Liver International最新文献

{"title":"Re: Low-Dose Hydrocortisone in Cirrhotic Patients With Septic Shock: A Double-Blind Randomised Placebo-Controlled Trial","authors":"Weina Song, Xiaofei Wang","doi":"10.1111/liv.70334","DOIUrl":"https://doi.org/10.1111/liv.70334","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934857","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":"Smoking Aggravates Inflammation, Fibrogenesis, Angiogenesis and Cancer Risk in Patients With Cirrhosis","authors":"Nina Dominik,&nbsp;Benedikt Simbrunner,&nbsp;Bernhard Scheiner,&nbsp;Michael Schwarz,&nbsp;Lukas Hartl,&nbsp;Mathias Jachs,&nbsp;Lorenz Balcar,&nbsp;Georg Semmler,&nbsp;Georg Kramer,&nbsp;Christian Sebesta,&nbsp;Michael Trauner,&nbsp;Matthias Pinter,&nbsp;Mattias Mandorfer,&nbsp;Thomas Reiberger,&nbsp;Benedikt Silvester Hofer","doi":"10.1111/liv.70314","DOIUrl":"https://doi.org/10.1111/liv.70314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Smoking induces a proinflammatory state, yet its role in advanced chronic liver disease (ACLD) remains understudied. This study evaluated its impact on disease-driving mechanisms and clinical outcomes in ACLD patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ACLD patients undergoing hepatic venous pressure gradient measurements from 2017 to 2021 were included. The association of smoking with biomarkers of inflammation, fibrogenesis, angiogenesis and the incidence of hepatocellular carcinoma (HCC), extrahepatic malignancies and mortality was examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 339 ACLD patients (66.1% men, median age: 56.8 years, MELD: 11, HVPG: 17 mmHg), 62% (<i>n</i> = 210) were ever-smokers (<i>n</i> = 78 former, <i>n</i> = 132 active). Compared to never/former smokers, active smokers exhibited significantly higher white blood cell counts (5.49 vs. former: 4.74 vs. never: 4.25 G/L; <i>p</i> &lt; 0.001) and C-reactive protein levels (CRP: 0.36 vs. former: 0.29 vs. 0.21 mg/dL; <i>p</i> = 0.035). Active smokers showed upregulated fibrogenic (TIMP-1: 364 vs. former: 324 vs. never: 278 ng/mL, <i>p</i> &lt; 0.001; P3NP: 20.9 vs. former: 15.6 vs. never: 17.2 μg/L, <i>p</i> = 0.008) and angiogenic (PLGF: 21.7 vs. former: 18.2 vs. never: 19.0 pg/mL, <i>p</i> = 0.004) activity markers. Over a median follow-up of 30.4 months, ever-smokers exhibited a higher incidence of extrahepatic malignancies (SHR: 11.30; <i>p</i> = 0.019) and numerically higher HCC incidence (SHR: 2.27 <i>p</i> = 0.150; mostly evident in Child-Pugh A patients: SHR: 7.44, <i>p</i> = 0.053). All-cause or liver-related mortality risk did not differ significantly between ever-smokers and never-smokers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Smoking is linked to an upregulation of inflammatory, fibrogenic and angiogenic processes in ACLD and increases the risk of extrahepatic malignancies. These findings underscore the importance of strategies supporting smoking cessation in ACLD patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>NCT03267615</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934815","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":"Letter to the Editor: Tofacitinib as a Steroid-Free Induction Strategy in Autoimmune Hepatitis: An Initial Experience","authors":"Arnav Aggarwal,&nbsp;Sarthak Saxena,&nbsp;Sagnik Biswas,&nbsp; Shalimar","doi":"10.1111/liv.70333","DOIUrl":"https://doi.org/10.1111/liv.70333","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927455","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":"Probiotics for Hepatic Encephalopathy Prevention After TIPS: Still an Open Question","authors":"Lorenzo Ridola","doi":"10.1111/liv.70322","DOIUrl":"https://doi.org/10.1111/liv.70322","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927456","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":"Statin Therapy and Portal Pressure Reduction in Cirrhosis: A Systematic Review and Meta-Analysis","authors":"Eyad Abdulrazzak,&nbsp;Butros Fakhoury,&nbsp;Ali Jaan,&nbsp;Mohamed Ebrahim,&nbsp;Imad Alabdul Razzak,&nbsp;Ahmed Shehadah,&nbsp;Leandro Sierra,&nbsp;Hazem Abosheaishaa,&nbsp;Elliot B. Tapper,&nbsp;Hirsh D. Trivedi","doi":"10.1111/liv.70326","DOIUrl":"https://doi.org/10.1111/liv.70326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Portal hypertension is the principal driver of cirrhosis decompensation, leading to heightened morbidity and mortality. While non-selective beta-blockers (NSBBs) remain the standard of care, up to 45% of patients fail to achieve sufficient portal pressure reduction. Statins have gained attention as a potential therapeutic agent for portal hypertension. