Annals of hepatology最新文献

{"title":"IDENTIFICATION OF NOVEL INTESTINAL MICROBIOTA-BASED MARKERS ASSOCIATED WITH DYSBIOSIS, SEPSIS AND SHORT-TERM MORTALITY IN ALCOHOL-RELATED DECOMPENSATED CIRRHOSIS AND ACUTE-ON-CHRONIC LIVER FAILURE","authors":"María Daniela Sánchez Gutiérrez ,&nbsp;Paula Alejandra Castaño Jimenéz ,&nbsp;Luis Gilberto Huerta Gómez ,&nbsp;Marina Campos Valdez ,&nbsp;Miriam Ruth Bueno Topete ,&nbsp;Tonatiuh Abimael Baltazar Díaz","doi":"10.1016/j.aohep.2025.101972","DOIUrl":"10.1016/j.aohep.2025.101972","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Decompensated cirrhosis (DC) and acute-on-chronic liver failure (ACLF) related to alcohol present high morbidity and mortality and complications such as sepsis and multiorgan failure. The intestinal microbiota (IM) suffers from marked dysbiosis, altering SCFA biosynthesis and affecting the gut-liver axis. The microbial pathways involved, poorly understood in these pathologies, could represent useful prognostic markers.</div><div>To evaluate the relative quantification of bacterial SCFA genes in the IM of patients with CD and ACLF, and their association with different clinical outcomes and alpha-diversity.</div></div><div><h3>Materials and Methods</h3><div>Retrospective analytical study. Fecal samples from 19 ACLF patients, 16 DC, and 16 healthy controls (HC) were included. The butCoA, buk, ackA, and mmdA genes were quantified by qPCR. ROC curves and Kaplan-Meier analyses were performed using GraphPad. Approval number: CI-01023. No conflicts of interest are reported.</div></div><div><h3>Results</h3><div>Relative abundances of butCoA and ackA genes were significantly decreased in DC and ACLF patients (p&lt;0.05), whereas mmdA increased in DC. buk increased in patients who died at 28 days (p&lt;0.01) and showed a negative correlation with alpha-diversity, being associated with dysbiosis. Furthermore, buk and butCoA discriminated 28-day mortality in DC and ACLF (AUROC 0.75 and 0.85, respectively). In Kaplan-Meier analyses, increased buk was associated with 28-day mortality of 53% in DC and 71% in ACLF.</div></div><div><h3>Conclusions</h3><div>Intestinal microbiota of DC/ACLF showed reduction of butCoA, ackA, and mmdA, correlating with functional loss. Increased buk was associated with 28-day mortality, loss of alpha-diversity and sepsis. These findings propose novel microbial biomarkers in the Mexican population which will have to be validated later.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101972"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TRANSFORMING OUTPATIENT HEPATIC CARE IN LATIN AMERICA: A SCALABLE, NURSE-DRIVEN APPROACH","authors":"Francisco Vargas-Navarro ,&nbsp;Maria Soto-Echeverri ,&nbsp;Daniel Mondragón-Bustos ,&nbsp;Wagner Ramírez-Quesada ,&nbsp;Maria Lynch-Mejía ,&nbsp;Roy Quesada-Mora ,&nbsp;Alejandra Ochoa-Palominos ,&nbsp;Pablo Coste","doi":"10.1016/j.aohep.2025.101962","DOIUrl":"10.1016/j.aohep.2025.101962","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Chronic liver diseases are increasingly prevalent in Latin America, where fragmented care and hospital overcrowding limit timely, cost-effective management. Nurse-led outpatient programs may offer a viable alternative in resource-constrained environments.</div><div>To evaluate the safety and cost-effectiveness of a nurse-driven Outpatient Intervention Program (OIP) for patients with liver disease and its potential scalability across Latin America.</div></div><div><h3>Materials and Methods</h3><div>An OIP was implemented in 2019 at a tertiary care transplantation center. The program included outpatient liver biopsies (LB), albumin and blood product infusions, and diagnostic/therapeutic paracentesis. Retrospective data from 2019-2024 were analyzed.</div></div><div><h3>Results</h3><div>A total of 418 procedures were performed on 258 patients: 162 LB, 104 albumin or blood product infusions, and 152 paracentesis. This demonstrates a 3,240% increase in the number of LB and a 1,680% increase in paracentesis compared to 2018, before the program began.</div><div>The overall complication rate was 0.87% (4 complications), with only 2 major events (0.43%): spontaneous bacterial peritonitis after paracentesis and post-biopsy bleeding.