Annals of hepatology最新文献

{"title":"#16 - DIAGNOSTIC ACCURACY OF SPLENIC STIFFNESS BY VIBRATION-CONTROLLED TRANSIENT ELASTOGRAPHY FOR NONINVASIVE IDENTIFICATION OF ESOPHAGEAL VARICES IN PATIENTS WITH COMPENSATED ADVANCED CHRONIC LIVER DISEASE — SPHERE —","authors":"María Viera,&nbsp;Leidy España,&nbsp;Eivar Cruz,&nbsp;Luisa Gómez,&nbsp;Marco Luján","doi":"10.1016/j.aohep.2026.102298","DOIUrl":"10.1016/j.aohep.2026.102298","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Clinically significant portal hypertension (CSPH) is the primary prognostic determinant in patients with compensated advanced chronic liver disease (cACLD). Although hepatic venous pressure gradient measurement represents the gold standard, its invasive nature limits its clinical applicability, driving the development of non-invasive methods such as spleen stiffness measurement (SSM) via 100-Hz vibration-controlled transient elastography (VCTE).</div></div><div><h3>Materials and Methods</h3><div>A retrospective cohort study was conducted in adults with cACLD (LSM 15 kPa). SSM was quantified via FibroScan® using specialized 100-Hz probes, with results correlated against platelet counts and esophagogastroduodenoscopy performed within a maximum interval of six months.</div></div><div><h3>Results</h3><div>Spearman's rank correlation coefficient, ROC curves (AUC), DeLong's test, and Decision Curve Analysis (DCA) were applied. To validate the cutoff value (SSM &lt; 40 kPa), a negative predictive value (NPV) of 95% was required using contingency tables. In 51 patients, SSM was significantly associated with the presence of varices (Rho = 0.310; <em>p</em> = 0.027), but not with their size. SSM demonstrated an AUC of 0.676, a performance comparable to platelet count and LSM. The 40-kPa threshold yielded an insufficient NPV of 86.7%.</div></div><div><h3>Conclusions</h3><div>Transient elastography for measuring spleen stiffness is a promising tool, but its implementation in screening protocols must be approached with caution. To ensure patient safety and effectively reduce the burden of unnecessary endoscopic procedures, integrating SSM into combined algorithms is recommended.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102298"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#123 - NATIONAL PRE-POST ASSESSMENT OF HEPATITIS C CARE CASCADE INDICATORS FOLLOWING IMPLEMENTATION OF PUBLIC HEALTH POLICIES IN URUGUAY","authors":"Victoria Mainardi,&nbsp;Susana Cabrera,&nbsp;Luciana Noble,&nbsp;Anaclara Firpo,&nbsp;Daniela Olivari,&nbsp;Solange Gerona,&nbsp;Sebastian Marciano,&nbsp;Julio Medina","doi":"10.1016/j.aohep.2026.102276","DOIUrl":"10.1016/j.aohep.2026.102276","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Uruguay implemented major hepatitis C virus policies in 2024-2025, including HCV RNA testing into the national health benefits package, one-time anti-HCV screening in mandatory occupational health examinations, initially targeting individuals aged 56-64 years, and HCV screening during pregnancy care.</div><div>We aim to assess changes in HCV cascade-of-care indicators before and after implementation of national HCV policies in Uruguay.</div></div><div><h3>Materials and Methods</h3><div>We conducted a national pre-post analysis using structured surveys distributed by the Ministry of Health to all 44 healthcare providers. The pre-policy period was 2022–2023 and the post-policy was 2024–2025. Preliminary 2025 data included responses available at analysis. Indicators included anti-HCV testing, seropositivity, RNA confirmation among anti-HCV-positive individuals, RNA positivity, and treatment initiation. Analyses were restricted to providers with data in both periods. Rates were expressed per 100,000 user-years. Rate ratios with 95% confidence intervals were estimated using Poisson-based methods. Proportions were compared using two-proportion tests.