Liver International最新文献

{"title":"Helicobacter pylori-Associated Surrogate Markers of Intestinal Permeability, Bacterial Translocation and Gut Barrier Damage in Liver Cirrhosis","authors":"Jannis Kountouras, Christos Zavos, Paraskevi Polizou-Laspia, Ioannis S. Papanikolaou","doi":"10.1111/liv.70142","DOIUrl":"https://doi.org/10.1111/liv.70142","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944643","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":"Serum Metabolite Profile in Progressive Versus Nonprogressive Alcohol-Related Liver Disease: A Cross-Sectional Metabolomics Study","authors":"Eemeli Puhakka,&nbsp;Hany Ahmed,&nbsp;Retu Haikonen,&nbsp;Sophie Leclercq,&nbsp;Kati Hanhineva,&nbsp;Luca Maccioni,&nbsp;Camille Amadieu,&nbsp;Marko Lehtonen,&nbsp;Ville Männistö,&nbsp;Jaana Rysä,&nbsp;Peter Stärkel,&nbsp;Olli Kärkkäinen","doi":"10.1111/liv.70128","DOIUrl":"https://doi.org/10.1111/liv.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Alcohol-related liver disease (ALD) is a major cause of mortality and disability-adjusted life years. It is not fully understood why a small proportion of patients develop progressive forms of ALD (e.g., fibrosis and cirrhosis). Differences in the metabolic processes could be behind the individual progression of ALD. Our aim was to examine differences in serum metabolome between patients with nonprogressive ALD and patients with an early form of progressive ALD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study had three study groups: progressive ALD (alcohol-related steatohepatitis or early-stage fibrosis, <i>n</i> = 50), nonprogressive ALD (simple steatosis, <i>n</i> = 50) and healthy controls (<i>n</i> = 32). Both ALD groups took part in a voluntary alcohol rehabilitation programme. A nontargeted metabolomics analysis and targeted analysis of short-chain fatty acids were done to the serum samples taken on the day of admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found 111 significantly (<i>p</i> &lt; 0.0005) altered identified metabolites between the study groups. Our main finding was that levels of glycine-conjugated bile acids (Cohen's <i>d</i> = 0.90–0.91), glutamic acid (<i>d</i> = 1.01), 7-methylguanine (<i>d</i> = 0.77) and several phosphatidylcholines (<i>d</i> = 0.61–0.85) were elevated in the progressive ALD group in comparison to the nonprogressive ALD group. Glycine-conjugated bile acids, glutamic acid and 7-methylguanine also positively correlated with increased levels of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, cell death biomarker M65 and liver stiffness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results indicate that the enterohepatic cycle of glycine-conjugated bile acids, as well as lipid and energy metabolism, is altered in early forms of progressive ALD. These metabolic processes could be a target for preventing the progression of ALD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939471","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":"Liver Fibrosis Marker FIB-4 Is Associated With Hepatic and Extrahepatic Malignancy Risk in a Population-Based Cohort Study","authors":"Shira Zelber-Sagi,&nbsp;Yochai Schonmann,&nbsp;Galit Weinstein,&nbsp;Hanny Yeshua","doi":"10.1111/liv.70139","DOIUrl":"https://doi.org/10.1111/liv.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>An association between Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) and the development of extrahepatic malignancies has been demonstrated. However, the association of fibrosis with extrahepatic cancer is unclear. Our study aimed to test the long-term association between liver fibrosis marker and the incidence of hepatic and extrahepatic malignancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of a nationally representative sample, following 763 752 adult Clalit health services members without pre-existing liver-related diagnoses or malignancies for 14.67 years. The adjusted association between baseline liver Fibrosis-4 score (FIB-4; FIB-4 ≥ 2.67 indicated presumed advanced fibrosis), assessed from routine laboratory measurements, and incident cancer was assessed through multivariable Cox regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 763 752 people (mean age 54.3 ± 8.2 years, 43.9% males). Presumed advanced fibrosis was associated with a 16% greater risk for malignancy compared to the risk of those with no fibrosis (hazard ratio (HR) = 1.16; 95% CI, 1.10–1.22), adjusting for age, sex, ethnicity, socioeconomic status, peripherality index, baseline smoking, and obesity. The association of advanced fibrosis with malignancy was stronger when the age-specific FIB-4 cutoff was applied (HR = 1.40; 1.34–1.46) and in a subsample of subjects with MASLD diagnosis at baseline (HR = 1.43; 1.12–1.83). The association remained robust across sex, age, and ethnic groups. Both inconclusive fibrosis and fibrosis were strongly associated with malignancy of the liver or bile ducts [(HR = 1.41; 1.21–1.66) and (HR = 5.66; 4.19–7.64), respectively].