforming junior and middle hepatologists. Gemini-2.5 Pro demonstrated strongest agreement with senior (κ = 0.43). LLMs all exhibited lower accuracy and specificity than hepatologists. A similar result was observed in 12-month chronicity. For overall mortality, the senior achieved highest AUROC (0.87) with an accuracy of 83%. Gemini-2.5 Pro and GPT-5.1 achieved AUROCs of 0.86, outperforming junior hepatologist, Hy's Law, and nHy's Law. GPT-5.1 achieved strongest agreement with senior (κ = 0.25). LLM-Rules demonstrated stability for predicting outcomes across cohorts. OR and AND rules improved sensitivity and specificity, respectively.</p><p><strong>Conclusions: </strong>GPT-5.1 and Gemini-2.5 Pro showed AUROCs approaching senior hepatologists for DILI outcomes with limited accuracy and specificity. LLM-Rules demonstrated stable performance across cohorts with improved sensitivity or specificity, supporting the potential of multi-LLM approaches as clinician-supervised complementary tools.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 10","pages":"e70879"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990581","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":"Distinct Plasma Proteomic Signatures Distinguish MASLD From Non-Steatotic Individuals but Not From MetALD.","authors":"Niharika Jakhar, Tobias Seibel, Maria Mironova, Corinna Meeßen, Jan Clusmann, Yazhou Chen, Thriveni B Raju, Paul-Henry Koop, Juliette E Pearce, Ivan G Costa, Thomas Stiehl, Andreas Schuppert, Kai Markus Schneider, Yaron Rotman, Carolin V Schneider","doi":"10.1111/liv.70873","DOIUrl":"10.1111/liv.70873","url":null,"abstract":"<p><strong>Background and aims: </strong>Metabolic dysfunction associated steatotic liver disease (MASLD) is the most prevalent liver disease, yet accurate early detection remains challenging. A particular diagnostic obstacle is distinguishing MASLD from metabolic dysfunction and alcohol-related liver disease (MetALD), currently defined using clinically informed moderate alcohol consumption thresholds without biological validation. This study aimed to identify and externally validate plasma proteomic signatures associated with MASLD and assess whether proteomic profiles support a molecular distinction between MASLD and MetALD as currently defined.</p><p><strong>Methods: </strong>We analysed plasma proteomic profiles using OLINK data from UK Biobank (UKB) participants with liver MRI. MASLD was defined as MRI-PDFF ≥ 5% and metabolic dysfunction (n = 165), MetALD (n = 46) as MASLD with additional moderate alcohol intake and controls as PDFF < 5% (n = 741).</p><p><strong>Results: </strong>Compared to controls, participants with MASLD showed 17 upregulated and 3 downregulated proteins after Bonferroni correction (adjusted p < 0.05). Among upregulated proteins, leptin (LEP), fatty acid-binding protein, liver (FABP1) and aminoacylase1 (ACY1) and among downregulated, insulin-like growth factor-binding protein 1 (IGFBP1) were externally validated in an independent cohort (clinicaltrials.gov NCT02520609, n = 47). Individuals with MetALD showed no significant proteomic distinction from MASLD. Although the small MetALD sample size may have limited detection of differences, direct differential expression analysis did not identify statistically significant differences between MASLD and MetALD under the current clinical thresholds.</p><p><strong>Conclusions: </strong>MASLD was associated with a reproducible plasma proteomic signature enriched for proteins involved in lipid metabolism, inflammation and hormonal regulation. We did not identify a clear proteomic distinction between MASLD and MetALD under the current alcohol thresholds. However, this finding should be interpreted considering limited power and potential alcohol-exposure misclassification.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 10","pages":"e70873"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081180","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":"Ultrasound-Based Skeletal Muscle Assessment for Prognostication in Cirrhosis: A Systematic Review.","authors":"Simone Di Cola, Paolo Gallo, Jakub Gazda, Saniya Khan, Lucia Lapenna, Stefania Gioia, Silvia Nardelli, Umberto Vespasiani-Gentilucci, Manuela Merli","doi":"10.1111/liv.70891","DOIUrl":"10.1111/liv.70891","url":null,"abstract":"<p><strong>Background and aims: </strong>Sarcopenia is a major determinant of adverse outcomes in cirrhosis, yet CT- and MRI-based assessments are difficult to implement in routine and longitudinal practice. Ultrasound is a feasible bedside alternative, but its prognostic role remains unclear. We performed a systematic review to evaluate the association between ultrasound-derived skeletal muscle measures and mortality in adults with cirrhosis.</p><p><strong>Methods: </strong>This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251056162). MEDLINE, Scopus, Web of Science and the Cochrane Library were searched to October 2025. Prospective studies assessing ultrasound-based muscle parameters and mortality in cirrhosis were included. Risk of bias was evaluated using QUIPS.</p><p><strong>Results: </strong>Six prospective studies (n = 731) were included. Heterogeneity in muscle sites, ultrasound protocols, indexation methods, sarcopenia definitions and outcomes precluded meta-analysis. Lower ultrasound-derived muscle measures were consistently associated with higher mortality. In acute decompensation, reduced rectus femoris area predicted 90-day mortality (sHR 0.57; 95% CI 0.38-0.85). Rectus abdominis thickness and psoas indices were also associated with mortality. In hospitalized decompensated cirrhosis, ultrasound-defined sarcopenia was strongly associated with 6-month mortality (HR 6.37; 95% CI 3.15-12.87). In critically ill liver transplant candidates, higher serial rectus femoris muscle area measurements were associated with better survival. In advanced chronic liver disease, sarcopenia was linked to increased 1-year mortality.</p><p><strong>Conclusions: </strong>In our systematic review, ultrasound-based muscle measures demonstrated a broadly consistent association with mortality; although not yet fully validated, they represent a promising bedside prognostic tool. Standardization is needed before clinical implementation.