Annals of hepatology最新文献

{"title":"#167 - BEYOND CT-DEFINED SARCOPENIA IN CIRRHOSIS: A CRITICAL REVIEW AND META-ANALYSIS OF SIMPLIFIED DIAGNOSTIC TOOLS","authors":"Thiago Araujo,&nbsp;Catiele Antunes,&nbsp;Pedro Passos,&nbsp;Bruna Noronha,&nbsp;Alisson Silva,&nbsp;Guilherme Cançado","doi":"10.1016/j.aohep.2026.102280","DOIUrl":"10.1016/j.aohep.2026.102280","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Sarcopenia in cirrhosis is commonly assessed using computed tomography (CT)-derived skeletal muscle index, despite current concepts emphasizing muscle strength and function as central components. CT also has practical limitations, restricting its use as a universal screening strategy. We aimed to evaluate simplified diagnostic tools for sarcopenia in cirrhosis compared with CT-based assessment and to discuss a broader multidimensional approach beyond muscle mass alone.</div></div><div><h3>Materials and Methods</h3><div>A systematic review and meta-analysis were conducted according to PRISMA-DTA guidelines (PROSPERO: CRD420251270343). Studies evaluating simplified methods for sarcopenia in adults with cirrhosis were included, using CT-derived skeletal muscle index at L3 as the reference standard. Diagnostic performance was summarized using pooled diagnostic odds ratios (DORs), while correlation coefficients assessed agreement with CT-based evaluation. Random-effects models, subgroup analyses, and meta-regression were performed. Study quality was assessed with QUADAS-2.</div></div><div><h3>Results</h3><div>Twelve studies comprising 2,522 patients were included. Simplified methods demonstrated moderate diagnostic performance overall (DOR 12.91, 95% CI 5.63–29.62). Ultrasound showed the highest performance (DOR 22.43), followed by handgrip strength (15.39), whereas bioelectrical impedance analysis (4.48) and SARC-F (3.44) performed less favorably. Correlation with CT-based assessment was moderate (r0.58), indicating only partial overlap between methods. Meta-regression showed no significant association between diagnostic performance and age, body mass index, or sex. Study quality was overall acceptable, without evidence of publication bias.</div></div><div><h3>Conclusions</h3><div>Simplified bedside methods provide moderate diagnostic performance and only partial agreement with CT-defined sarcopenia, supporting a shift toward a more accessible and multidimensional assessment strategy in cirrhosis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102280"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810648","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":"#81 - TREND IN MORTALITY OF THE HEPATOCELLULAR CARCINOMA IN COLOMBIA, 2000-2024","authors":"Nelson Alvis-Guzman,&nbsp;Ismael Yepes,&nbsp;Nelson Alvis-Zakzuk","doi":"10.1016/j.aohep.2026.102352","DOIUrl":"10.1016/j.aohep.2026.102352","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide; in low- and middle-income countries like Colombia, its burden remains poorly characterised, limiting effective public health responses. This study describes HCC mortality trends across Colombia (2000–2024), stratified by age and sex.</div></div><div><h3>Materials and Methods</h3><div>HCC was defined using ICD-10 code C22. Crude mortality rates (HCMR) per 100,000 person-years were estimated and distributed by age, sex, and year. Temporal trends were analysed using Joinpoint regression, calculating annual percent change (APC). Data were obtained from DANE vital statistics microdata</div></div><div><h3>Results</h3><div>4,407 HCC-related deaths were recorded (0.80% of total); 51.3% in women and 78.4% in individuals aged 60 and over. Mean age at death was 69.3 years (SD: 14.1). C22.9 accounted for 58.5% of deaths, C22.0 for 20.1%, and C22.1 for 16.1%. HCMR increased from 3.49 (95% CI: 3.30–3.68) to 4.27 (95% CI: 4.09–4.45). In men, it rose from 3.33 to 4.48 (APC: 0.94); in women, from 3.64 to 4.07 (APC: 0.07, non-significant).</div></div><div><h3>Conclusions</h3><div>HCC-related mortality increased significantly in Colombia over the study period, driven primarily by rising rates in men, with no significant change observed in women.