Annals of hepatology最新文献

{"title":"THE ROLE OF GLYCEMIC CONTROL IN STEATOSIS AND HEPATIC FIBROSIS IN PATIENTS WITH A DIAGNOSIS OF TYPE 2 DIABETES MELLITUS","authors":"Yenni Joseline Cruz Ramírez ,&nbsp;Miguel Angel Quiñonez Barrera ,&nbsp;Mayra Virginia Ramos Gómez","doi":"10.1016/j.aohep.2025.101997","DOIUrl":"10.1016/j.aohep.2025.101997","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Type 2 diabetes mellitus (DM2) prevalent in Mexico (18.3%) related to hepatic steatosis associated with metabolic dysfunction (MASLD), in 30%. Glycosylated hemoglobin (HbA1c) is a key biomarker of glycemic control. The aim of this study was to analyze the association between HbA1c levels and the degree of steatosis and hepatic fibrosis in type 2 diabetes mellitus.</div></div><div><h3>Materials and Methods</h3><div>The following study is observational, descriptive and retrospective in 90 patients older than 18 years with DM2, attended in gastroenterology outpatient clinic in a third level center, between February 2024 and February 2025. Hepatic Elastography (FibroScan®) and HbA1c determination were performed at the time of the study. Non-parametric statistics (Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whitney U with Bonferroni correction) were used.</div></div><div><h3>Results</h3><div>Of the patients studied, 78.9% were female and 21.1% male, for an H:M ratio of 1:3, the most affected age was between 41-50 (27.8%). 71.1% were at Hb1Ac goals, and 29% decompensated. The 71.1% were in Hb1Ac goals, and 29% were unbalanced. From the hepatic elastography (fibroscan) the results were statistically significant. The post hoc analysis revealed significant differences between patients without steatosis and hepatic steatosis grade II and III with (p = &lt;0.005). According to the grade of hepatic fibrosis 39.1% presented hepatic fibrosis, the most predominant grade was 2 (in 16.7%) Table 1.</div></div><div><h3>Conclusions</h3><div>We conclude that the higher the degree of hepatic steatosis, the worse the glycemic control. All patients with DM2 should undergo hepatic elastography since hepatic fibrosis can present with glycosylated hemoglobin in goals and increase in a state of glycemic decompensation.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101997"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154748","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":"RELATIONSHIP BETWEEN QUALITY OF LIFE AND AN EDUCATIONAL STRATEGY BASED ON THE INFORMATION NEEDS OF PATIENTS WITH COMPENSATED LIVER CIRRHOSIS","authors":"Ismael de Jesús Yepes Barreto ,&nbsp;Yohana Poveda ,&nbsp;Guillermo Donado","doi":"10.1016/j.aohep.2025.101982","DOIUrl":"10.1016/j.aohep.2025.101982","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Educational strategies may improve quality of life (QoL) in patients with cirrhosis, yet available evidence remains limited and often not generalizable to Latin American settings. Sociocultural and demographic differences can influence both information needs and determinants of health-related quality of life (HRQoL).</div><div>This study aimed to evaluate the effect of a locally tailored educational intervention on QoL in patients with compensated cirrhosis and caregiver burden.</div></div><div><h3>Patients and Methods</h3><div>In this prospective, longitudinal study, adult outpatients with cirrhosis were enrolled. Patients completed the Chronic Liver Disease Questionnaire (CLDQ), and both patients and caregivers completed PROMs (Patient-Reported Outcome Measures). Caregiver burden was assessed using the Zarit Burden Interview, both before and after the intervention. Descriptive statistics were used for demographic and clinical variables. Paired t-tests assessed changes in CLDQ scores, and univariate linear regression identified predictors of QoL improvement. A p-value &lt;0.05 was considered significant.</div></div><div><h3>Results</h3><div>Thirty-nine patients were included (64% female; 86% Child-Pugh A). The most frequent etiologies were MASLD (33%) and autoimmune hepatitis (23%). Most belonged to socioeconomic level 2 (41%). Thirty-three caregivers were also included (78.1% female; mean age 50.1±13.7 years). Educational session attendance was 64% for patients and 72% for caregivers.