</div></div><div><h3>Results</h3><div>Among 23 comparable providers, anti-HCV testing increased from 3,189 to 4,650 tests per 100,000 user-years after policy implementation (RR 1.46; 95%CI 1.45-1.47; p&lt;0.001). Anti-HCV seropositivity decreased from 0.50% to 0.34% (p&lt;0.001). Confirmatory HCV RNA testing among anti-HCV-positive individuals increased from 44.8% to 52.3% (p=0.042). RNA positivity decreased non-significantly from 30.0% to 24.3% (p=0.221). Among 25 providers, treatment initiation increased from 2.61 to 4.34 per 100,000 user-years (RR 1.66; 95%CI 1.34-2.06; p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Early post-policy data suggest significant improvements in HCV screening, confirmatory testing uptake, and treatment initiation following implementation of national HCV policies. Decreased seropositivity likely reflects broader population-based screening.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102276"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#32 - HIGH BURDEN OF ADVANCED LIVER DISEASE IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS: A MEXICAN TERTIARY-CARE HOSPITAL SERIES","authors":"Deborah Espinoza,&nbsp;Viridiana Lopez,&nbsp;Fatima Higuera","doi":"10.1016/j.aohep.2026.102310","DOIUrl":"10.1016/j.aohep.2026.102310","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Primary sclerosing cholangitis (PSC) is a chronic fibroinflammatory cholangiopathy associated with cirrhosis, portal hypertension, cholangitis, hepatobiliary malignancies, and inflammatory bowel disease. Data from Mexico regarding advanced hepatic disease burden are limited.</div></div><div><h3>Objectives</h3><div>To describe the clinical, biochemical, and hepatobiliary complications of PSC patients treated at a tertiary-care hospital.</div></div><div><h3>Materials and Methods</h3><div>Observational, retrospective, descriptive study conducted from 2021 to 2024. Sixteen patients with PSC, defined by clinical, biochemical, and cholangiographic criteria, were included. Descriptive statistics were used to summarize demographic, clinical, biochemical, intestinal, bone, hepatobiliary, oncologic, and disease-severity variables.</div></div><div><h3>Results</h3><div>Mean age was 49.8 ± 11.4 years, and 9/16 patients were female. Large-duct PSC was recorded in 14/16, and mixed intra-/extrahepatic distribution in 14/16. Immune-mediated disease, including inflammatory bowel disease, was present in 9/16; ulcerative colitis was documented in 5/16. Median alkaline phosphatase was 413 U/L (IQR 260.5-476.8), and GGT was 173.5 U/L (IQR 126.2-511). Median MELD was 10.5 (IQR 8.5-14.5), and MELD-Na was 12.5 (IQR 7.8-19.5). Cirrhosis, portal hypertension, and Child-Pugh B/C status were documented in 14/16, 12/16, and 7/16, respectively. Pruritus, fatigue, and jaundice occurred in 11/16, 8/16, and 8/16. Osteoporosis occurred in 4/16, low vitamin D in 3/8, cholangitis in 3/16, ERCP in 5/16, transplantation in 2/16, and cholangiocarcinoma in 1/16; no colorectal cancer was documented.</div></div><div><h3>Conclusions</h3><div>In this Mexican series, PSC showed a high burden of advanced liver disease, cholestatic symptoms, immune-mediated comorbidity, and bone complications. These findings support hepatobiliary, intestinal, bone, and oncologic surveillance. Sample size and retrospective design limit generalizability.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102310"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#37 - THREE-POINT VIBRATION-CONTROLLED TRANSIENT ELASTOGRAPHY: A STRATEGY TO REDUCE UNDERESTIMATION OF LIVER STIFFNESS IN CHRONIC LIVER DISEASE","authors":"Camila Montes,&nbsp;Oscar Morales,&nbsp;Ángel Santana,&nbsp;Fátima Higuera,&nbsp;Daneli Urzúa,&nbsp;José Pérez","doi":"10.1016/j.aohep.2026.102315","DOIUrl":"10.1016/j.aohep.2026.102315","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Liver fibrosis has a heterogeneous parenchymal distribution, which may limit the diagnostic performance of vibration-controlled transient elastography (VCTE) when single-measurement protocols are used. The aim of this study was to evaluate whether multiple VCTE acquisitions increase the identification of maximum liver stiffness values and reduce the potential underestimation of clinically relevant fibrosis.