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102352"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810658","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":"#27 - EVALUATION OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE IN AGRICULTURAL WORKERS EXPOSED AND UNEXPOSED TO MANCOZEB","authors":"Hidayat Ullah,&nbsp;Dvora Joveleviths,&nbsp;Camila Baldin,&nbsp;Nelson Suarez,&nbsp;Vittoria Calvi,&nbsp;Raquel Da Costa,&nbsp;Patricia Riedel,&nbsp;Isabela Carvalhal,&nbsp;Ana Lazzari,&nbsp;Eduardo Klein,&nbsp;Debora Costa,&nbsp;Theo Teloken,&nbsp;Tiago Soares","doi":"10.1016/j.aohep.2026.102306","DOIUrl":"10.1016/j.aohep.2026.102306","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Mancozeb is a widely used agricultural fungicide with potential hepatotoxic effects and metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in the general population.This study aimed to compare liver profile (fibrosis index-4),hormonal parameters (thyroid-stimulating hormone, free thyroxine, and C-peptide) and metabolic markers (homeostasis model assessment of insulin resistance, glycated hemoglobin and lipid profile)between individuals chronically exposed to Mancozeb and unexposed individuals.</div></div><div><h3>Materials and Methods</h3><div>This cross-sectional study included 92 participants from Veranópolis,Brazil (46 exposed and 46 unexposed),using statistical tests (p &lt; 0.05),with sample power of 70% and significance level of 5%.</div></div><div><h3>Results</h3><div>HOMA-IR values were similar between groups (2.46vs.2.6).Higher liver fibrosis risk was observed among exposed individuals, with higher mean FIB-4 values (1.38vs.1.12) and FIB-4 &gt;2.67 in 4% of exposed participants,absent in unexposed individuals.The unexposed group had more low-risk individuals (31vs.24),whereas the exposed group had more individuals at increased fibrosis risk (22 vs. 15). Mean TSH levels were slightly higher in exposed individuals (2.7 µIU/mLvs.1.9 µIU/mL),while FT4 levels were similar.HbA1c showed no difference, with mean values of 5.5% in both groups. C-peptide levels were comparable (2.4ng/mL vs. 2.3ng/mL). Exposed individuals showed lower total cholesterol (192.9 mg/dL vs. 215 mg/dL) and triglycerides (138.1 mg/dL vs. 163.2 mg/dL),likely related to higher occupational physical activity.</div></div><div><h3>Conclusions</h3><div>Chronic exposure to Mancozeb may be associated with increased hepatic fibrosis risk and subclinical thyroid axis alterations in individuals with cardiometabolic criteria for MASLD.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102306"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810717","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":"#90 - AUTOIMMUNE HEPATITIS IN MEXICO: FIBROSIS BURDEN AT DIAGNOSIS AND THE URGENCY FOR EARLY RECOGNITION","authors":"Orfanel Pineda,&nbsp;Liz Topanta-Yanchapaxi,&nbsp;Viridiana López-Ladrón De Guevara,&nbsp;María Jourdan-Rodríguez,&nbsp;Ricardo Gutierrez-Monterrubio,&nbsp;Julio Rincón-Camacho,&nbsp;Alejandro Gutierrez-Castillo,&nbsp;Luis Rubio-Acosta,&nbsp;Araceli Lopez-Nepomuceno,&nbsp;Claudia López-López,&nbsp;Ignacio García-Juárez","doi":"10.1016/j.aohep.2026.102360","DOIUrl":"10.1016/j.aohep.2026.102360","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Autoimmune hepatitis (AIH) is a heterogeneous disease lacking pathognomonic features, often delaying diagnosis and treatment. Consequently, many patients present with advanced fibrosis or cirrhosis at diagnosis. This study aimed to describe the prevalence of advanced fibrosis at diagnosis and clinical outcomes in a Mexican multicenter AIH cohort</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective multicenter cohort study including adult patients with AIH treated between 2010 and 2025. Demographic, clinical, and histological data were obtained from medical records and pathology archives. Continuous variables were analyzed using Student’s t-test or Mann-Whitney U test, and categorical variables using Chi-square tests.