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Liver fibrosis score is independently associated with malignancy occurrence and certain types of malignancies, and may serve as an indicator of high-risk cancer in the general population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939472","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":"Not So Quiet on the Viral Front: Low-Level HBV Viraemia Undermines Immunotherapy in HCC","authors":"Christina Karampera,&nbsp;Antonio D'Alessio","doi":"10.1111/liv.70140","DOIUrl":"https://doi.org/10.1111/liv.70140","url":null,"abstract":"&lt;p&gt;Hepatocellular carcinoma (HCC) constitutes one of the leading causes of cancer-related death worldwide [&lt;span&gt;1&lt;/span&gt;]. Over the last decade, the treatment strategy for advanced HCC has shifted from single agent multikinase inhibitors (MKIs) to combinations between immune checkpoint inhibitors (ICI), antiangiogenic agents and MKIs, with a significant improvement in patient outcomes [&lt;span&gt;2-5&lt;/span&gt;]. The efficacy of these agents is attributed to their mechanism of action in modulating the tumour immune microenvironment, suppressing tumour angiogenesis and blocking various tumour proliferation signalling pathways.&lt;/p&gt;&lt;p&gt;Despite its declining prevalence rate, with the integration of universal vaccination programmes, chronic hepatitis B virus (HBV) infection remains a major risk factor for the development of HCC globally, and especially in Africa, East and Southeast Asia [&lt;span&gt;6&lt;/span&gt;]. Studies support that most of the HBV-associated HCC present a more aggressive phenotype with poorer survival and response rate outcomes when compared to non-viral HCC, owing to the oncogenic effects of HBV-DNA integration into the host genome [&lt;span&gt;7, 8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In the recently published article in the &lt;i&gt;Liver International&lt;/i&gt;, Li et al. present the results of a multicentre retrospective study of HBV infected patients with unresectable HCC who received ICI-based treatments, in which they aim to evaluate the effect of low-level viraemia (LLV) on treatment efficacy and survival outcomes [&lt;span&gt;9&lt;/span&gt;]. They included 329 patients, of which 170 had LLV after 48 weeks of nucleoside analogues (NAs) antiviral treatment, and 159 had maintained viral response (MVR). In both groups, patients received ICI combinations, including a heterogeneous variety of molecular targeted therapies with or without additional locoregional treatments, as first or subsequent line therapy. The investigators demonstrated that the LLV group was associated with significantly worse ICI-based treatment outcomes compared to the MVR group, with objective response rate (ORR) 21.2% versus 36.5% (&lt;i&gt;p&lt;/i&gt; = 0.002) and disease control rate (DCR) 78.8% versus 92.5% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), respectively. Survival outcomes were also worse in the LLV group compared to the MVR group, with median progression-free survival (mPFS) being 7.6 versus 12.6 months (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and median overall survival (mOS) 22.8 versus 40.0 months (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), respectively. Differential expression analysis of proteomic data from a subset of patients' serum samples identified proteins involved in immune response regulation that were differentially expressed between the MVR and LLV group.