Annals of hepatology最新文献

{"title":"FROM POLICY TO PRACTICE: HEPATITIS C CARE INDICATORS IN URUGUAY BEFORE AND AFTER THE INTRODUCTION OF PUBLIC HEALTH STRATEGIES","authors":"Victoria Mainardi ,&nbsp;Susana Cabrera ,&nbsp;Luciana Noble ,&nbsp;Daniela Olivari ,&nbsp;Solange Gerona ,&nbsp;Sebastian Marciano ,&nbsp;Huaiyang Zhong ,&nbsp;Julio Medina","doi":"10.1016/j.aohep.2025.102040","DOIUrl":"10.1016/j.aohep.2025.102040","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Uruguay has implemented measures since 2022 to strengthen its hepatitis C response, aligned with WHO’s 2030 elimination targets. These include national guidelines and awareness campaigns. In July 2024, two key policies were introduced: the inclusion of HCV RNA testing in the national health plan and a one-time anti-HCV screening during mandatory health exams for work and physical activity, initially targeting individuals aged 56–64.</div><div>We aimed to assess differences in the national hepatitis C cascade of care before and after the implementation of these public policies.</div></div><div><h3>Materials and Methods</h3><div>Data were collected through structured surveys sent by the Ministry of Health to all 44 national healthcare providers. Cascade indicators were analyzed for 2022, 2023 and 2024, including anti-HCV testing, seropositivity, HCV RNA testing, RNA positivity, and treatment initiation. All indicators were normalized per 100,000 users covered by respondents.</div></div><div><h3>Results</h3><div>In 2024, 29 healthcare providers responded (covering 90% of health system users). In 2022–2023, 22 providers reported laboratory indicators (35% coverage), while 25 reported treatment indicators (73%).</div><div>Anti-HCV testing rose from 2,883 in 2022 to 5,548 per 100,000 users in 2024. HCV RNA testing increased from 6.1 to 20.4, and treatment initiation from 2.6 to 4.9 per 100,000 users. Seropositivity remained stable (0.7%). Among anti-HCV–positive individuals, HCV RNA testing uptake increased from 37% in 2022 to 54% in 2024.</div></div><div><h3>Conclusions</h3><div>Improvements observed in the cascade of care align with the implementation of targeted hepatitis C policies, highlighting their potential role in supporting national elimination efforts.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102040"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154332","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":"FROM PATIENT TO EXPERT: EDUCATION FOR SELF-MANAGEMENT OF HEPATOCELLULAR CARCINOMA IN A CLINICAL EXCELLENCE PROGRAM","authors":"William Hernando Jiménez Mariño ,&nbsp;Angélica María Sanabria Jiménez ,&nbsp;María del Rosario Ariza de la Hoz ,&nbsp;Oscar Alfredo Beltrán Galvis ,&nbsp;María del Rosario Ariza de la Hoz ,&nbsp;María Cristina Torres Caro ,&nbsp;Diana Carolina Salinas Gómez ,&nbsp;Martín Garzón Jiménez ,&nbsp;Geovanny Hernández Cely ,&nbsp;Adriana Varón Puerta","doi":"10.1016/j.aohep.2025.102010","DOIUrl":"10.1016/j.aohep.2025.102010","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Education for patients and caregivers is essential to improve understanding of hepatocellular carcinoma, support self-management, and promote informed decisions. At Fundación Cardioinfantil, a structured educational program was implemented as part of the Clinical Excellence Program. This work aims to describe the program’s implementation, and the progress achieved in patient knowledge, treatment adherence, and continuity of care at home.</div></div><div><h3>Materials and Methods</h3><div>A descriptive, cross-sectional study was conducted to describe the educational process delivered to patients with hepatocellular carcinoma and their caregivers. Patients are initially assessed to determine their level of disease knowledge and classified into basic, intermediate, or advanced levels. Based on this, they receive a personalized education plan with printed materials and guided sessions. Progress is evaluated quarterly during follow-up visits to reinforce or adjust the intervention.