Portal Hypertension & Cirrhosis最新文献

{"title":"Investigation on the short‐term outcome and prognostic impact of predisposition, and precipitants in inpatients with chronic liver disease from Chinese AcuTe on CHronic LIver FailurE (CATCH‐LIFE) cohorts","authors":"Yan Zhang, Wenting Tan, Xiaobo Wang, Xin Zheng, Yan Huang, Beiling Li, Zhongji Meng, Yanhang Gao, Zhiping Qian, Feng Liu, Xiaobo Lu, Jia Shang, Yubao Zheng, Weituo Zhang, Shan Yin, Wenyi Gu, Tongyu Wang, Jianyi Wei, Zixuan Shen, Guohong Deng, Yi Zhou, Yixin Hou, Qun Zhang, Shue Xiong, Jing Liu, Liyuan Long, Ruochan Chen, Jinjun Chen, Xiuhua Jiang, Sen Luo, Yuanyuan Chen, Chang Jiang, Jinming Zhao, Liujuan Ji, Xue Mei, Jing Li, Tao Li, Rongjiong Zheng, Xinyi Zhou, Haotang Ren, Yu Shi, Hai Li","doi":"10.1002/poh2.53","DOIUrl":"https://doi.org/10.1002/poh2.53","url":null,"abstract":"Abstract Aim The study aimed to investigate the short‐term outcomes of hospitalized patients with chronic liver disease (CLDs) and assess the prognostic impact of predisposition and precipitants, which currently remains unclear. Methods The study included 3970 hospitalized patients with CLDs from two prospective longitudinal multicenter studies (NCT02457637 and NCT03641872) conducted in highly endemic hepatitis B virus (HBV) areas. Competing risk analysis was used to evaluate the effect of predispositions, including the etiology and severity of CLDs and precipitants; on sequential 28, 90, and 365‐day liver transplantation (LT)‐free mortality. Results Among all enrolled patients, 76.8% of adverse outcomes (including death and LT) within one year occurred within 90 days. Compared with alcoholic etiology, the association of HBV etiology with poorer outcomes was remarkably on the 28 th day (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.07–3.06; p = 0.026); however, and diminished or became insignificant at 90 days and 365 days. Cirrhosis increased the adjusted risk for 365‐day (HR, 1.50; CI, 1.13–1.99; p = 0.004) LT‐free mortality when compared with noncirrhosis. In patients with cirrhosis, prior decompensation (PD) independently increased the adjusted risk of 365‐day LT‐free mortality by 1.25‐fold ( p = 0.021); however, it did not increase the risk for 90‐day mortality. Neither the category nor the number of precipitants influenced the adjusted risk of 28 or 90‐day LT‐free mortality. Conclusions The 90‐day outcome should be considered a significant endpoint for evaluating the short‐term prognosis of hospitalized patients with CLD. Predisposing factors, other than etiology, mainly affected the delayed (365‐day) outcome. Timely effective therapy for CLD etiology, especially antiviral treatments for HBV, and post‐discharge long‐term surveillance monitoring in cirrhotic patients undergoing PD are suggested to enhance disease management and reduce mortality.","PeriodicalId":471681,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive diagnosis of liver fibrosis in schistosomiasis japonica: Opportunities and challenges","authors":"Tao Wang, HaiYong Hua, JianFeng Zhang, Wei Li, Kun Yang","doi":"10.1002/poh2.38","DOIUrl":"https://doi.org/10.1002/poh2.38","url":null,"abstract":"Schistosomiasis is an infectious disease caused by trematode parasites of the genus Schistosoma. According to the World Health Organization (WHO), it is estimated that about 250 million people in the world are infected with the disease, nearly 800 million people are at risk of infection, and more than 200,000 people die of schistosomiasis every year.1, 2 In China, the endemic species of schistosome that primarily infects humans is Schistosoma japonicum. Schistosomiasis japonica has been a major public health problem affecting human health and economic development in the past decades. The latest national epidemiological data showed that there were still 29,517 advanced cases of schistosomiasis japonica at the end of 2020. Moreover, approximately 842,500 patients had been previously infected with S. japonicum nationwide, of whom 83.3% had chronic schistosomiasis.3 Our previous studies confirmed that past cases have no possibility of re-infection after antiparasitic treatment and that liver fibrosis continues to progress and eventually develops into advanced schistosomiasis.4 Some studies have also shown that although chemotherapy with praziquantel is readily available and has good efficacy, liver fibrosis remains the most serious consequence of S. japonicum chronic infection, with an incidence of nearly 20% in infected patients.5 Hence, nearly one million patients with chronic schistosomiasis are at risk of later developing liver fibrosis. Unlike Schistosoma haematobium which causes urinary tract morbidities, S. japonicum causes gastrointestinal and liver diseases. In the human host, some schistosome eggs excreted by adult parasites that have settled in the mesenteric venous plexuses are transported by mesenteric circulation to the liver, where they are trapped in small portal branches. A granulomatous cell-mediated response to egg antigens occurs around the eggs, resulting in the excessive production and deposition of collagen along the portal vein and tract branches by activated hepatic stellate cells. Repeated embolization of eggs over time, especially in cases of high-burden infection, leads to hepatosplenic schistosomiasis (HSS) or also known as Symmers' fibrosis, a form of hepatopathy that results in periportal fibrosis (PPF) with portal hypertension. HSS represents one of the most common chronic sequelae of this infection.6, 7 Patients with periportal fibrosis retain hepatocellular function, differentiating the disease from cirrhosis and other liver diseases (Table 1).8 Confluent granulomata around trapped helminth ova → portal “pipe-stem” fibrosis around portal vessels; liver parenchyma preserved Liver cell necrosis followed by nodular hepatocellular regeneration and fibrous septa and bands involving the entire liver parenchyma Presinusoidal block; normal occluded hepatic venous pressure Sinusoidal block; increased occluded hepatic venous pressure Liver function preserved Liver function impaired Normal hepatic vein pressure gradient Increas","PeriodicalId":471681,"journal":{"name":"Portal Hypertension & Cirrhosis","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136051649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}