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) to evaluate the impact of statins on portal pressure and cirrhosis-related outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched five databases through November 2024 for RCTs evaluating statin therapy in adults with cirrhosis and clinically significant portal hypertension (CSPH). The primary outcome was HVPG reduction, assessed as an absolute decrease or the proportion achieving a haemodynamic response (HVPG reduction ≥ 20% from baseline or to ≤ 12 mmHg). Secondary outcomes included variceal bleeding, ascites and mortality. Random-effects meta-analyses were performed using pooled mean differences (MDs) and risk differences (RDs) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six RCTs (<i>n</i> = 492) were included. Statin therapy was associated with significant HVPG reduction (MD: 1.1 mmHg; 95% CI: 0.44–1.77; <i>I</i>² = 38.7%) and higher hemodynamic response (RD: 0.24; 95% CI: 0.02–0.45; <i>I</i>² = 76.8%). No significant differences were seen in variceal bleeding, ascites or mortality. On subgroup analysis, HVPG benefit was limited to studies with short-term follow-up. In studies comparing statin plus NSBB to NSBB alone, the addition of statins further reduced HVPG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Statins modestly lower HVPG in cirrhosis-related portal hypertension and may be a useful adjunct to NSBBs. Larger trials are needed to assess long-term clinical benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO registration number: CRD42025622478</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927457","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":"Modelling Assumptions in Cost-Effectiveness Analysis of Antiviral Therapy for High Viremic Indeterminate Phase Chronic Hepatitis B","authors":"Suk-Chan Jang,&nbsp;Won-Mook Choi,&nbsp;Hye-Lin Kim,&nbsp;Young-Suk Lim","doi":"10.1111/liv.70335","DOIUrl":"https://doi.org/10.1111/liv.70335","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927673","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":"The Impact of Access to Clinical Guidelines on LLM-Based Treatment Recommendations for Chronic Hepatitis B","authors":"Robert Siepmann,&nbsp;Carolin Victoria Schneider,&nbsp;Marc Sebastian von der Stueck,&nbsp;Iakovos Amygdalos,&nbsp;Karsten Große,&nbsp;Kai Markus Schneider,&nbsp;Maike Rebecca Pollmanns,&nbsp;Mohamad Murad,&nbsp;Joel Joy,&nbsp;Elena Kabak,&nbsp;Marcella Ricardis May,&nbsp;Jan Clusmann,&nbsp;Christiane Kuhl,&nbsp;Sven Nebelung,&nbsp;Jakob Nikolas Kather,&nbsp;Daniel Truhn","doi":"10.1111/liv.70324","DOIUrl":"https://doi.org/10.1111/liv.70324","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Large language models (LLMs) can potentially support clinicians in their daily routine by providing easy access to information. Yet, they are plagued by stating incorrect facts and hallucinating when queried. Increasing the context by providing external databases while prompting LLMs may decrease the risk of misinformation. This study compares the influence of increased context on the coherence of LLM-based treatment recommendations with the recently updated WHO guidelines for the treatment of chronic hepatitis B (CHB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>GPT-4 was queried with five clinical case vignettes in two configurations: with and without additional context. The clinical vignettes were explicitly constructed so that treatment recommendations differed between the formerly applicable 2015 WHO guidelines and the updated 2024 ones. GPT-4 with context was provided access to the updated guidelines, while GPT-4 without context had to rely on its internal knowledge. GPT-4 was accessed only a few days after the release of the new WHO guidelines. Treatment recommendations were compared regarding guideline coherence, information inclusion, textual errors, wording clarity and preciseness by seven physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using GPT-4 with context increased the coherence of the treatment recommendations with the new 2024 guidelines from 51% to 91% compared to GPT-4 without context. Similar trends were observed for all other categories, leading to an increase of 54% in preciseness and clarity, 24% in completeness of incorporating the case vignette information, and 12% in textual correctness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>If LLMs are consulted by clinicians for medical advice, they should be given access to external data sources to increase the chance of providing factually correct advice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/liv.70324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927674","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":"Caution in Using cT1 Alone for Risk Stratification in MASLD","authors":"Jingya Wang,&nbsp;Yize Ying,&nbsp;Xiaoge Geng","doi":"10.1111/liv.70318","DOIUrl":"https://doi.org/10.1111/liv.70318","url":null,"abstract":"","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923392","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":"MiR-126-3p and MiR-195-5p