</div></div><div><h3>Results</h3><div>Since its implementation, the program has provided education to 106 patients. Currently, 68% have progressed to intermediate or advanced levels, while 32% remain at the basic level, either because they are in the early stages of the program or awaiting the start of treatment. Among the 40 active patients, 28 have reached an advanced educational level, reflected in greater disease understanding, recognition of warning signs, and improved adherence reported during clinical follow-up.</div></div><div><h3>Conclusions</h3><div>Educational strategy implemented within the Hepatocellular Carcinoma Clinical Excellence Program has proven effective in empowering patients through a structured and personalized approach. The educational progress underscores the value of integrating education into clinical care, allowing patients to actively and confidently participate in managing their condition. This experience represents a replicable model that could be adapted to other chronic disease care initiatives, particularly in high-complexity healthcare settings across Latin America.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102010"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154495","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":"IMPACT OF DIRECT-ACTING ANTIVIRALS ON THE FIB-4 INDEX IN PATIENTS WITH CHRONIC HEPATITIS C AND SUSTAINED VIROLOGICAL RESPONSE.","authors":"Raúl Ramírez Marcial ,&nbsp;Scherezada María Isabel Mejía Loza ,&nbsp;María del Rosario Herrero Maceda ,&nbsp;Rodrigo Vázquez Pérez ,&nbsp;Oswaldo Pavel Cervantes Gutiérrez","doi":"10.1016/j.aohep.2025.102019","DOIUrl":"10.1016/j.aohep.2025.102019","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Fibrosis regression is associated with broad clinical benefits and remains an important therapeutic goal in patients with advanced fibrosis who achieve a sustained virological response (SVR) to hepatitis C virus (HCV) treatment. Studies conducted in Asia have reported fibrosis regression in 55% to 75% of patients. Currently, there are no published reports from studies conducted in our country.</div><div>Evaluate the impact of direct-acting antiviral (DAA) therapy on the Fib-4 index in patients with chronic hepatitis C who achieved a sustained virological response (SVR).</div></div><div><h3>Materials and Methods</h3><div>Patients were classified into two groups: non-cirrhotic (n=28) and cirrhotic (n=62). Pre- and post-treatment Fib-4 index values were collected and compared. The Wilcoxon signed-rank test, a non-parametric test, was used to compare pre- and post-treatment Fib-4 scores within each group. The Mann-Whitney U test was applied to compare whether the magnitude of change in the Fib-4 score differed between the non-cirrhotic and cirrhotic groups. A p-value of ≤ 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Both groups experienced a statistically significant reduction in post-treatment Fib-4 scores (p&lt;0.001). The magnitude of this reduction was significantly greater in the group of patients with cirrhosis compared to those without cirrhosis (p = 0.027). (See Figure 1).</div><div>Our study demonstrates that successful DAA therapy leads to a statistically significant reduction in the Fib-4 index in a Mexican cohort of patients with chronic HCV, a finding that is consistent with reports from other regions. This reduction in a key non-invasive marker suggests a regression of liver fibrosis or, at a minimum, a significant decrease in necroinflammatory activity upon viral eradication.</div></div><div><h3>Conclusions</h3><div>DAA therapy significantly reduces the Fib-4 score in patients with chronic HCV, regardless of the presence of cirrhosis. This demonstrates a favorable impact, thereby improving the prognosis for these patients.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102019"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154576","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":"EXPERIENCE IN THE TREATMENT OF HEPATITIS C IN PREGNANT PATIENTS AT THE HEPATITIS CLINIC OF THE VERACRUZ HIGH SPECIALTY HOSPITAL","authors":"Maria Teresa Guzmán Terrones ,&nbsp;Eve Flynn Ferreira ,&nbsp;Luis Del Carpio Orantes ,&nbsp;Raúl Terrones Castro","doi":"10.1016/j.aohep.2025.102002","DOIUrl":"10.1016/j.aohep.2025.102002","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Currently, HCV treatment options during pregnancy are not well-defined. Typical clinical practice is to refer and link pregnant women for treatment after pregnancy and breastfeeding; however, in practice, very few have completed successful treatment. To date, three case series have been published that include safety results for HCV treatment in pregnancy. ACOG recommends that DAAs be initiated only through a clinical trial and that pregnant women while taking a DAA should be counseled about the risks and benefits of continuing treatment.