</div></div><div><h3>Results</h3><div>A total of 329 patients were included; 83.3% were women, with a median age of 43 years (IQR 32–55). AIH was diagnosed in 61.4% of patients, AIH-primary biliary cholangitis overlap syndrome in 36.5%, and AIH-primary sclerosing cholangitis overlap in 2.1%. Advanced fibrosis at diagnosis was present in 51.8% of women and 54.5% of men. Metabolic comorbidities were identified in 51.2% of patients, including dyslipidemia (33.1%), diabetes mellitus (27.6%), and hypertension (22.7%). Among patients with advanced fibrosis, only 28.5% achieved a complete response, while 18.6% underwent liver transplantation and 12.8% died during follow-up. Despite treatment, progression to F4 fibrosis increased during follow-up in both women and men.</div></div><div><h3>Conclusions</h3><div>Advanced fibrosis was highly prevalent at diagnosis and remained associated with poor clinical outcomes despite treatment, underscoring the importance of earlier recognition and structured long-term follow-up in AIH.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102360"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810719","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":"#132 - CYSTATIN C VERSUS CREATININE AND MELD SCORE FOR MORTALITY PREDICTION IN PATIENTS WITH ACLF: A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"Eliabe Abreu,&nbsp;Bernardo Moraes,&nbsp;Gabriel Fernandes,&nbsp;Ana Leite,&nbsp;Diego Sousa,&nbsp;Luisa Visentini,&nbsp;Yigit Yazarkan,&nbsp;Yohanna Rossi,&nbsp;Sriharsha Koduru,&nbsp;Guilherme Cançado","doi":"10.1016/j.aohep.2026.102277","DOIUrl":"10.1016/j.aohep.2026.102277","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The CLIF-C ACLF score is used for mortality prediction and treatment prioritization in patients with acute-on-chronic liver failure (ACLF), utilizing creatinine to assess renal function. Cystatin C (CysC) has emerged as a more accurate biomarker for renal function assessment. We compared the mortality prediction performances of CysC, creatinine, and MELD (exploratory) in patients with ACLF.</div></div><div><h3>Materials and Methods</h3><div>We systematically searched PubMed, EMBASE, and Web of Science for studies comparing CysC with creatinine or MELD score in patients with ACLF. Random-effects meta-analyses were performed using the ratio of hazard ratios (RHRs) and pooled areas under the receiver-operating-characteristic-curve (AUCs) when data were available. Results are presented with 95% confidence intervals (95%CI).</div></div><div><h3>Results</h3><div>Six studies, including 1,123 patients, were included. Overall, 69.4% (n=779) of the patients were male. CysC was not significantly superior to creatinine for mortality prediction (RHR 1.77, 95%CI 0.97–3.24; I²=84.2%; 1,011 patients). At its best cut-off, defined by the Youden index, CysC sensitivity, specificity, and AUC for 90-day mortality prediction were 0.708 (0.646-0.762), 0.673 (0.566-0.702), and 0.715 (0.632-0.762), respetively.</div><div>Similarly, MELD sensitivity, specificity, and AUC for the same outcome were 0.604 (0.461-0.731), 0.702 (0.516-0.839), and 0.668 (0.436-0.872), respectively. There was no statistically significant difference between CysC and MELD score (p=0.826).</div></div><div><h3>Conclusions</h3><div>In patients with ACLF, CysC presented a similar performance for mortality prediction as creatinine and MELD. Considering the current evidence, limited availability and higher cost of CysC compared to creatinine, creatinine-based assessment of renal function remains the most suitable strategy for mortality prediction in patients with ACLF.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102277"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810721","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":"#42 - PRIMARY BILIARY CHOLANGITIS IN A REGIONAL CHILEAN HOSPITAL: INDIGENOUS MAPUCHE ETHNICITY AS AN INDEPENDENT PREDICTOR OF UDCA NON-RESPONSE IN A SIX-YEAR RETROSPECTIVE COHORT","authors":"Hugo Lucero,&nbsp;Luis Bustamante,&nbsp;Carolina Ruiz,&nbsp;Marco Hidalgo,&nbsp;Raul Martínez,&nbsp;Jesmi Quiroz,&nbsp;Paula de la Rosa","doi":"10.1016/j.aohep.2026.102317","DOIUrl":"10.1016/j.aohep.2026.102317","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Primary biliary cholangitis (PBC) is a chronic cholestatic autoimmune liver disease. Epidemiological data from Latin America are scarce, and the role of indigenous ethnicity on treatment response remains unexplored.