</div><div>CLDQ scores increased by 29 points (95% CI: 24–34; p&lt;0.001), a 21.8% relative improvement, especially in emotional and worry domains. Zarit scores decreased from 21.2 to 11.5 points, indicating a 46% reduction in caregiver burden.</div></div><div><h3>Conclusions</h3><div>A targeted educational intervention improved QoL and reduced caregiver burden. Educational support should be integrated into comprehensive cirrhosis care in Latin America.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101982"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154235","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":"HIGH PREVALENCE OF DILI/HILI IN A CENTER PARTICIPATING IN A MULTICENTER STUDY FOR DIAGNOSING ACUTE HEPATITIS IN BRAZIL","authors":"Tayna da Silva Domingos ,&nbsp;Vinicius Santos Nunes ,&nbsp;Luiz Antônio Rodrigues de Freitas ,&nbsp;Sidelcina Rugeri Pacheco ,&nbsp;Raymundo Paraná Ferreira Filho ,&nbsp;Maria Isabel Schinoni","doi":"10.1016/j.aohep.2025.102037","DOIUrl":"10.1016/j.aohep.2025.102037","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatotoxicity caused by drugs and herbs (DILI/HILI) can cause mild to severe lesions. The diagnosis is based on exclusion, and it is essential to investigate the use of drugs and herbal remedies.</div><div>To assess the prevalence of DILI/HILI in a multicenter study on acute hepatitis.</div></div><div><h3>Materials and Methods</h3><div>A cross-sectional, descriptive, and analytical study conducted at a university hospital in Bahia, as part of a national multicenter screening project for acute hepatitis. Patients with clinical suspicion of acute hepatitis were included.</div></div><div><h3>Results</h3><div>The sample included 50 patients: 17 (34%) with DILI/HILI and 33 (66%) with other etiologies. These included: autoimmune hepatitis 4 (8%), cholestatic syndrome 1(2%), late transplant rejection 1(2%), Chikungunya and Dengue 2(4%), alcoholic hepatitis 1(2%), Caroli syndrome 1 (2%), and biliary cholangiopathy 1(2%). Viral etiologies: hepatitis B 6 (12%), including one case of chronic HBV reactivated by herbal use, hepatitis C 3 (6%), Epstein-Barr virus IgM 5 (10%), and Cytomegalovirus IgM 3 (6%), with one CMV case in the DILI/HILI group. Thirteen cases (26%) had undefined or non-hepatic causes. Two groups were stratified: Group 1 with DILI/HILI (17) and Group 2 without DILI/HILI (33). Median values were calculated for ALT, AST, ALP, GGT, and bilirubin total. Group 1: AST 257 U/L, ALT 313 U/L, GGT 696 U/L, ALP 234 U/L, BT 7.6 mg/dL. Group 2: AST 162 U/L, ALT 109 U/L, GGT 216 U/L, ALP 172 U/L, TB 4.9 mg/dL. AST, ALT, and GGT were higher in the DILI/HILI group. No statistical difference in ALP and BT (p=0.5120; p=0.8057).</div></div><div><h3>Conclusions</h3><div>DILI/HILI cases showed a more prominent biochemical profile, suggesting more severe liver injury. Careful investigation of drug and herbal use is essential in the evaluation of acute hepatitis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102037"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154329","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":"FACTORS ASSOCIATED WITH HEALTH LITERACY IN PATIENTS DIAGNOSED WITH LIVER CIRRHOSIS IN COLOMBIA","authors":"Ismael de Jesus Yepes Barreto ,&nbsp;Carlos Martelo ,&nbsp;Nicole Chamorro","doi":"10.1016/j.aohep.2025.101953","DOIUrl":"10.1016/j.aohep.2025.101953","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Health literacy (HL) refers to a patient’s ability to obtain, process, and understand medical information needed to make informed health decisions. Low HL is associated with increased healthcare costs, higher hospitalization rates, reduced access to transplantation, and increased mortality—especially among vulnerable populations. In patients with cirrhosis, HL has been linked to sex, education, employment, and disease etiology in other countries, but data are scarce in Latin America. This study aimed to identify factors associated with HL in patients with liver cirrhosis in Cartagena, Colombia.