</div><div>LB costs dropped from $2,894 to $549, generating $379,890 in savings over six years, due to avoiding overnight hospitalization. Paracentesis, albumin infusions and blood transfusions were previously performed in the emergency department, incurring an additional expense of $420. This transition to OIP generated total savings of $107,160 and contributed to reduced congestion in the emergency department.</div></div><div><h3>Conclusions</h3><div>This nurse-led model yields promising results in outpatient liver care and represents a cost-effective, Potential intervention. Its integration into public health systems across Latin America could contribute to more efficient management of CLD.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101962"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CHARACTERIZATION AND DESCRIPTION OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE ASSESSED BY HEPATIC ELASTOGRAPHY IN A CENTER IN BOGOTA","authors":"Lina Marcela Dorado Delgado ,&nbsp;Laura Cristina Arocha Dugand ,&nbsp;Martin Alonso Garzón Olarte ,&nbsp;Danna Lesley Cruz Reyes ,&nbsp;Nicole Guzmán ,&nbsp;Oscar Beltrán ,&nbsp;Geovanny Hernández ,&nbsp;Carolina Salinas ,&nbsp;Cristina Torres ,&nbsp;Adriana Varón Puerta","doi":"10.1016/j.aohep.2025.102029","DOIUrl":"10.1016/j.aohep.2025.102029","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally, with 25–30% of patients progressing to fibrosis. It is associated with complications such as cirrhosis, liver failure, and liver cancer. Transient liver elastography (TLE) is a non-invasive, reliable tool to assess hepatic steatosis and fibrosis, with lower risk than biopsy. This study aims to characterize patients with MASLD at Fundación Cardioinfantil by analyzing demographic and clinical factors, and the grade of liver steatosis and fibrosis using TLE</div></div><div><h3>Materials and Methods</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally, with 25–30% of patients progressing to fibrosis. It is associated with complications such as cirrhosis, liver failure, and liver cancer. Transient liver elastography (TLE) is a non-invasive, reliable tool to assess hepatic steatosis and fibrosis, with lower risk than biopsy. This study aims to characterize patients with MASLD at Fundación Cardioinfantil by analyzing demographic and clinical factors, and the grade of liver steatosis and fibrosis using TLE</div></div><div><h3>Results</h3><div>In the interim analysis of 899 patients, elastography results met international quality standards (IQR/M 18.3). The average BMI was 27.2 kg/m², and common comorbidities included hypertension and diabetes. Steatosis was typically moderate (LiSA S2), with a higher LiSA score in those with higher BMI (graphic 1). Fibrosis was absent in 78.3% of cases, while 21.7% showed progression (table 1) of this population 69.9% have overweight or obesity.</div></div><div><h3>Conclusions</h3><div>MASLD is primarily associated with metabolic diseases. This study found that higher BMI is linked to an increased risk of steatosis, and higher levels of fibrosis were seen in older patients (with no linear relationship). These patients should be prioritized for early screening and treatment, reducing complications and overall morbidity and mortality.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102029"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LATIN AMERICAN SURVEILLANCE REGISTRY REVEALS HIGHER ANTIMICROBIAL RESISTANCE IN INVASIVE ISOLATES FROM PATIENTS WITH CIRRHOSIS COMPARED TO EUROPEAN BENCHMARKS","authors":"Gonzalo Gomez Perdiguero ,&nbsp;Maria Dolores Murga ,&nbsp;Ana Palazzo ,&nbsp;Esteban Gonzalez Ballerga ,&nbsp;Ilse Pardo Ivirico ,&nbsp;Maria Daniela Perez ,&nbsp;Lorena Notari ,&nbsp;Josefina Pages ,&nbsp;Manuel Mendizabal ,&nbsp;Camila Maria Briz ,&nbsp;Agustin Di Santo ,&nbsp;Julia Brutti ,&nbsp;Brenda Osso Sanchez ,&nbsp;Margarita Anders ,&nbsp;Pablo Calzetta ,&nbsp;Alina Raquel Zerega ,&nbsp;Angelo Z. Mattos ,&nbsp;Astrid Smud ,&nbsp;Laura R. Maboni ,&nbsp;Maximiliano Castro ,&nbsp;Sebastian Marciano","doi":"10.1016/j.aohep.2025.101959","DOIUrl":"10.1016/j.aohep.2025.101959","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Given