</div><div>To characterize a regional PBC cohort and identify independent predictors of UDCA non-response and hepatic complications, evaluating whether Mapuche ethnicity predicts UDCA non-response.</div></div><div><h3>Materials and Methods</h3><div>Descriptive, observational, retrospective single-center cohort carried out between January 2018 and December 2024.</div><div>All patients with a confirmed PBC diagnosis. Biochemical response was assessed by Paris II, and Toronto criteria. GLOBE score was evaluated pre-and post-treatment. Multivariable logistic regression identified predictors of non-response and complications.</div></div><div><h3>Results</h3><div>85 patientes were included in the study. Mean age at diagnosis was 59.0±10.9 years; 97.6% female; 30.6% Mapuche indigenous. Response rates: 34.1% Paris II, 36.5% Toronto at 12 months.</div><div>Multivariable analysis identified three independent predictors of UDCA non-response: Mapuche ethnicity, high GLOBE score pre-treatment, and elevated IgM. Independent predictors of hepatic complications were: baseline cirrhosis, platelet count &lt;175,000/mm³, and UDCA non-response.</div><div>No patient with low post-treatment GLOBE score developed complications. Toronto response at 6 months showed substantial concordance with 12-month response (kappa=0.631).</div></div><div><h3>Conclusions</h3><div>Mapuche ethnicity is an independent predictor of UDCA non-response. Platelet count below 175,000/mm³ is an accessible, low-cost biomarker for complication risk. GLOBE score may have a role in latin america population in predicting complications and UDCA biochemical response. Six-month evaluation should guide second-line treatment decisions.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102317"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810485","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":"#61 - ASSESSMENT OF LIVER FIBROSIS BY ELASTOGRAPHY IN FARMERS EXPOSED TO ETHYLENEBISDITHIOCARBAMATES (EBDC) AND 2,4-D","authors":"Nelson Suarez,&nbsp;Dvora Joveleviths,&nbsp;Matheus Truccolo,&nbsp;Raquel De Fraga,&nbsp;Raquel Da Costa,&nbsp;Vittoria Sampaio,&nbsp;Theo Telöken,&nbsp;Ana Lazzari,&nbsp;Camila Pereira,&nbsp;Sheila Toniasso,&nbsp;Patrícia Riedel,&nbsp;Alexandre De Araújo,&nbsp;Hidayat Kassim,&nbsp;Tiago Soares","doi":"10.1016/j.aohep.2026.102335","DOIUrl":"10.1016/j.aohep.2026.102335","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>The use of chemical inputs such as fertilizers and pesticides makes Brazil one of the largest consumers of agrochemicals worldwide, with emphasis on the fungicide Mancozeb and the herbicide 2,4-D (2,4-dichlorophenoxyacetic acid).To evaluate liver fibrosis and steatosis in rural workers exposed to these pesticides, comparing them with non-exposed individuals and correlating the findings with biochemical markers, oxidative stress, and genotoxicity.</div></div><div><h3>Materials and Methods</h3><div>A total of 150 participants were evaluated and divided into three groups: controls (n=50), individuals exposed to 2,4-D (n=50), and individuals exposed to Mancozeb (n=50). All participants underwent transient liver elastography (FibroScan), as well as clinical and laboratory data collection.</div></div><div><h3>Results</h3><div>After confirmation of chronic exposure and biochemical hepatotoxicity, increased liver stiffness was observed in the group exposed to 2,4-D, with 16% (8/50) presenting values &gt;7.1 kPa, compatible with F1 fibrosis, compared with 3% (1/33) in the control group. Regarding steatosis, 28% (14/50) of exposed individuals presented CAP values &gt;268 dB/m, while the frequency in the control group was 24% (8/33). Preliminary findings suggest an association between chronic occupational exposure to 2,4-D and liver abnormalities. Analysis of the Mancozeb-exposed group is ongoing.