</div></div><div><h3>Patients and Methods</h3><div>We conducted a cross-sectional, analytical study between September and December 2024. Adults with a confirmed diagnosis of cirrhosis completed the validated Spanish version of the Short Assessment of Health Literacy (SAHL-S). Scores below 14 indicated inadequate HL. A separate, validated questionnaire assessed disease-specific knowledge across four domains: diagnosis, signs/symptoms, treatment, and medication.</div></div><div><h3>Results</h3><div>A total of 93 patients were analyzed (61.2% female; mean age: 63.9±11.7 years). MASLD and cryptogenic cirrhosis were the most common etiologies (30% each), and 80% were Child-Pugh A. Adequate HL was found in 79.6% (mean SAHL-S score: 15.3). Knowledge was highest for treatment (77%) and lowest for signs/symptoms (65%).</div><div>Multivariable analysis identified higher education (OR 1.81), number of dependents (OR 2.03), and employment (OR 2.2) as positive predictors of HL. Older age (OR 0.95) and hypertension (OR 0.32) were negatively associated.</div></div><div><h3>Conclusions</h3><div>One in five cirrhotic patients had suboptimal HL, especially regarding symptom recognition. Sociodemographic and clinical factors should guide patient-centered interventions.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101953"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154437","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":"SOCIAL AND HEALTH VULNERABILITY ANALYSIS AMONG PEOPLE WHO INJECT DRUGS IN ARMENIA, COLOMBIA","authors":"Javier Enrique Hernandez Blanco ,&nbsp;Juan Ignacio Marin Zuluaga ,&nbsp;Ismael de Jesús Yepes Barreto ,&nbsp;Diana Chávez Bejarano ,&nbsp;Alfredo Spath ,&nbsp;Sara Milena Ramos Jaraba ,&nbsp;Dedsy Yajaira Berbesí Fernández","doi":"10.1016/j.aohep.2025.101967","DOIUrl":"10.1016/j.aohep.2025.101967","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>People who inject drugs (PWID) face significant barriers to accessing healthcare, which increases their vulnerability to infections such as hepatitis C virus (HCV). Stigmatization, marginalization, and unsafe injection practices further elevate the risk of infection and hinder opportunities for timely diagnosis and treatment.</div></div><div><h3>Objective</h3><div>To characterize social and health vulnerability among PWID in Armenia, Colombia, and to determine the prevalence of HCV infection according to vulnerability levels.</div></div><div><h3>Materials and Methods</h3><div>A cross-sectional study was conducted using Respondent Driven Sampling (RDS) among 205 PWID between may 2024 and october 2024. Sociodemographic, drug use, and health condition data were collected through structured interviews. Rapid anti-HCV testing was performed, with confirmatory HCV RNA testing. A social vulnerability index was constructed using K-means cluster analysis to classify participants into low, medium, and high vulnerability groups.</div></div><div><h3>Results</h3><div>The HCV antibody testing was positive in 84% (172/205 cases).</div><div>The overall prevalence of HCV (with detectable viremia by quantitative measurement of HCV RNA) was 54.15% (111/205 cases).</div><div>High vulnerability was observed in 44.88% of participants and was significantly associated with higher HCV prevalence (29.35%; p=0.025). Key vulnerability factors included a history of incarceration (43.9%) and homelessness (40.49%). Most participants had low educational attainment (48.29% completed only primary education) and reported low monthly income levels.</div></div><div><h3>Conclusions</h3><div>There is a high burden of HCV infection among PWID in Armenia, particularly among those with higher social vulnerability. These findings highlight the urgent need for harm reduction strategies, systematic screening, and expanded access to antiviral treatment for highly marginalized populations.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101967"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154398","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":"CLINICAL CHARACTERIZATION OF HCC IN A SILENT REGION: REAL-WORLD DATA FROM A PROSPECTIVE COHORT IN CENTRAL AMERICA","authors":"Francisco Vargas-Navarro ,&nbsp;Maria Lynch-Mejía ,&nbsp;Wagner Ramírez-Quesada ,&nbsp;Maria Soto-Echeverri ,&nbsp;Daniel Pérez-Muñoz ,&nbsp;Alejandra Ochoa-Palominos ,&nbsp;Pablo Coste","doi":"10.1016/j.aohep.2025.102030","DOIUrl":"10.1016/j.aohep.2025.102030","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. However, clinical data from Central America and the Caribbean are scarce, limiting the development of region-specific public health strategies and clinical guidelines.