the growing burden of antimicrobial resistance (AMR), we aimed to report the prevalence of key AMR patterns in Latin American patients with cirrhosis and compare them with the European Antimicrobial Resistance Surveillance Network (EARS-Net) data</div></div><div><h3>Materials and Methods</h3><div>Cross-sectional study of invasive isolates (blood, ascitic or pleural fluid) from adults with cirrhosis enrolled in the Latin American surveillance registry (ClinicalTrials.gov: NCT0634940). AMR patterns were reported for key pathogens: E. coli, K. pneumoniae, S. aureus, Acinetobacter spp., E. faecium, and P. aeruginosa.</div></div><div><h3>Results</h3><div>Between December 2020 and May 2025, 908 bacterial isolates were collected from Argentina, Uruguay, Brazil, and Peru. Of these, 226 (25%) were obtained from invasive sites and correspond to predefined bacteria of epidemiological interest included in the analysis. Isolates were 39% nosocomial, 38% community-acquired, and 23% healthcare-associated. The main infections were spontaneous bacteremia (38%) and SBP (32%). Quinolone resistance was higher in Latin American vs. Europe for K. pneumoniae (56% vs. 34%) and E. coli (46% vs. 24%). Carbapenem resistance in K. pneumoniae was 46% (vs. 13%), and in E. coli, 5.3% (vs. 0.3%). Methicillin resistance among S. aureus was higher in Latin American (32%) than in Europe (16%). Other pathogens also showed higher resistance (Table).</div></div><div><h3>Conclusions</h3><div>The elevated resistance rates observed in Latin American patients with cirrhosis demand attention. In a region where regulatory gaps at multiple levels may contribute to antibiotic misuse, these findings call for urgent action to strengthen rational antibiotic use and implement effective stewardship strategies.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101959"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AMA-NEGATIVE PRIMARY BILIARY CHOLANGITIS IN LATIN AMERICA: A DISTINCT SUBSET WITH LOWER TREATMENT RESPONSE","authors":"Claudia Alves Couto ,&nbsp;Guilherme Grossi Lopes Cançado ,&nbsp;María Lucía Ferraz Ferraz ,&nbsp;Debora Raquel Terrabuio ,&nbsp;Alejandra Villamil ,&nbsp;Lorena Castro Solari ,&nbsp;Graciela Elia Castro-Narro ,&nbsp;Ezequiel Ridruejo ,&nbsp;Cristiane A. Villela-Nogueira ,&nbsp;Danay Guerrero ,&nbsp;Daniela Chiodi ,&nbsp;Carla Enrique ,&nbsp;Paulo Lisboa Bittencourt ,&nbsp;Gustavo Pereira ,&nbsp;Fernando Bessone ,&nbsp;Stefanny Cornejo Hernández ,&nbsp;Rodrigo Zapata ,&nbsp;Hugo Cheinquer ,&nbsp;Nicolás Ortiz López ,&nbsp;Manuel Mendizabal ,&nbsp;Nélia Hernandez","doi":"10.1016/j.aohep.2025.102013","DOIUrl":"10.1016/j.aohep.2025.102013","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Primary biliary cholangitis (PBC) is an autoimmune cholestatic disease, typically diagnosed by the presence of anti-mitochondrial antibodies (AMA). Whether AMA-negative PBC represents a distinct clinical phenotype remains controversial. This study aimed to characterize the epidemiological profile of PBC according to AMA status in Latin America.</div></div><div><h3>Materials and Methods</h3><div>This ongoing, retrospective, international multicenter cohort study, sponsored by ALEH, includes PBC patients from multiple Latin American countries. Patients were stratified by AMA status; those with autoimmune hepatitis-PBC overlap were excluded.</div></div><div><h3>Results</h3><div>Data from 1,204 patients were analyzed: Brazil (48.3%), Argentina (23.4%), Chile (10.8%), Mexico (7.4%), and others. Most were female (92.3%) with a mean age at diagnosis of 53±13 years; 22.2% had cirrhosis at baseline. Overlap syndrome was excluded. AMA were positive in 76.8%. AMA-positive and AMA-negative patients had similar rates of female sex (92.5% each, p=0.963), baseline cirrhosis (22.4% vs. 23.6%, p=0.706), and symptomatic presentation (77.5% vs. 79.4%, p=0.544). MASLD was more frequent among AMA-negative patients (7.5% vs. 3.8%, p=0.024), which also had higher rates of sp100 (9.1% vs 2.5%, p&lt; 0.001) and gp210 (7.3 vs 3.3%, p&lt; 0.001) positivity. Treatment with UDCA was performed in 95.2% of patients and, from those, 28.3% had second line treatment indicated due to incomplete response to UDCA. AMA-positive patients showed higher response to ursodeoxycholic acid (UDCA) at 12 months, including ALP normalization (29.7% vs. 21.2%, p=0.035) and deep response (17.5% vs. 8.6%, p=0.007). Similar findings were observed after 12 months of fibrate therapy (34.8% vs. 9.4%, p=0.005). No difference was found in transplant-free survival (p=0.213).