&lt;/p&gt;&lt;p&gt;It is now well established that administration of ICIs in patients with chronic HBV infection receiving NAs is safe with a rate of HBV reactivation as low as 1% (95% CI 0%–2%) and a significantly reduced risk of HBV-related hepatitis (OR = 0.05, 95% CI [0.01–0.28]) [&lt;span&gt;10, 11&lt;/span&gt;]. Chronic HBV infection c","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939473","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":"Key Role of Recompensation in Systemic Therapy for Hepatocellular Carcinoma","authors":"Patrick Twohig,&nbsp;Wei-Fan Hsu,&nbsp;Nida Ansari","doi":"10.1111/liv.70141","DOIUrl":"https://doi.org/10.1111/liv.70141","url":null,"abstract":"&lt;p&gt;Hepatocellular carcinoma (HCC) is the leading cause of liver-related mortality and is frequently associated with underlying cirrhosis, and HCC is unresectable at the time of diagnosis in a major proportion of patients [&lt;span&gt;1&lt;/span&gt;]. In the 2022 GLOBOCAN report, there were 905 677 new cases of liver cancer (including HCC), with 830 180 deaths due to liver cancer. The incidence is predicted to increase significantly between 2020 and 2040, with 1.4 million new diagnoses expected in 2040 [&lt;span&gt;2&lt;/span&gt;]. The management of advanced hepatocellular carcinoma (HCC) in patients with cirrhosis remains a formidable clinical challenge, complicated further by the interplay between tumour burden and liver function. Historically, decompensated cirrhosis was considered a near-absolute contraindication to systemic cancer therapies due to the fragile hepatic reserve and high treatment-related risks. However, systemic therapies for unresectable HCC (uHCC) have advanced from tyrosine kinase inhibitors, such as sorafenib [&lt;span&gt;3&lt;/span&gt;] and lenvatinib [&lt;span&gt;4&lt;/span&gt;], to immune checkpoint inhibitor (ICI) combinations, such as atezolizumab plus bevacizumab (Atezo-Bev), which have become standard of care [&lt;span&gt;5&lt;/span&gt;]. ICIs have become the standard of care. In patients with HCC as opposed to other solid tumours, the underlying hepatic reserve is a crucial determinant of treatment outcomes. In the current issue of &lt;i&gt;Liver International&lt;/i&gt;, Piñero et al. present a prospective, multicenter observational study on the effect of recompensated cirrhosis on survival in Latin American patients with uHCC receiving systemic therapy. This study highlights hepatic recompensation as a possible inflection point in patient outcomes. Their study included 240 patients with cirrhosis from 2018 to 2024 (compensated cirrhosis, 53.7%; decompensated cirrhosis, 28.8%; and recompensated cirrhosis, 17.5%) [&lt;span&gt;6&lt;/span&gt;]. Cirrhosis classification was based on the Baveno VII definition [&lt;span&gt;7&lt;/span&gt;]. The key findings are compelling, as patients with recompensated cirrhosis (those previously decompensated but with recovered hepatic function) had similar survival rates to those with compensated cirrhosis (hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 0.76–2.10), those with decompensated cirrhosis had a significantly worse prognosis (HR: 1.91, 95% CI: 1.04–3.51). These findings reinforce recompensation as a clinically meaningful state [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The Baveno VII workshop used the following criteria to define the state of recompensation: (a) suppression or cure of the primary aetiology, such as the elimination of hepatitis C virus (HCV) and sustained suppression of hepatitis B virus (HBV); (b) resolution of ascites and encephalopathy without medical control and the absence of variceal bleeding without discontinuation of nonselective beta blockers for at least 12 months; and (c) improvement of liver function tests, including albumin, international normalised rati","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939424","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":"Hepatitis B and C Screening and Linkage to Care in Migrants From Endemic Countries in Barcelona Through a Community Action","authors":"Anna Not,&nbsp;Hakima Ouaarab-Essadek,&nbsp;Marcos Montoro,&nbsp;Begoña Treviño,&nbsp;María Buti,&nbsp;Rosa M. Morillas,&nbsp;Antoni E. Bordoy,&nbsp;Cinta Folch,&nbsp;Xavier Majó,&nbsp;Jordi Casabona,&nbsp;Jordi Gómez i Prat,&nbsp;Elisa Martró","doi":"10.1111/liv.70126","DOIUrl":"https://doi.org/10.1111/liv.70126","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Migrants from endemic areas are key populations for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection screening in Europe. This study assessed the feasibility and outcomes of a community action that combined education, screening, and simplified access to care for migrants in Barcelona.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult migrants from Pakistan, Romania, and Senegal were included from 2021 to 2023, through a community action involving education, an epidemiological questionnaire, and rapid testing for HBV surface antigen (HBsAg) and HCV antibodies. If positive, DBS samples were collected for laboratory confirmation. Viremic cases were referred to an International Health Unit (IHU).