</div><div>Describe the clinical and demographic characteristics of patients diagnosed with HCC, providing the first prospective dataset from this underrepresented region.</div></div><div><h3>Materials and Methods</h3><div>This observational cohort study included all patients diagnosed with or referred for HCC between September 2018 and June 2024. Clinical data were extracted from medical records, anonymized, and recorded electronically. Patients with incomplete or unverifiable data were excluded.</div></div><div><h3>Results</h3><div>A total of 260 patients were included (mean age 67 years; 38.5% women). Cirrhosis was present in 92.7%, and 95% met at least one metabolic syndrome (MS) criterion; 54.6% met full MS criteria. MASLD or alcohol-related liver disease accounted for 85% of underlying etiologies. Nineteen patients (7.3%) had non-cirrhotic HCC, predominantly MASLD-related. HCC diagnoses increased by 90.5% between 2017–2018 and 2023–2024. Screening detected 43.5% of cases. Ultrasound was the first imaging modality in 90.4%, with an average delay of 70 days to confirmatory imaging. AFP levels ≥20 IU/mL and ≥400 IU/mL were seen in 42.1% and 21.2%, respectively. At diagnosis, 60.6% were Child-Pugh A and 66.9% had MELD &lt;15. BCLC staging: 0 (1.9%), A (48.8%), B (16.9%), C (20.4%), D (11.9%).</div></div><div><h3>Conclusions</h3><div>This first prospective characterization of HCC in Central America shows high rates of metabolic dysfunction and cirrhosis. Increasing incidence and diagnostic delays highlight the urgent need for structured screening and better resource allocation.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102030"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154401","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":"HIGH RATE OF EARLY ALP NORMALIZATION WITH UDCA–BEZAFIBRATE COMBINATION THERAPY IN TREATMENT-NAÏVE PRIMARY BILIARY CHOLANGITIS: PRELIMINARY RESULTS","authors":"Juan Antonio Sorda ,&nbsp;Fernando Javier Barreyro ,&nbsp;Matías Bori ,&nbsp;Guillermo Fernández ,&nbsp;Esteban González Ballerga","doi":"10.1016/j.aohep.2025.102033","DOIUrl":"10.1016/j.aohep.2025.102033","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div> Six-month alkaline phosphatase (ALP) normalisation predicts one-year response and survival in primary biliary cholangitis (PBC). Bezafibrate (BZF) benefits incomplete ursodeoxycholic-acid (UDCA) responders. We therefore assessed ALP normalization at six-month with UDCA alone versus UDCA+BZF at two different doses.</div></div><div><h3>Materials and Methods</h3><div>in an open-label trial (January 2022–2025) antimitochondrial-antibody–positive, non-cirrhotic PBC patients were randomised 2 : 2 : 1 to UDCA 13–15 mg kg⁻¹ day⁻¹ (n=21), UDCA+BZF 400 mg (n=23) or UDCA+BZF 800 mg (n=8). Liver tests were obtained monthly for six months. The primary end point was ALP ≤ 1 × ULN at month 6; secondary end points were changes in other enzymes, pruritus and safety.</div></div><div><h3>Results</h3><div> Fifty-two patients (94 % female, 57 ± 11 years, BMI 25 ± 6 kg m⁻², histological stages 1(n23)/2(n16/3(n13) completed follow-up. ALP normalised in 36 % with UDCA, 78 % with UDCA+BZF 400 mg and 100 % with UDCA+BZF 800 mg (χ² &lt; 0.01). Mean ALP (× ULN) at six months was 1.5±0.7 (UDCA), 0.98±0.2 (UDCA+BZF 400 mg), and 0.8±0.2 (UDCA+BZF 800 mg) (ANOVA p&lt;0.001). Linear mixed-effects analysis showed significant time-dependent ALP declines in all groups; BZF intensified these monthly slopes (β = –0.34 for 400 mg, –0.44 for 800 mg vs UDCA, both Tukey-adjusted p&lt;0.01). Pruritus persisted in 14 % of UDCA recipients but in none on BZF, and renal function and creatine kinase were unchanged across groups.</div></div><div><h3>Conclusions</h3><div>Up-front UDCA+BZF achieves dose-dependent, near-universal six-month ALP normalisation and accelerates biochemical improvement without early safety concerns. These interim data support initiating combination therapy at diagnosis, particularly in symptomatic PBC.