</div></div><div><h3>Materials and Methods</h3><div>Observational, cross-sectional, and descriptive study. Three sequential measurements were performed according to manufacturer quality standards: one at the conventional site and two additional measurements 5 cm above and below the standard point. The primary outcome was the ability of each strategy to match the maximum potentially clinically relevant liver stiffness value.</div></div><div><h3>Results</h3><div>A total of 300 patients were analyzed (58.7 ± 13.7 years). The most frequent etiologies were METALD (43.7%), ALD (14.9%), and MASLD (13.6%). Mean BMI was 28.1 kg/m², and median liver stiffness was 7.9 kPa (IQR 5.3–19.1). A single measurement matched the maximum liver stiffness value in 47% of patients, while a second acquisition increased this proportion to 75.3% (95%CI: 70.7–80.0%). Additional acquisitions reclassified 17 patients into 10 kPa categories and 18 patients into 15 kPa categories. Exact McNemar analysis showed a significant difference for the 7 kPa cutoff (OR 0.46, 95%CI 0.23–0.91; p=0.034).</div></div><div><h3>Conclusions</h3><div>Multipoint measurements increased identification of maximum liver stiffness values; however, studies using a reference standard are required to confirm their diagnostic impact.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102315"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#48 - HEPATIC HYDROTHORAX VERSUS REFRACTORY ASCITES: COMPARATIVE SURVIVAL AND OUTCOME PREDICTORS IN DECOMPENSATED CIRRHOSIS","authors":"Carlos Coronel-Castillo,&nbsp;Fernando Balarezo-Arias,&nbsp;Celina González-Peña,&nbsp;Fatíma Higuera-De-La-Tijera","doi":"10.1016/j.aohep.2026.102323","DOIUrl":"10.1016/j.aohep.2026.102323","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatic hydrothorax (HH) is a complication of advanced chronic liver disease (CLD) whose prognostic impact, compared to other severe portal hypertension-related decompensations, remains poorly defined. The objective was to compare transplant-free survival between patients with HH and refractory ascites (RA) and to identify predictors of outcome.</div></div><div><h3>Materials and Methods</h3><div>Retrospective study of patients with CLD decompensated by HH or RA. Baseline clinical and biochemical characteristics, MELD-Na at diagnosis, follow-up at 1 month and 90 days, complications, and transplant-free survival as a composite endpoint were analyzed. Statistical analysis included Kaplan-Meier curves, log-rank test, and Cox regression.</div></div><div><h3>Results</h3><div>49 patients (55% female, median age 54 years, IQR 47-61): HH without ascites n=6, HH with ascites n=28, RA n=15. Groups were comparable at baseline for MELD-Na (16.2, 16.9, and 19.2, p=0.617) and renal function. 23 events occurred (20 deaths, 3 transplants). Median survival was shorter in HH (141 and 184 days) than in RA (541 days, log-rank p=0.22). 90-day survival was 83%, 64%, and 100%, respectively (<strong>Figure 1).</strong> On multivariable analysis (concordance=0.78), bilirubin was an independent predictor of outcome (HR=1.20, 95%CI 1.03-1.40, p=0.021). In the HH subgroup, non-selective beta-blocker use showed a trend toward lower event risk (HR=0.36, 95%CI 0.13-1.03, p=0.057).</div></div><div><h3>Conclusions</h3><div>HH was associated with substantially shorter survival than RA despite comparable baseline MELD-Na, raising questions about whether current prognostic tools adequately capture its severity. Bilirubin was an independent outcome predictor, and beta-blocker use showed an exploratory signal of potential benefit in HH.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102323"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#56 - COSTS IN LIVER CIRRHOSIS: CLINICAL SEVERITY SURPASSES ETIOLOGY AS THE MAIN ECONOMIC DETERMINANT","authors":"Francisco Arreola-Banda,&nbsp;Katia Torres-Barrera,&nbsp;Javier Carrillo-Rojas,&nbsp;Ana Hernández-Borjón,&nbsp;Viridiana Rodríguez-Granados,&nbsp;Mauricio Castillo-Barradas","doi":"10.1016/j.aohep.2026.102331","DOIUrl":"10.1016/j.aohep.2026.102331","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Liver cirrhosis imposes a substantial economic burden; however, the impact of etiology on healthcare costs remains uncertain. The objective was to evaluate healthcare cost differences among patients with liver cirrhosis according to disease etiology.