as Novel Therapeutic Attenuators of Liver Fibrosis by Targeting the IRS1/PI3K Signalling Pathway","authors":"Xia Yuan,&nbsp;Kun Zhang,&nbsp;Dan Wang,&nbsp;Jie Li,&nbsp;Peng Lyu,&nbsp;Xuemei Zhao,&nbsp;Kang Zhang,&nbsp;Hongting Li,&nbsp;Bo Liu,&nbsp;Liping Ma","doi":"10.1111/liv.70302","DOIUrl":"https://doi.org/10.1111/liv.70302","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background &amp; Aims</h3>\u0000 \u0000 <p>Hepatic fibrosis is a progressive response to chronic liver injury. A key event in the development of hepatic fibrosis is the activation of hepatic stellate cells (HSCs); emerging research indicates that microRNAs play crucial roles in regulating HSCs activation. However, the specific roles of miR-126-3p (miR-126) and miR-195-5p (miR-195) in liver fibrosis remain inadequately understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined the expression of miR-126 and miR-195 in activated HSCs, fibrotic liver tissues from animal models, and blood samples from patients with liver disease. The effects on cell proliferation and migration were investigated by MTT, colony formation assay, cell wound healing assay, and Transwell assay. Finally, we evaluated the effect of miR-126 and miR-195 on the progression of liver fibrosis in mice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We revealed that miR-126 and miR-195 were markedly downregulated in activated HSCs, fibrotic liver tissues from animal models, and blood samples from patients with liver diseases. Functional experiments demonstrated that the overexpression of miR-126 and miR-195 significantly inhibited the proliferation, migration, and fibrotic markers expression in HSCs. Conversely, silencing miR-126 and miR-195 produced the opposite effects. Further mechanistic studies showed that miR-126 and miR-195 downregulate insulin receptor substrate 1 (IRS1) or phosphoinositide 3-kinase regulatory subunit 2 (PIK3-R2), respectively, thereby inhibiting the pro-fibrotic signalling pathway (IRS1/PI3K) and regulating the functions of HSCs. Importantly, in vivo experiments demonstrated that miR-126 and miR-195 markedly alleviated CCL₄-induced hepatic fibrosis in mice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results unravel that miR-126 and miR-195 inhibit liver fibrosis by suppressing the IRS/PI3K pathway.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923391","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":"High Grade Hepatotoxicity From Dual Checkpoint Inhibitors Is More Common in Hepatocellular Carcinoma Than Other Cancers.","authors":"Elsie Ennin, Niharika Mallepally, Myra Ali, Layla Shojaie, Sean Dewberry, Melissa Trieu, Evanthia T Roussos Torres, Kali Zhou, Jeffrey Kahn, Jennifer L Dodge, Lily Dara","doi":"10.1111/liv.70255","DOIUrl":"10.1111/liv.70255","url":null,"abstract":"<p><strong>Background & aims: </strong>Immune checkpoint inhibitors (ICIs) are therapy for many malignancies including hepatocellular carcinoma (HCC), yet the impact of HCC on immune-mediated liver injury from checkpoint inhibitors (ILICI) remains poorly understood and no direct comparison exists for hepatotoxicity rates between ICI and sorafenib in HCC.</p><p><strong>Methods: </strong>In this retrospective cohort study, we extracted data on adult patients treated with five ICI regimens for HCC or non-HCC cancers, and HCC patients who received sorafenib between 2010 and 2020. The primary outcome was grade ≥ 3 ILICI or sorafenib (DILI). Logistic regression estimated adjusted odds ratios (OR) for liver injury.</p><p><strong>Results: </strong>We identified 530 patients, 129 (24%) HCC-ICI, 256 (48%) non-HCC ICI, and 145 (27%) HCC-sorafenib. Compared to non-HCC ICI, HCC-ICI and HCC-sorafenib were more often male (57%, 82%, 77%), Hispanic (14%, 35%, 34%), and cirrhotic (1%, 85%, 88%). Twenty-three patients developed grade ≥ 3 ILICI. ILICI incidence was higher for HCC-ICI (11%, CI 6-18) versus non-HCC ICI (4%, CI 2-6, p = 0.006) and DILI in HCC-sorafenib (3%, CI 1-8, p = 0.02) with incidence highest for ipilimumab-nivolumab (HCC-ICI 42%, CI 15-72 versus non-HCC 10%, CI 3-24; p = 0.02). On multivariable regression, ILICI was associated with HCC (OR 4.5, CI 1.8-11.4, p = 0.002) and treatment with ipilimumab-nivolumab (OR 6.9, CI 2.6-18.3, p < 0.001). Incidence of liver injury in HCC remained elevated for ICI versus sorafenib (OR 3.5, CI 1.2-10.4, p = 0.02).</p><p><strong>Conclusions: </strong>We identified an elevated risk of liver injury in HCC patients receiving ICIs compared to ICI-treated non-HCC cancers and sorafenib-treated HCC, with dual ipilimumab-nivolumab therapy carrying the highest risk.</p>","PeriodicalId":18101,"journal":{"name":"Liver International","volume":"45 9","pages":"e70255"},"PeriodicalIF":5.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799526","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}