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102033"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154404","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":"VALIDATION OF NONINVASIVE CLINICAL PATHWAYS TO IDENTIFY ADVANCED","authors":"Luis Antonio Díaz Piga ,&nbsp;Natalia Baeza ,&nbsp;Francisco Idalsoaga ,&nbsp;Xiao-Dong Zhou ,&nbsp;Ming-Hua Zheng ,&nbsp;Fátima Higuera de la Tijera ,&nbsp;Fernando Javier Barreyro ,&nbsp;Rakhi Maiwall ,&nbsp;Shiv K. Sarin ,&nbsp;Anand V. Kulkarni ,&nbsp;Ramagundam Ramyasri ,&nbsp;Gustavo Ayares ,&nbsp;Terry Cheuk-Fung Yip ,&nbsp;Vincent Wai-Sun Wong ,&nbsp;Grace Lai-Hung Wong ,&nbsp;Jimmy Che-To Lai ,&nbsp;Yu Jun Wong ,&nbsp;Xin En Goh ,&nbsp;May Xuan Goh ,&nbsp;David Marti-Aguado ,&nbsp;Juan Pablo Arab","doi":"10.1016/j.aohep.2025.101949","DOIUrl":"10.1016/j.aohep.2025.101949","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Limited data exist on non-invasive clinical algorithms for MetALD and ALD. We aimed to (1) quantify the false-negative rate of standard algorithms combining Fibrosis-4 index (FIB-4) and vibration-controlled transient elastography (VCTE) for detecting advanced fibrosis in MetALD and ALD, and (2) evaluate the diagnostic accuracy of FIB-4 for advanced fibrosis in MetALD.</div></div><div><h3>Materials and Methods</h3><div>Retrospective cohort including 764 well-characterized adults with MetALD (n=334, 43.7%) or ALD (n=430, 56.3%) from 14 countries (2003–2025) according to the 2023 criteria; other concomitant liver diseases were excluded. All underwent VCTE (&gt;8 kPa considered elevated); 244 (31.9%) also had liver biopsy. FIB-4 was categorized as low risk &lt;1.3, indeterminate 1.3–2.67 (2.0–2.67 if ≥65 years), and high risk &gt;2.67. Analysis included AUROC curves.</div></div><div><h3>Results</h3><div>Mean age was 49.5 years (IQR 41–59); 73.1% were male; mean BMI 28.0 kg/m² (IQR 24.1–31.6); 32.2% had diabetes. Median FIB-4 was 1.57 (IQR 0.92–3.29); median LSM 8.6 kPa (IQR 5.9–22.3). Among those biopsied (n=244), 14.3% had F3 and 11.9% had cirrhosis (F4). Of the low FIB-4 group, 28.1% had elevated VCTE (32.0% MetALD; 24.9% ALD). Sixteen participants classified as low-risk by both FIB-4 and LSM had ≥F3 fibrosis on biopsy—false-negative rate 6.6% overall (5.7% MetALD; 7.4% ALD) (Figure). In MetALD, FIB-4 yielded an AUROC of 0.736 (95%CI:0.610–0.863) for ≥F3 fibrosis; the optimal cut-point was ≥1.65 (sensitivity 74%, specificity 73%). Applying ≥1.65 to participants over 65 years with MetALD reduced the false-negative rate to 2.0%, while the referral rate rose only from 30.3% to 33.6%.</div></div><div><h3>Conclusions</h3><div>Standard noninvasive pathways combining FIB-4 and VCTE had low false-negative rates for advanced fibrosis in MetALD and ALD. In patients with MetALD aged +65 years, lowering the FIB-4 threshold to ≥1.65 may improve advanced fibrosis detection.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101949"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154558","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":"EFFECTIVE RE-ENGAGEMENT OF HEPATITIS C PATIENTS: A MULTICENTER STUDY BASED ON LABORATORY RECORDS IN ARGENTINA","authors":"Fernando Cairo ,&nbsp;Manuel Barbero ,&nbsp;Nicolas Dominguez ,&nbsp;Stefania Burgos ,&nbsp;Lucia Navarro ,&nbsp;Ignacio Roca ,&nbsp;Adrian Bologna ,&nbsp;Daniel Calfunao ,&nbsp;Rodrigo Belloni ,&nbsp;Andrea Curia ,&nbsp;Ayelen Trillo ,&nbsp;Susana Melina ,&nbsp;Omar Galdame ,&nbsp;Esteban Gonzalez Ballerga","doi":"10.1016/j.aohep.2025.101958","DOIUrl":"10.1016/j.aohep.2025.101958","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Hepatitis C virus (HCV) remains a significant cause of global morbidity despite the availability of highly effective direct-acting antivirals (DAAs). In Argentina, fragmented healthcare access and a high prevalence of advanced liver disease underscore the need for re-engagement strategies to achieve HCV elimination. This study aimed to assess the effectiveness of a multicenter re-engagement program for HCV patients lost to follow-up in high-complexity healthcare settings.