</div></div><div><h3>Materials and Methods</h3><div>A retrospective cohort study was conducted on adult patients with liver cirrhosis treated at a tertiary hospital in Mexico (2020–2025). Direct costs during the first year were analyzed using institutional cost schedules. Etiology was classified as metabolic, alcohol-related, viral, or autoimmune. Cohort restriction matched groups by age and disease severity. Results were expressed as median (IQR) and compared using the Kruskal–Wallis test, followed by Dunn’s post-hoc test with Bonferroni correction.</div></div><div><h3>Results</h3><div>Overall, 195 patients were included; 60.4% were women, with a median age of 60 years (IQR 52–65), median MELD-Na of 13 (IQR 9–19), and Child–Pugh classes A, B, and C at 38%, 40.5%, and 21.5%, respectively. Significant cost differences were observed by etiology (H=9.08, p=0.028). Autoimmune and metabolic etiologies had the highest costs; alcohol-related had the lowest. Hospitalization was the principal cost driver (64.0%–70.8%). No pairwise comparisons remained significant after Bonferroni correction.</div></div><div><h3>Conclusions</h3><div>Hospitalization represents the major economic burden in cirrhosis. After balancing age and severity, cost differences among etiologies were limited, suggesting that decompensation and clinical severity exert a greater influence on costs than etiology itself.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102331"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#52 - MODELING THE HIDDEN CARDIOVASCULAR MORTALITY BURDEN POTENTIALLY ATTRIBUTABLE TO METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE IN MEXICO: A NATIONAL POPULATION ATTRIBUTABLE RISK ANALYSIS","authors":"Fátima Higuera,&nbsp;Anaís Servín-Higuera,&nbsp;Yoali Maribel Velasco-Santiago,&nbsp;José Pérez","doi":"10.1016/j.aohep.2026.102327","DOIUrl":"10.1016/j.aohep.2026.102327","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>MASLD cardiovascular mortality burden in Mexico is not directly captured in national death records. Aim: To estimate the annual national cardiovascular mortality burden potentially attributable to MASLD in Mexico.</div></div><div><h3>Materials and Methods</h3><div>A national population-attributable risk model was developed using official Mexican mortality data, ENSANUT-based estimates of metabolic fatty liver phenotypes, and published cardiovascular relative-risk estimates associated with MASLD/NAFLD. Cardiovascular mortality for 2024 was defined as deaths from diseases of the heart plus cerebrovascular diseases. Nationally, 192,518 deaths were attributed to heart disease and 34,784 to cerebrovascular disease, yielding 227,302 cardiovascular deaths. Because Mexico lacks a nationwide imaging- or biopsy-confirmed MASLD registry, a base-case MASLD/MAFLD proxy prevalence of 49.6% was used. Three scenario-based relative-risk values were modeled: RR 1.13, 1.20, and 1.40. Population attributable fraction was calculated as PAF = Pe(RR 1)/[1 + Pe(RR 1)], and attributable deaths as observed cardiovascular deaths × PAF.</div></div><div><h3>Results</h3><div>With a modeled MASLD prevalence of 49.6%, the estimated PAF increased progressively across risk scenarios: 6.1% for RR 1.13, 9.0% for RR 1.20, and 16.6% for RR 1.40. These fractions corresponded to 13,769, 20,513, and 37,631 annual cardiovascular deaths potentially attributable to MASLD, respectively. Compared with the most conservative scenario, the intermediate-risk scenario estimated 6,744 additional attributable deaths, whereas the high-risk scenario estimated 23,862 additional deaths. Overall, the modeled burden ranged from approximately 13,700 to 37,600 deaths/year.</div></div><div><h3>Conclusions</h3><div>MASLD may represent a substantial hidden contributor to cardiovascular mortality in Mexico. Prospective Mexican cohorts are needed to validate these estimates.