</div></div><div><h3>Conclusions</h3><div>Chronic exposure to 2,4-D increases the risk of hepatic steatosis and fibrosis. This pioneering study uses liver elastography to investigate occupational hepatotoxicity in individuals exposed to Mancozeb and 2,4-D.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102335"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810595","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":"#15 - BCLC STAGE MIGRATION AND TREATMENT TRAJECTORIES IN PATIENTS WITH HEPATOCELLULAR CARCINOMA MANAGED AT A CLINICAL EXCELLENCE CENTER","authors":"Angélica Sanabria-Jiménz,&nbsp;María Ariza-De La Hoz,&nbsp;Oscar Beltrán-Galvis,&nbsp;Geovanny Hernández-Cely,&nbsp;Cristina Torres-Caro,&nbsp;Martín Garzón-Olarte,&nbsp;Carolina Salinas-Gómez,&nbsp;Adriana Varón-Puerta","doi":"10.1016/j.aohep.2026.102297","DOIUrl":"10.1016/j.aohep.2026.102297","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular carcinoma is a dynamic disease in which prognosis and treatment allocation may change over time according to tumor progression, liver function, and clinical status. Describing BCLC stage migration may help understand real-world patient trajectories within specialized multidisciplinary care programs.</div><div>To describe BCLC stage migration and treatment trajectories among patients with hepatocellular carcinoma managed at a Clinical Excellence Center in Colombia</div></div><div><h3>Materials and Methods</h3><div>Retrospective descriptive cohort of adults with confirmed HCC enrolled between September 2022 and December 2025. BCLC stage, multidisciplinary management, treatments, transplantation, stage transitions, and follow-up status were analyzed using transition matrices and alluvial plots. Progression was defined as migration to a higher BCLC stage or death.</div></div><div><h3>Results</h3><div>Among 134 patients, most were diagnosed at early or intermediate stages, mainly BCLC A (62.69%) and BCLC B (26.12%). Initial treatments included ablation (23.88%), transarterial chemoembolization (23.13%), systemic therapy (19.40%), combined therapy (15.67%), liver transplantation (9.70%), hepatectomy (2.99%), and other strategies (5.22%). Among patients initially classified as BCLC A, 51.2% remained stable, 12.8% progressed to a higher stage, 15.1% underwent liver transplantation, and 20.9% died during follow-up. Among BCLC B patients, 54.3% remained stable, 17.2% progressed to stages C or D, 8.6% underwent transplantation, and 20.0% died. Among BCLC C patients, 66.7% died during follow-up, and all patients initially classified as BCLC D died.</div></div><div><h3>Conclusions</h3><div>In this real-world cohort, BCLC stage migration and death occurred despite a high proportion of early-stage diagnosis. These findings highlight the dynamic clinical course of hepatocellular carcinoma and support the need for longitudinal multidisciplinary follow-up beyond initial treatment allocation.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102297"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810711","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":"#95 - REGIONAL HETEROGENEITY OF FIBROSIS SEVERITY AND AGE-ADJUSTED FIB-4 PERFORMANCE IN A BRAZILIAN BIOPSY-PROVEN MASLD COHORT","authors":"Cristiane Villela-Nogueira,&nbsp;Cristiane Tovo,&nbsp;Nathalie Leite,&nbsp;Cláudia Ivantes,&nbsp;Cláudia Couto,&nbsp;Giovanni Silva,&nbsp;Helma Pinchemel Cotrim,&nbsp;Mário Álvares-Da-Silva,&nbsp;Edson Parise,&nbsp;Ana Cardoso,&nbsp;Natália Wajsbrot,&nbsp;Luis Ferreira,&nbsp;Muriel Manica,&nbsp;Gabriela Coral,&nbsp;Claudia Cardoso,&nbsp;Gil Salles,&nbsp;Rafael Novaes,&nbsp;Brian Pinheiro,&nbsp;Rosangela Réa,&nbsp;Luciana Faria,&nbsp;Claudia de Oliveira","doi":"10.1016/j.aohep.2026.102273","DOIUrl":"10.1016/j.aohep.2026.102273","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>MASLD is currently the most prevalent chronic liver disease worldwide, with an estimated prevalence of 44% in Latin America. This study reassessed MASLD prevalence across Brazilian regions and evaluated FIB-4 accuracy in biopsy-confirmed patients.</div></div><div><h3>Materials and Methods</h3><div>A multicenter observational study evaluated 2.335 MASLD Brazilian patients from tertiary hepatology centers across different regions of the country.