</div><div>To report the experience of the HAEV Hepatitis Clinic with the treatment of 3 pregnant women with HCV on DAAs during the second half of pregnancy with sustained viral response (SVR) and no adverse effects to the combination to date.</div></div><div><h3>Patients and Methods</h3><div>Since 2021, three cases of pregnant women with HCV infection confirmed by viral load have been presented. After evaluation and categorization as F0-F1 by FIB 4, they were treated with Sofosbuvir-Velpatasvir 400/100 mg for 90 days</div></div><div><h3>Results</h3><div>Patients were treated with Sofosbuvir-Velpatasvir 400/100 mg for 90 days, with no reports of perinatal abnormalities. The subsequent negative viral load was achieved in the pair. Only one patient reported headache and dizziness as adverse symptoms. After monitoring, a planned termination of pregnancy was decided to reduce the risk of vertical transmission, and counseling on proper breastfeeding techniques was provided to discontinue breastfeeding.</div></div><div><h3>Conclusions</h3><div>Sofosbuvir-Velpatasvir was administered for 12 weeks without adverse effects on the pair, and SVR was achieved at the time of treatment in the three treated patients, demonstrating the effectiveness and safety of the treatment. This provides a solution to a public health and maternal-fetal problem in our setting, which prevents perinatal transmission. Following these results, we propose evaluating its use in similar cases with the intention of contributing to the eradication of HCV infection.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102002"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154754","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":"NURSING CARE STRATEGIES FOR INDIVIDUALS WITH VIRAL HEPATITIS IN THE CONTEXT OF PRIMARY HEALTH CARE","authors":"Joao Vítor da Silva Mota ,&nbsp;Ana Paula Maciel Gurski ,&nbsp;Carla Francisca dos Santos Cruz ,&nbsp;Mario Peribanez Gonzalez ,&nbsp;Elton Carlos de Almeida ,&nbsp;Aline Alves da Silva ,&nbsp;Ana Mônica de Mello ,&nbsp;Nathalia da Silva Cruz ,&nbsp;Isabelle Cristine de Jesus Macedo ,&nbsp;José Nilton Neris Gomes ,&nbsp;Leonardo Carrara Matsuura","doi":"10.1016/j.aohep.2025.102045","DOIUrl":"10.1016/j.aohep.2025.102045","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Nursing professionals play an important role in the prevention, diagnosis, and care of viral hepatitis in Primary Health Care. Understanding nursing practices is essential to strengthening disease elimination strategies.</div><div>To identify nursing actions in the care of people with viral hepatitis in the context of Primary Health Care.</div></div><div><h3>Materials and Methods</h3><div>Data were collected through a form developed by the General Coordination for the Surveillance of Viral Hepatitis and the Federal Nursing Council, sent to nursing professionals in Brazil. The data were then tabulated, entered into an electronic database, and analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>The sample consisted of 1,573 participants. It was found that 91.3% of nursing professionals assess users' vaccination status. However, 71.3% of nurses reported never having requested viral load or molecular tests for viral hepatitis, although 83.6% stated that doing so would simplify diagnosis and patient referrals. Regarding complementary exams, 42.8% of nurses had never made such requests, despite recognizing they have legal support based on established clinical protocols. Additionally, 47.6% acknowledged that allowing nurses to request viral load and complementary tests would simplify diagnosis and referrals, highlighting the need for training to support this role.