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 10","pages":"e70891"},"PeriodicalIF":6.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990575","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":"Integrating HCV Testing and Treatment Into HIV Care: A Cohort Study of the HCV Care Cascade in Southwest China","authors":"Minyang Xiao,&nbsp;Chuntao Liu,&nbsp;Yu Han,&nbsp;Yanling Ma,&nbsp;Yan Guo,&nbsp;Zuyang Zhang,&nbsp;Liru Fu,&nbsp;Xuehua Li,&nbsp;Xiujie Zhang,&nbsp;Zhi Zhao,&nbsp;Yuhua Shi,&nbsp;Manhong Jia,&nbsp;Jian Li","doi":"10.1111/liv.70899","DOIUrl":"https://doi.org/10.1111/liv.70899","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Within the global population living with human immunodeficiency virus (HIV), achieving hepatitis C virus (HCV) micro-elimination is a crucial public health strategy. We assessed the HCV care continuum among people with HIV (PWH) in Yunnan Province, China, a region with a historically high burden of both infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Linked data from provincial HIV and HCV surveillance systems (January 2022–June 2025) were analysed. An eight-stage care continuum was constructed, ranging from anti-HCV testing to sustained virologic response. Annual trends in the HCV care cascade were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 143 959 PWH, 90.3% underwent anti-HCV testing. Of the 20 627 individuals who tested anti-HCV positive, 67.3% were referred to the national surveillance system; among those reported, 84.7% tested positive for HCV RNA. Among individuals who were HCV RNA positive, 85.0% initiated direct-acting antiviral treatment; the rate was 87.7% among those who were alive and retained in care. Those who completed post-treatment assessment demonstrated a sustained virologic response rate of 99.1%. Between January 2022 and June 2025, the HCV RNA positivity rate among reported cases increased from 44.6% to 84.7%, with treatment initiation increasing from 77.5% to 85.0%. Subgroup analyses identified lower testing and treatment uptake among individuals lost to follow-up, those who died, and certain demographics such as older adults and farmers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Yunnan has made significant strides toward HCV micro-elimination among PWH, demonstrating the feasibility of integrating HCV services into existing HIV care platforms. The findings may be useful to other resource-limited settings seeking to achieve elimination targets established by the World Health Organization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 11","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149072589","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":"Portal Hypertension in Biliary Atresia: The Need for Clinically Anchored Endpoints","authors":"Qiupeng Feng,&nbsp;Luojie Liu","doi":"10.1111/liv.70908","DOIUrl":"https://doi.org/10.1111/liv.70908","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 11","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149072660","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":"Influence of Albumin Treatment Duration on Outcome of Terlipressin Therapy in Patients With HRS-AKI","authors":"Eva Maria Schleicher,&nbsp;Christian Labenz,&nbsp;Frank Erhard Uschner,&nbsp;Julian Pohl,&nbsp;Moritz Passenberg,&nbsp;Michael Praktiknjo,&nbsp;Marcus Maximilian Mücke,&nbsp;Henrik Karbannek,&nbsp;Nina Böhling,&nbsp;Karsten Große,&nbsp;Marlene Reincke,&nbsp;Sarah Schütte,&nbsp;Paul Jamme,&nbsp;Julian Cardinal von Widdern,&nbsp;Christoph Welsch,&nbsp;Jonel Trebicka,&nbsp;Cornelius Engelmann,&nbsp;Jassin Rashidi-Alavijeh,&nbsp;Cristina Ripoll,&nbsp;Dominik Bettinger,&nbsp;the German cirrhosis study group","doi":"10.1111/liv.70888","DOIUrl":"https://doi.org/10.1111/liv.70888","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Volume expansion with albumin is recommended to establish a diagnosis of hepatorenal syndrome–acute kidney injury (HRS-AKI). The optimal duration of albumin administration is debated and requires balancing the risk of overtreatment with the need for timely diagnosis and treatment. Therefore, this study aimed to compare the impact of different albumin treatment durations on terlipressin response and the prognosis of patients with HRS-AKI treated with terlipressin and albumin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, retrospective secondary analysis included patients with suspected HRS-AKI who were treated with terlipressin and albumin at 12 German centers. One hundred forty five patients were available for further analysis. The cohort was dichotomized into patients treated with albumin for &lt; 24 h and for 24–60 h before initiation of terlipressin. Patients were followed for treatment response to terlipressin, need for haemodialysis (HD), survival, or liver transplantation (LT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median MELD score of the cohort was 25 [IQR 21; 31]. During follow-up, 59 patients (40.7%) achieved a complete response to treatment with terlipressin, and 96 patients (66.2%) died or received an LT. Response rates to terlipressin therapy did not differ between albumin treatment groups (&lt; 24 h vs. 24–60 h). In multivariable competing risk models, treatment duration of albumin was not associated with any response to terlipressin, considering death and LT as competing events. Of note, albumin treatment duration did not affect HD−/LT-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Extending albumin treatment beyond 24 h had no impact on treatment response to terlipressin and albumin or HD-/LT-free survival in patients with HRS-AKI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Number</h3>\u0000 \u0000 <p>NCT 06161766</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"46 11","pages":""},"PeriodicalIF":6.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70888","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149072590","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}