</div></div><div><h3>Results</h3><div>The mean age was 49.1±14.4 years, and 50.3% were women. Significant fibrosis (F2) was identified in 34.3% patients, advanced fibrosis (F3) in 16.2%, and decompensated cirrhosis in 3.4%. Marked regional heterogeneity was observed, with the Northeast presenting the highest prevalence of significant fibrosis (50.4%) and advanced fibrosis (47.3%), while the South showed the lowest rates (16.6% and 12.9%, respectively; p&lt;0.001).</div><div>Multivariate analysis demonstrated that older age, T2DM, obesity, and residence in Northeast region were independently associated with advanced fibrosis. FIB-4 data were available for 1,853 individuals, with an overall AUROC of 0.80 (95% CI 0.77–0.83) for detecting F3. However, diagnostic performance was lower in patients aged 65 years (AUROC 0.77; 95% CI 0.66–0.80; p&lt;0.001), highlighting reduced specificity when traditional cutoffs (&lt;1.3 and 2.67) were applied in older individuals. Age-stratified analysis identified optimized cutoffs of 0.98 for patients 65 years and 1.78 for those &gt;65 years.</div></div><div><h3>Conclusions</h3><div>Brazilian MASLD patients demonstrated a substantial burden of significant and advanced fibrosis, with important regional disparities. These findings reinforce the heterogeneous and progressive nature of MASLD in Brazil and suggest that current FIB-4 cutoffs may require adjustment for Latin American populations, particularly in older individuals.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102273"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810632","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":"#66 - IN-HOSPITAL MORTALITY OF PATIENTS WITH COMPLICATED CIRRHOSIS: DEVELOPMENT OF A PREDICTIVE MODEL.","authors":"Dayron Páez,&nbsp;Kevin Pérez,&nbsp;Denya López,&nbsp;Ángel Espinoza,&nbsp;Yusniel Almeida,&nbsp;Roberto León","doi":"10.1016/j.aohep.2026.102340","DOIUrl":"10.1016/j.aohep.2026.102340","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Complications of hepatic cirrhosis are a major cause of hospitalization and mortality among affected patients.</div><div>To determine clinical predictors of in-hospital mortality in patients with complicated cirrhosis.</div></div><div><h3>Materials and Methods</h3><div>An observational, analitycal, retrospective study was conducted in the Gastroenterology Service of a tertiary-level institution between January 2022 and December 2024. The sample included 104 patients who met the selection criteria. Variables collected were Child-Pugh score, clinical stage (D’Amico), cirrhosis-related complications, history of prior decompensation, recent hospitalization (within the last 3 months), and discharge status (alive/deceased). Associations with mortality were evaluated using ² or Fisher’s exact test. A LASSO (L1) logistic regression model was constructed to identify predictors of in-hospital mortality, with a significance level of = 0.05.</div></div><div><h3>Results</h3><div>The mean age was 59.3 ± 11.0 years, and 59.6% were men. Toxic alcohol use was reported in 41.3%. Ascites was the leading cause of admission (41.3%) and the most frequent complication (76%), followed by hepatocellular carcinoma (26.9%) and encephalopathy (23.1%). Most patients were classified as D’Amico stage 5 (48.1%) and Child-Pugh class B (50.9%). Overall mortality was 14.4%. The LASSO model identified six predictors of in-hospital mortality: prior decompensation, Child-Pugh class C, D’Amico stage 6, portal hypertension–related gastrointestinal bleeding, hepatorenal syndrome, and ACLF. The model demonstrated good discriminative capacity (p &lt; 0.05) and acceptable calibration despite class imbalanced (survivors = 89; deceased = 15).</div></div><div><h3>Conclusions</h3><div>In-hospital mortality in patients with complicated cirrhosis is associated with advanced disease stages and major complications.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"31 ","pages":"Article 102340"},"PeriodicalIF":6.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148810654","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}