</div></div><div><h3>Conclusions</h3><div>Nursing plays a strategic role in eliminating viral hepatitis within Primary Health Care. Ongoing training and professional empowerment are essential to expand access, overcome barriers, and implement the actions outlined in Technical Note 369/2020 at the local level.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102045"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154241","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 LIVER FIBROSIS IN RELATIVES OF PATIENTS WITH MASLD-RELATED CIRRHOSIS: A STUDY ON DEGREE OF KINSHIP","authors":"Ismael de Jesús Yepes Barreto ,&nbsp;Nicole Chamorro ,&nbsp;Guillermo Donado","doi":"10.1016/j.aohep.2025.101981","DOIUrl":"10.1016/j.aohep.2025.101981","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>First-degree relatives of patients with MASLD-related cirrhosis are considered at high risk for liver fibrosis, based on evidence from Europe and the U.S. supporting a strong hereditary component, including genetic polymorphisms linked to fibrosis progression. However, it is unclear whether this risk extends beyond first-degree relatives, especially in Latin American populations.</div><div>This study aimed to assess the prevalence of liver fibrosis and associated factors among first-, second-, and third-degree relatives of patients with MASLD-related cirrhosis in Cartagena, Colombia.</div></div><div><h3>Patients and Methods</h3><div>Patients with MASLD-related cirrhosis were identified from a hepatology clinic, and their relatives were invited for transient elastography (FibroScan) and body composition analysis (InBody 270) after fasting. Only elastography results with an IQR ≤30% and success rate ≥60% were analyzed. All participants underwent physical exams and interviews covering medical history and alcohol use. Those with abnormal elastography (≥7.2 kPa) were referred for hepatology evaluation.</div></div><div><h3>Results</h3><div>Of 99 relatives included (56 first-degree, 13 second-degree, 30 third-degree), the mean age was 44 years; 32.3% were male. The prevalence of fibrosis was 15.2% overall, with 21.4% in first-degree, 7.7% in second-degree, and 6.7% in third-degree relatives (p &gt; 0.05). Advanced fibrosis (≥10 kPa) was found in five individuals. BMI, visceral fat, total body fat, and waist circumference were associated with fibrosis.</div></div><div><h3>Conclusions</h3><div>These findings support targeted screening in first-degree relatives and suggest that body composition metrics may help identify at-risk individuals. Further research is needed to clarify familial risk beyond first-degree relatives in Latin American settings.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101981"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154234","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 OF PATIENTS CO-INFECTED WITH HEPATITIS C AND HIV IN THE NORTH REGION OF BRAZ","authors":"Isabelle Cristine de Jesus Macedo ,&nbsp;Aline Alves da Silva ,&nbsp;Elton Carlos de Almeida ,&nbsp;João Vitor da Mota Silva ,&nbsp;Carla Francisca dos Santos Cruz ,&nbsp;Ana Paula Maciel Gurski ,&nbsp;Ana Monica de Mello ,&nbsp;Nathália da Silva Cruz ,&nbsp;Mário Peribanez Gonzalez ,&nbsp;Jose Nilton Neris Gomes ,&nbsp;Leonardo Carrara Matsuura","doi":"10.1016/j.aohep.2025.102041","DOIUrl":"10.1016/j.aohep.2025.102041","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Patients co-infected with Human Immunodeficiency Virus (HIV) and hepatitis C virus (HCV) are at higher risk of unfavorable outcomes, such as accelerated development of liver fibrosis and cirrhosis, as well as increased morbidity and mortality.</div><div>To describe the profile of patients co-infected with hepatitis C and HIV in the North region of Brazil between 2013 and 2023.</div></div><div><h3>Materials and Methods</h3><div>A descriptive, cross-sectional study using data from the Notifiable Diseases Information System (Sinan) for the period from 2013 to 2023. The variables analyzed were sex, race, and education level. Descriptive statistical analysis was performed to characterize the profile of the cases.