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102327"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#20 - REVIRAL-LATAM: A MULTINATIONAL SURVEY ON VIRAL HEPATITIS ELIMINATION IN LATIN AMERICA","authors":"Joaquín Cabezas,&nbsp;Javier Crespo,&nbsp;Ezequiel Ridruejo,&nbsp;Graciela Castro,&nbsp;Nelia Hernández,&nbsp;Hugo Cheinquer,&nbsp;Fernando Contreras,&nbsp;Christie Perelló,&nbsp;Manuel Mendizabal,&nbsp;Fernando Cairo,&nbsp;Mario Pessoa,&nbsp;Eduardo Emerim,&nbsp;Patricia Guerra,&nbsp;Rodrigo Zapata,&nbsp;Alejandro Soza,&nbsp;Leyla Nazal,&nbsp;Oscar Beltran,&nbsp;Javier Hernández,&nbsp;Martin Garzón,&nbsp;Pablo Coste,&nbsp;José Calleja","doi":"10.1016/j.aohep.2026.102268","DOIUrl":"10.1016/j.aohep.2026.102268","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Viral hepatitis remains a leading cause of cirrhosis and hepatocellular carcinoma globally. Implementation of the WHO 2030 elimination agenda across Latin America and the Caribbean (LAC) remains heterogeneous. REVIRAL-LATAM was conducted under the auspices of the Latin American Association for the Study of the Liver (ALEH) to evaluate policies, clinical practices, structural barriers, and implementation gaps in viral hepatitis elimination across the region.</div></div><div><h3>Patients and Methods</h3><div>Multinational cross-sectional study using a REDCap-based questionnaire adapted from the Hep-CORE framework (171 variables across ten thematic domains—including governance, diagnosis, treatment, screening, micro-elimination, surveillance, and innovation). Data were collected between May–September 2025, with country-level stratification and construction of a Global Elimination Index (IGE).</div></div><div><h3>Results</h3><div>A total of 475 valid responses from 19 LAC countries were analyzed; awareness of national elimination plans was reported for HCV - 67.6% respondents, HBV - 59.1%, and HDV - 11.0%. Test-and-treat implementation remained limited (HCV 19.5%, HBV 13.7%, HDV 3.2%), despite broad availability of simplified HCV treatment (81.5%). Leading barriers included public misinformation(93.1%), insufficient healthcare professional training(86.0%), territorial inequalities(84.8%), lack of prescribing training(81.3%), and hospital-centered care models (77.3%). Coverage was particularly low for indigenous populations(21.8%), migrants(25.5%), and homeless individuals(29.4%). Telemedicine(25.6%), and re-linkage programs(11.4%) remained isolated initiatives. The IGE revealed marked regional heterogeneity(23.7%–55.6%).</div></div><div><h3>Conclusions</h3><div>The principal regional gap is implementation capacity, not therapeutic availability—particularly in decentralized diagnosis, surveillance, vulnerable populations, and integrated care. HDV remains the most neglected elimination component. Reflex-testing, simplified treatment pathways, and micro-elimination strategies should be prioritized toward WHO 2030 targets.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102268"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#79 - BEYOND ALT: MECHANISTIC BIOMARKERS AND ACTIVE PHARMACOVIGILANCE IMPROVE DETECTION OF DRUG-INDUCED LIVER INJURY IN HOSPITALIZED PATIENTS","authors":"Raquel da Costa,&nbsp;Vittoria Sampaio,&nbsp;Paola Alves,&nbsp;Nelson Suarez,&nbsp;Marina Siebert,&nbsp;Patrícia Riedel,&nbsp;Ana Lazzari,&nbsp;Theo Telöken,&nbsp;Tiago Soares,&nbsp;Isabela Carvalhal,&nbsp;Fernando Wolff,&nbsp;Rui D'avila,&nbsp;Mercedes Robles-Diaz,&nbsp;Dvora Joveleviths","doi":"10.1016/j.aohep.2026.102269","DOIUrl":"10.1016/j.aohep.2026.102269","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Drug-induced liver injury (DILI) remains a major challenge in hospitalized patients, where polypharmacy and comorbidities frequently obscure diagnosis. Traditional biomarkers such as alanine aminotransferase (ALT) lack sufficient specificity for accurate differentiation in complex clinical settings.</div><div>To evaluate the diagnostic and prognostic performance of mechanistic biomarkers (K18, GLDH, and MCSFR) and to assess the impact of an active pharmacovigilance system on DILI detection.