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 786 participants were included (346 from Pakistan, 304 from Senegal and 136 from Romania). Previous screening for HBV and HCV was 8.0% and 7.7%, respectively. HBsAg prevalence was 0.9% for migrants from Pakistan, 8.2% for those from Senegal and 1.4% for those from Romania (<i>n</i> = 30/786, 23 new diagnoses). Among these, 69.6% attended the IHU and were HBV-DNA positive, but none met treatment criteria. Anti-HCV prevalence was 3.5%, 0.7% and 1.4% for migrants from Pakistan, Senegal and Romania, respectively (<i>n</i> = 16/768, 12 new diagnoses), and HCV-RNA prevalence was 0.9%, 0.3% and 0.7%, respectively (<i>N</i> = 6, all new diagnoses); 4 (66.6%) cases were linked to treatment and two were cured.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This novel community action successfully reached migrants in a situation of vulnerability and provided them access to testing and care. The high prevalence observed and the limited self-knowledge of their HBV and HCV status justify targeted screening in these groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939356","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":"Procalcitonin as a Predictive Marker of Incident Liver Disease","authors":"Amanda Finnberg-Kim,&nbsp;Mats Pihlsgård,&nbsp;Kristina Önnerhag,&nbsp;Olle Melander,&nbsp;Sofia Enhörning","doi":"10.1111/liv.70132","DOIUrl":"https://doi.org/10.1111/liv.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Previous studies have shown that procalcitonin (PCT) concentration is elevated in patients with liver disease without evidence of bacterial infection. We aimed to investigate the association between elevated PCT and the future risk of liver disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>PCT was measured in 3897 individuals without known liver disease in the Malmö Diet and Cancer Cardiovascular Cohort (MDC-CC) and in 3854 individuals in the Malmö Preventive Project cohort (MPP). Cox proportional hazards regression models were used to analyse the risk of register-verified incident liver disease by PCT levels. We performed our analyses in a pooled sample of both the MPP and MDC-CC cohorts, as well as separate analyses for each cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>70 subjects in MDC-CC and 49 subjects in MPP were diagnosed with non-viral liver disease during a median follow-up of 27.1 and 14.8 years, respectively. In multivariate adjusted models in the pooled sample, individuals with high PCT (&gt; 0.05 ng/mL) had a significantly increased risk of developing liver disease compared to subjects with PCT concentrations below the cutoff (hazard ratio (HR) 3.4, 95% confidence interval (CI) 2.07–5.63, <i>p</i> &lt; 0.001). The HR per standard deviation increase of log-transformed PCT was 1.56 (95% CI 1.32–1.85, <i>p</i> &lt; 0.001) in multivariate adjusted models. Separate cohort-specific sensitivity analyses, including additional adjustment for C-reactive protein, showed similar effect estimates as the pooled analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elevated concentration of PCT independently predicts non-viral liver disease. These findings could have implications for risk assessment but also highlight the possibility of PCT as a direct cause of hepatocyte damage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939425","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":"Large Language Models for Diagnosing Focal Liver Lesions From CT/MRI Reports: A Comparative Study With Radiologists","authors":"Liuji Sheng,&nbsp;Yidi Chen,&nbsp;Hong Wei,&nbsp;Feng Che,&nbsp;Yingyi Wu,&nbsp;Qin Qin,&nbsp;Chongtu Yang,&nbsp;Yanshu Wang,&nbsp;Jingwen Peng,&nbsp;Mustafa R. Bashir,&nbsp;Maxime Ronot,&nbsp;Bin Song,&nbsp;Hanyu Jiang","doi":"10.1111/liv.70115","DOIUrl":"https://doi.org/10.1111/liv.