</div></div><div><h3>Results</h3><div>A total of 420 cases of co-infection with hepatitis C and HIV were identified. The majority were male (69.0%) and self-declared as \"pardo\" (brown/mixed-race) (81.4%). Regarding education level, 26.2% of the records were unknown; among the available data, those with complete high school education (19.0%) and 5 to 8 incomplete years of study (18.1%) stood out. In terms of geographical distribution, Amazonas had the highest proportion of cases (38.8%), followed by Pará (29.5%) and Rondônia (16.7%).</div></div><div><h3>Conclusions</h3><div>The data indicate a predominant profile of co-infection among men, \"pardo\" individuals, and those with low education levels, with a concentration in the state of Amazonas. These findings reinforce the need for specific prevention, diagnosis, and care strategies aimed at the most vulnerable populations in the North region.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102041"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154333","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":"EARLY IDENTIFICATION OF LIVER TRANSPLANTATION REQUIREMENT IN ALCOHOL-ASSOCIATED HEPATITIS","authors":"Luis Antonio Díaz Piga ,&nbsp;Francisco Idalsoaga ,&nbsp;Gene Im ,&nbsp;Bastián Alcayaga ,&nbsp;Muzzafar Haque ,&nbsp;Stephanie Rutledge ,&nbsp;Hanna Blaney ,&nbsp;Pojsakorn Danpanichkul ,&nbsp;Arun Valsan ,&nbsp;Gowripriya Nair ,&nbsp;Gustavo Ayares ,&nbsp;Renata Farias ,&nbsp;Jorge Arnold ,&nbsp;Pedro Acuña ,&nbsp;Kaanthi Rama ,&nbsp;Carlos Esteban Coronel-Castillo ,&nbsp;Carolina Ramírez Cádiz ,&nbsp;Vinay Jahagirdar ,&nbsp;Winston Dunn ,&nbsp;Heer Mehta ,&nbsp;Juan Pablo Arab","doi":"10.1016/j.aohep.2025.101964","DOIUrl":"10.1016/j.aohep.2025.101964","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Severe alcohol‐associated hepatitis (AH) has a high risk of short-term mortality especially in those r with acute‐on‐chronic liver failure (ACLF). Delayed evaluation for liver transplantation (LT) in severe AH often worsens nutritional and functional status. This study aimed to identify early mortality predictors.</div></div><div><h3>Materials and Methods</h3><div>In a prospective study, 981 adults with AH were enrolled from 32 centers in 14 countries (January 2015–September 2024). ACLF was classified by EASL-CLIF criteria. Primary outcomes were 30- and 90-day mortality. Competing-risk regression (LT as the competing event) and receiver-operating-characteristic (AUROC) analyses evaluated clinical scores predicting development of ACLF grades 2–3 within seven days of admission.</div></div><div><h3>Results</h3><div>The mean age was 48.3 ± 11.2 years, and 88.7% were male. Within the first week, 68.8% of patients had ACLF—30.1% with grade 1, 34.5% with grade 2, and 35.4% with grade 3. Overall survival rates were 84.7% at 30 days and 75.8% at 90 days. Adjusted analyses identified increasing age, infections, higher admission MELD score, and ACLF grades 2 (subdistribution hazard ratio [sHR] 1.59) and 3 (sHR 2.58) as independent predictors of 90-day mortality. The MELD score was the best predictor of developing ACLF grades 2–3 (AUROC 0.869), with MELD ≥28 showing 64% sensitivity and 90% specificity. These findings were confirmed in two external validation cohorts: a prospectively enrolled U.S. cohort (n=234) and a retrospective cohort from seven countries (n=602).</div></div><div><h3>Conclusions</h3><div>ACLF and infections are key determinants of mortality in severe AH. The MELD score at admission is a robust early predictor of high‐grade ACLF, supporting its use to determine LT candidacy earlier.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101964"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154395","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":"LONG-TERM ALBUMIN THERAPY MAY IMPROVE SURVIVAL IN CIRRHOSIS WITH ASCITES: A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"W. Ray Kim ,&nbsp;Guadalupe Garcia-Tsao ,&nbsp;Cristina Coll-Ortega ,&nbsp;Elisabet Viayna ,&nbsp;Thomas Ardiles ,&nbsp;Rahul Rajkumar","doi":"10.1016/j.aohep.2025.101965","DOIUrl":"10.1016/j.aohep.2025.101965","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Single intravenous albumin infusions are indicated for specific events in decompensated cirrhosis. However, long-term albumin (LTA) use has been debated due to discrepant trial results. In light of recent additional evidence, we evaluated the impact of LTA on mortality in patients with cirrhosis and ascites through a meta-analysis of clinical trials.