</div></div><div><h3>Conclusions</h3><div>AMA-negative PBC patients in Latin America present similar baseline features but have lower response rates to UDCA and fibrates, supporting the hypothesis of a biologically distinct disease subset.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102013"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FULL COMPLIANCE TO QUALITY INDICATORS IN ACUTE VARICEAL BLEEDING REDUCES 6-WEEK MORTALITY.","authors":"Edgar Suarez ,&nbsp;Juan Carlos Montaño ,&nbsp;Ezequiel Demirdjian ,&nbsp;Diego Arufe","doi":"10.1016/j.aohep.2025.101993","DOIUrl":"10.1016/j.aohep.2025.101993","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Introduction: Quality indicators (QIs) for the management of acute variceal bleeding (AVB) encompass guideline-recommended interventions aimed at reducing mortality. However, the cumulative impact of full adherence to these measures remains unclear.</div><div>To evaluate whether complete compliance with five established QIs during AVB episodes is associated with reduced 6-week mortality.</div></div><div><h3>Materials and Methods</h3><div>This retrospective observational study included 135 AVB episodes from 2017 to 2024. Adherence to five QIs was assessed: antibiotic administration within 24 hours, vasoactive agent used within 24 hours, diagnostic endoscopy within 24 hours, endoscopic treatment, and beta-blocker prescription at discharge. Full adherence was defined as compliance with all five interventions. The primary outcome was 6-week mortality. Descriptive statistics and multivariate logistic regression adjusted for MELD score (&lt;15 vs. ≥15) and Child-Pugh class (A/B vs. C) were performed. An interaction term was included to evaluate whether the effect of QI compliance differed by Child-Pugh class.</div></div><div><h3>Results</h3><div>Overall 6-week mortality was 13.8%. Full adherence was achieved in 54.8% of episodes. Mortality rates by adherence level were 4.1% for full adherence, 16.3% for four QIs, and 42.9% for three or fewer QIs (p &lt; 0.001). In multivariate analysis, full adherence was independently associated with lower mortality (OR 0.20; 95% CI 0.05–0.82; p = 0.025). Child-Pugh class C was also significantly associated with increased mortality (OR 9.68; p = 0.001). An interaction analysis showed that the protective effect of QI adherence did not differ significantly between Child-Pugh A/B and Child-Pugh C patients (interaction term p = 0.87), suggesting a consistent benefit across severity strata.</div></div><div><h3>Conclusions</h3><div>Complete compliance with evidence-based quality indicators significantly reduces 6-week mortality in patients with AVB, independent of baseline liver disease severity. Rigorous implementation of these measures should be prioritized as a standard of care in cirrhotic patients presenting with AVB.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101993"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPLEMENTATION OF A TEST AND TREAT MODEL FOR HCV CARE UTILIZING POINT OF CARE HCV RNA TESTING IN LA BODEGA","authors":"Anthony Martinez ,&nbsp;Scott Springer ,&nbsp;Sean Owen","doi":"10.1016/j.aohep.2025.101998","DOIUrl":"10.1016/j.aohep.2025.101998","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The World Health Organization (WHO) aims to eliminate hepatitis C virus (HCV) by 2030; however, the United States (US) is unlikely to meet this target. Screening, linkage, and treatment initiation remain suboptimal.</div><div>To evaluate Point-of-care (POC) HCV RNA test (Xpert® HCV) in a test and treat model of care among People Who Use Drugs (PWUD).