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background &amp; Aims</h3>\u0000 \u0000 <p>Whether large language models (LLMs) could be integrated into the diagnostic workflow of focal liver lesions (FLLs) remains unclear. We aimed to investigate two generic LLMs (ChatGPT-4o and Gemini) regarding their diagnostic accuracies referring to the CT/MRI reports, compared to and combined with radiologists of different experience levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From April 2022 to April 2024, this single-center retrospective study included consecutive adult patients who underwent contrast-enhanced CT/MRI for single FLL and subsequent histopathologic examination. The LLMs were prompted by clinical information and the “findings” section of radiology reports three times to provide differential diagnoses in the descending order of likelihood, with the first considered the final diagnosis. In the research setting, six radiologists (three junior and three middle-level) independently reviewed the CT/MRI images and clinical information in two rounds (first alone, then with LLM assistance). In the clinical setting, diagnoses were retrieved from the “impressions” section of radiology reports. Diagnostic accuracy was investigated against histopathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>228 patients (median age, 59 years; 155 males) with 228 FLLs (median size, 3.6 cm) were included. Regarding the final diagnosis, the accuracy of <i>two-step</i> ChatGPT-4o (78.9%) was higher than <i>single-step</i> ChatGPT-4o (68.0%, <i>p</i> &lt; 0.001) and <i>single-step</i> Gemini (73.2%, <i>p</i> = 0.004), similar to real-world radiology reports (80.0%, <i>p</i> = 0.34) and junior radiologists (78.9%–82.0%; <i>p</i>-values, 0.21 to &gt; 0.99), but lower than middle-level radiologists (84.6%–85.5%; <i>p</i>-values, 0.001 to 0.02). No incremental diagnostic value of ChatGPT-4o was observed for any radiologist (<i>p</i>-values, 0.63 to &gt; 0.99).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p><i>Two-step</i> ChatGPT-4o showed matching accuracies to real-world radiology reports and junior radiologists for diagnosing FLLs but was less accurate than middle-level radiologists and demonstrated little incremental diagnostic value.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930226","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":"Response Letter: Bridging Gaps in Demographic Equity: Towards Inclusive Representation in MASH Randomised Trials","authors":"Matheus Souza,&nbsp;Ivanna Diaz,&nbsp;Alessandro Mantovani,&nbsp;Cristiane Alves Villela-Nogueira","doi":"10.1111/liv.70137","DOIUrl":"https://doi.org/10.1111/liv.70137","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930227","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":"Development and Validation of an Explainable Machine Learning Model for Warning of Hepatitis E Virus-Related Acute Liver Failure","authors":"Rui Dong,&nbsp;Zhenghan Luo,&nbsp;Hong Xue,&nbsp;Jianguo Shao,&nbsp;Lin Chen,&nbsp;Wenjuan Jin,&nbsp;Lingmei Yang,&nbsp;Chao Shen,&nbsp;Minzhi Xu,&nbsp;Mengping Wu,&nbsp;Jie Wang","doi":"10.1111/liv.70129","DOIUrl":"https://doi.org/10.1111/liv.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Early identification of patients with acute hepatitis E (AHE) who are at high risk of progressing to hepatitis E virus-related acute liver failure (HEV-ALF) is crucial for enabling timely monitoring and intervention. This multicentre retrospective cohort study aimed to develop and validate an interpretable machine learning (ML) model for predicting the risk of HEV-ALF in hospitalised patients with AHE in tertiary care settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study cohort included patients admitted to seven tertiary medical centers in Jiangsu, China, between 01 January 2018 and 31 December 2024. Multiple ML algorithms were applied for feature selection and model training. The predictive performance of the models was evaluated in terms of discrimination, calibration and clinical net benefit. The interpretability of the final model was enhanced using the SHapley Additive exPlanations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1912 participants were included in the study. Ten ML models were developed based on seven consensus-selected baseline features, with the survival gradient boosting machine (GBM) demonstrating superior performance compared to the traditional Cox proportional hazards regression model and other relevant models or scores. The GBM model achieved a Harrell's concordance index of 0.853 (95% CI: 0.791–0.914) in the external validation set. To facilitate clinical application, the GBM model was interpreted globally and locally and deployed as a web-based tool using the Streamlit-Python framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The GBM model demonstrated excellent performance in predicting HEV-ALF risk in hospitalised patients with AHE, offering a promising tool for clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 6","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925942","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}