</div></div><div><h3>Materials and Methods</h3><div>A systematic review and meta-analysis of randomized and non-randomized trials since 1995 was conducted using PubMed, with manual searches of conference abstracts in the past two years. Eligible studies enrolled adults with cirrhosis and ascites, compared ≥4 weeks of LTA to standard care or placebo, and reported ≥12-month mortality. A random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was evaluated using χ² and I² statistics.</div></div><div><h3>Results</h3><div>Of 22 studies, 7 met inclusion criteria. Exclusions were due to absent albumin intervention, short treatment duration, or no control group. A total of 711 and 675 patients were included in albumin and control groups, respectively. Death occurred in 131 and 166, respectively. Twelve-month mortality was obtained from all but two trials, which reported 20 and 24-month mortality. The pooled OR for up-to-24 -month mortality was 0.66 [95% CI: 0.47–0.93], indicating a 34% mortality reduction with LTA (Figure). τ² and I² indicated low heterogeneity.</div></div><div><h3>Conclusions</h3><div>This meta-analysis estimates that, on average, LTA was associated with a one-third reduction in mortality in patients with cirrhosis and ascites. Future analyses of individual-level mortality predictors and other liver-related complications may help identify patients more likely to benefit from LTA.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101965"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154396","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":"IRON METABOLISM DISTURBANCES ARE ASSOCIATED WITH LIVER FIBROSIS SEVERITY IN MASLD: A CROSS-SECTIONAL STUDY USING NON-INVASIVE TOOLS","authors":"Romina Rey Laguarda ,&nbsp;Martín Elizondo Barceló ,&nbsp;Lain Lin Liu ,&nbsp;Emilia Moreira Milanesi ,&nbsp;Solange Gerona Sangiovanni","doi":"10.1016/j.aohep.2025.102012","DOIUrl":"10.1016/j.aohep.2025.102012","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. Disturbances in iron metabolism—particularly hyperferritinemia—may play a role in fibrosis progression through mechanisms involving oxidative stress and chronic inflammation.</div><div>To describe iron metabolism parameters in patients with MASLD and analyze their association with liver disease severity using non-invasive tools.</div></div><div><h3>Materials and Methods</h3><div>We conducted a cross-sectional study including 199 adult patients with MASLD followed at a specialized hepatology clinic (2022–2024). Clinical, anthropometric, and biochemical variables were collected, including serum ferritin, transferrin, serum iron, and transferrin saturation index (TSI). Liver fibrosis was evaluated by FIB-4 score and transient elastography (FibroScan®); steatosis was assessed by controlled attenuation parameter (CAP). Non-parametric statistical tests were applied (Spearman correlation, Kruskal–Wallis, chi-square).</div></div><div><h3>Results</h3><div>The mean age was 57 ± 12 years; 58.3% were women and 39.7% had type 2 diabetes. The mean BMI was 33.8 ± 6.3 kg/m². Hyperferritinemia was observed in 43.4% of patients. Elevated ferritin, serum iron, and TSI were significantly associated with higher FIB-4 scores (p &lt; 0.05). Ferritin levels were also significantly associated with liver stiffness measured by FibroScan® (p &lt; 0.05). No significant association was found between iron metabolism parameters and the degree of steatosis assessed by CAP.</div></div><div><h3>Conclusions</h3><div>Iron metabolism disturbances, particularly hyperferritinemia, are frequent in MASLD and associated with greater risk of liver fibrosis, but not with steatosis. These findings support the potential utility of iron biomarkers as adjunctive non-invasive indicators of disease progression.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102012"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154497","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}