</div></div><div><h3>Materials and Methods</h3><div>La Bodega, a co-localized hepatology and addiction medicine program in Buffalo, New York (NY), specializes in HCV management among active PWUD. POC HCV RNA testing is utilized on-site. Patients with a positive HCV RNA initiate HCV therapy at the time of the initial visit. POC HCV RNA testing is also used in conjunction with lab-based RNA testing on serum to evaluate SVR4 when indicated.</div></div><div><h3>Results</h3><div>65 people were screened with POC HCV RNA of whom 40 had a previous HCV antibody. 11 individuals were found to be HCV RNA positive. Eleven individuals were assessed for SVR, all of whom had both undetectable serum HCV RNA and negative POC HCV RNA results. Among RNA-positive individuals, one was linked to their primary care clinic based on the patient’s preference and 10 individuals initiated therapy, receiving the full 8 or 12 weeks of therapy, depending on the chosen regimen. Two individuals remain on treatment; 6 are pending SVR assessment, and 2 achieved SVR, one of whom was pregnant and treated with sofosbuvir/velpatasvir.</div></div><div><h3>Conclusions</h3><div>POC HCV RNA testing is advantageous in shortening the HCV care cascade, enabling a true test-and-treat model of care for HCV.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101998"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PREVALENCE OF COVERT HEPATIC ENCEPHALOPATHY IN PATIENTS WITH COMPENSATED LIVER CIRRHOSIS","authors":"Oscar Suazo ,&nbsp;Aissatou Sow ,&nbsp;Susana Borges ,&nbsp;Marlén Castellanos ,&nbsp;Sila M. Gonzales ,&nbsp;Danay Guerrero ,&nbsp;Mirtha Infante Velasquez ,&nbsp;Yusimik Román","doi":"10.1016/j.aohep.2025.102027","DOIUrl":"10.1016/j.aohep.2025.102027","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Covert hepatic encephalopathy (CHE) is a complication that affects the quality of life and prognosis of cirrhotic patients. It is identified through appropriate neuropsychological tests. Objectives: To determine the prevalence of CHE in patients with compensated liver cirrhosis using the Psychometric Hepatic Encephalopathy Score (PHES) and its association with selected clinical factors.</div></div><div><h3>Materials and Methods</h3><div>A descriptive, cross-sectional study was conducted at the Institute of Gastroenterology in Havana, Cuba, between March 2023 and December 2024. Sixty-five patients with defined selection criteria were included. The prevalence of CHE was calculated according to the total PHES, using normality tables for the Cuban population. PHES scores and laboratory parameters were compared, and the association with sex, age, education, and etiology was explored between the groups with and without EHE.</div></div><div><h3>Results</h3><div>The prevalence of EHE was 32.3% (n=21). Differences were found between groups with and without EHE in the total PHES (p&lt;0.001) and in each of its components. No association was demonstrated between age, sex, educational level, and etiology of cirrhosis with EHE, nor was there statistical significance between ALAT (p=0.68), ASAT (p=0.90), albumin (p=0.65), and platelet count (p=0.63). Age &gt;60 years, male sex, viral etiology, low educational level, and liver function did not influence the diagnosis of EHE.</div></div><div><h3>Conclusions</h3><div>The PHES is an objective tool that allowed the identification of EHE in the context studied, which is relevant for the early management of compensated cirrhosis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102027"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HEALTH LITERACY AS A DETERMINANT OF FRAILTY IN PATIENTS WITH LIVER CIRRHOSIS","authors":"Ismael de Jesús Yepes Barreto ,&nbsp;Nicole Chamorro ,&nbsp;Guillermo Donado","doi":"10.1016/j.aohep.2025.101980","DOIUrl":"10.1016/j.aohep.2025.101980","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Health literacy (HL) is a key social determinant of health, especially in chronic conditions like cirrhosis, where disease management depends heavily on patient comprehension and engagement. HL refers to the ability to access, understand, and use health information to make informed decisions. Frailty, a state of decreased physiological reserve and increased vulnerability, is a strong predictor of adverse outcomes in cirrhosis. Although the Liver Frailty Index (LFI) is commonly used to assess physical frailty, the role of HL in this context remains poorly explored. This study aimed to determine the association between HL and frailty in patients with cirrhosis.