</div></div><div><h3>Materials and Methods</h3><div>A multicenter prospective study (March–November 2024) analyzed blood samples from five hospitals to identify HCV antibody-positive patients. Positive cases were contacted to confirm viremia, undergo clinical evaluation, and initiate treatment. Data collected included re-engagement rates, fibrosis staging (FibroScan), genotype distribution, treatment regimens, and sustained virologic response (SVR) rates. Chi-square tests were used to compare positivity rates, genotype distribution, and treatment regimens.</div></div><div><h3>Results</h3><div>Among 206,053 samples, 3,334 (1.62%) tested positive for HCV antibodies, and 2,149 (64.5%) were potentially eligible for re-engagement. Non-re-engagement causes included deaths (419), previous cure (741), and liver transplants (25). Positive cases were 54.16% male (p = 0.03). A total of 422 patients (19.6%) were successfully re-engaged, of whom 311 (73.8%) exhibited advanced fibrosis (≥F2). Genotype 3 prevalence was similar to others (p = 0.3). Among re-engaged patients, 167 initiated treatment with Sofosbuvir/Velpatasvir (70.08%), Glecaprevir/Pibrentasvir (29.92%) (p = 0.12). Overall SVR12 rate was 97.98% among treated patients. SVR4 was assessed in 112 patients, showing a 100% correlation with SVR12.</div></div><div><h3>Conclusions</h3><div>This program successfully re-engaged HCV patients lost to follow-up, achieving high SVR12 rates and demonstrating the utility of SVR4 as an early predictor. A significant proportion of patients were unaware of their diagnosis, available treatments, or disease progression. The majority of treated patients had advanced fibrosis, highlighting the need for proactive strategies targeting high-risk populations. These findings underscore the necessity of establishing elimination programs in countries with complex healthcare systems like Argentina.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101958"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154478","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":"FUELING THE FIRE: INFECTIONS TRIGGER AND MALNUTRITION DRIVES SEVERE ACLF IN CIRRHOSIS","authors":"Silvia Cvekova","doi":"10.1016/j.aohep.2025.102015","DOIUrl":"10.1016/j.aohep.2025.102015","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Cirrhosis-associated immune dysfunction (CAID) increases the risk of infections, which are the most common trigger of acute-on-chronic liver failure (ACLF), a syndrome with high short-term mortality. Malnutrition may further impair immune function and affect the course of ACLF. This study aimed to elucidate the interplay between nutritional status, cirrhosis etiology, infection type, their combined impact on ACLF severity and clinical outcomes.</div></div><div><h3>Materials and Methods</h3><div>A retrospective analysis of 19 cirrhotic patients with ACLF treated between February 2023 and January 2024 at a tertiary centre was conducted. Data included infection type, nutritional status, cirrhosis etiology, ACLF grade, and in-hospital mortality.</div></div><div><h3>Results</h3><div>A total of 19 patients (6 females [32%],13 males [68%]), median age of 68 years (range 40–80) were included. Infections were the trigger for ACLF in 13 patients (68%), most commonly respiratory. Fungal or polymicrobial infections were identified in 6 patients (32%), including Klebsiella pneumoniae, Candida spp., Chlamydia sp., and Mycoplasma pneumoniae. Among patients with ACLF grade 3, 4 of 6 (67%) had fungal or polymicrobial infections. Malnutrition was observed in 9 patients (47%), including 3 of 6 (50%) with ACLF grade ≥2. It was more common in alcoholic cirrhosis (7 of 12; 58%) than in non-alcoholic cases (2 of 7; 29%). In-hospital mortality occurred in 6 patients (32%); 3 deaths (50%) were infection-related and 4 (67%) involved malnourished patients.</div></div><div><h3>Conclusions</h3><div>Malnutrition, alcohol-related cirrhosis, fungal or polymicrobial infections were associated with more severe ACLF and poorer outcomes. Early recognition of these risk factors may improve prognostication and guide therapy.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102015"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154572","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}