</div></div><div><h3>Materials and Methods</h3><div>This multicenter prospective cohort study (2021–2025) employed an active pharmacovigilance strategy. Among 5,534 patients identified with elevated liver enzymes, 3,000 medical records underwent rigorous review to adjudicate suspected DILI cases. A total of 78 participants were included and categorized into DILI (RUCAM &gt;3), pre-existing liver disease (PLD), and hospitalized controls. Biomarkers were measured by immunoassay, and diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC).</div></div><div><h3>Results</h3><div>Active pharmacovigilance identified tenfold more DILI cases than passive reporting (23 vs. 2 cases). Anti-infective agents (45.2%) and antineoplastic drugs (19.0%) were the most frequently implicated classes. K18 demonstrated excellent diagnostic accuracy for distinguishing DILI from controls (AUC 0.938; p&lt;0.001). GLDH emerged as a significant prognostic biomarker for DILI-related mortality (AUC 0.806; p=0.030). MCSFR showed moderate diagnostic performance (AUC 0.714) and was associated with mortality in the PLD group (AUC 0.707).</div></div><div><h3>Conclusions</h3><div>Active pharmacovigilance is essential to overcome DILI underreporting in hospitalized populations. K18 represents a robust diagnostic biomarker, while GLDH shows promise as a prognostic indicator of DILI-related mortality.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102269"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"#70 - DIAGNOSTIC CONCORDANCE BETWEEN POINT SHEAR WAVE ELASTOGRAPHY AND ENDOSCOPIC ULTRASOUND-GUIDED LIVER BIOPSY IN THE ASSESSMENT OF HEPATIC FIBROSIS AT A CENTER IN COSTA RICA.","authors":"Carlos Umaña,&nbsp;Melissa Arias,&nbsp;Jorge Vargas,&nbsp;Doris Davila","doi":"10.1016/j.aohep.2026.102344","DOIUrl":"10.1016/j.aohep.2026.102344","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Assessment of hepatic fibrosis is essential in chronic liver disease. Although liver biopsy remains the reference standard, noninvasive methods such as point shear wave elastography (pSWE) are increasingly used in clinical practice.</div><div>To evaluate the diagnostic concordance between pSWE and endoscopic ultrasound-guided liver biopsy (EUS-LB) for hepatic fibrosis assessment and determine the influence of clinical and biochemical factors on concordance.</div></div><div><h3>Materials and Methods</h3><div>A retrospective study was conducted in patients who underwent EUS-guided liver biopsy between March 2025 and March 2026, with pSWE performed within 3 months of biopsy. Demographic, clinical, biochemical, and fibrosis staging data were analyzed. Concordance between fibrosis stages determined by pSWE and biopsy was assessed, along with the influence of age, liver enzymes, alkaline phosphatase, and liver disease etiology.</div></div><div><h3>Results</h3><div>Thirty-one patients underwent both procedures. MASLD was the most common etiology (35.5%), followed by undetermined causes (29.0%) and autoimmune/cholestatic disease (29.0%). Most patients were Child-Pugh A (83.9%). Biopsy identified more F0 fibrosis cases (32.3% vs 19.4%), whereas pSWE classified more patients as having significant fibrosis (F2: 45.2% vs 32.3%), suggesting fibrosis overestimation in low-to-moderate stages.pSWE demonstrated excellent ability to discriminate the presence of significant fibrosis (F2), with an AUC of 0.933. The 12.23 kPa cutoff value maximized the combination of sensitivity and specificity,achieving a very high specificity (95.2%). Exact concordance between techniques was 61.3%, while concordance within ±1 fibrosis stage reached 83.9%. Linear weighted kappa demonstrated substantial agreement (=0.606). No clinical or biochemical variable showed a statistically significant association with concordance (all p&gt;0.05).</div></div><div><h3>Conclusions</h3><div>pSWE demonstrated substantial agreement with EUS-guided liver biopsy for hepatic fibrosis staging, with most discordances limited to minor differences in fibrosis classification. In addition, pSWE showed excellent diagnostic performance for the identification of significant fibrosis (F2), supporting its role as a reliable noninvasive tool for fibrosis stratification in patients with chronic liver disease.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102344"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}