</div></div><div><h3>Patients and Methods</h3><div>We conducted a cross-sectional study among adults with confirmed cirrhosis attending outpatient hepatology clinics in Cartagena, Colombia, between September and December 2024. HL was measured using the Short Assessment of Health Literacy for Spanish Adults (SAHL-S), and frailty was assessed with the LFI, which includes grip strength, chair stands, and balance tests. Trained clinicians performed all tests using calibrated equipment. Demographic and clinical variables were obtained from records and structured interviews. Patients with encephalopathy or severe mobility limitations were excluded. Frailty was defined as LFI ≥ 4.5.</div></div><div><h3>Results</h3><div>Among 89 participants (57.3% women, mean age 64.8), 85.4% were Child-Pugh A. History of decompensation and variceal bleeding were present in 24.7% and 13.5%, respectively. LFI categorized 15.7% as robust, 65.2% as prefrail, and 19.1% as frail. In multivariable analysis, low HL (OR 2.8; 95% CI 1.3–6.0) and variceal bleeding (OR 3.2; 95% CI 1.4–7.1) independently predicted frailty.</div></div><div><h3>Conclusions</h3><div>Low HL independently predicts frailty and should be addressed to improve outcomes in cirrhosis care.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101980"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PLANT-DERIVED MONOTERPENE SYNERGIZES WITH SORAFENIB TO SUPPRESS DRUG-TRIGGERED HEPATOCELLULAR CARCINOMA IN ANIMALS","authors":"Amr Amin","doi":"10.1016/j.aohep.2025.101986","DOIUrl":"10.1016/j.aohep.2025.101986","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Sorafenib (SB), while established as a first-line multikinase inhibitor for advanced hepatocellular carcinoma (HCC), demonstrates constrained clinical utility due to significant adverse effects and the emergence of drug resistance. To potentially enhance its therapeutic profile, we explored combination therapy with natural compounds. Previous investigations from our group identified safranal (SF), a major bioactive monoterpene constituent of saffron, as exhibiting notable anti-HCC properties.</div><div>This study aimed to investigate potential synergistic interactions between SB and SF that might improve HCC treatment outcomes.</div></div><div><h3>Materials and Methods</h3><div>We employed a chemically-induced cirrhotic HCC rat model to evaluate both SF monotherapy and SB-SF combination therapy. Comprehensive molecular characterization included RNA sequencing with subsequent differential gene expression analysis, pathway enrichment studies, and protein interaction network mapping. Mechanistic findings were confirmed through immunohistochemical and immunoblotting techniques.</div></div><div><h3>Results</h3><div>The SB-SF combination demonstrated enhanced anticancer efficacy compared to SB alone. Transcriptomic profiling identified 45 differentially expressed genes associated with HCC suppression, particularly those involved in proliferation control, oxidative stress response, and apoptotic regulation. The combination therapy significantly downregulated key oncogenic markers including NF-κB-p65, COX-2, and β-catenin, suggesting its potential as a cost-effective therapeutic approach that warrants further clinical investigation.</div></div><div><h3>Conclusions</h3><div>The study reveals a multifaceted mechanism by which SF augments SB's anticancer activity in HCC. The combined treatment modulates critical oncogenic pathways including NF-κB and Wnt/β-catenin signaling while rebalancing apoptotic regulators through decreased Bcl-2 and increased Bax/caspase expression. Additionally, it suppresses proliferative markers such as Ki-67 and PCNA while attenuating inflammatory mediators including TNF-α and MMP-9. These coordinated effects demonstrate potent anti-tumorigenic, anti-angiogenic, and pro-apoptotic activity, highlighting the therapeutic promise of this combination approach for HCC treatment.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101986"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}