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"Liver cirrhosis"

Editorial

Call for Preemptive Treatment of Cytomegalovirus in Patients with Cirrhosis and Acute Decompensation
Norihiro Imai
Received July 26, 2025  Accepted August 3, 2025  Published online August 6, 2025  
DOI: https://doi.org/10.3350/cmh.2025.0840    [Accepted]
  • 1,682 View
  • 24 Download

Snapshot

Decoding platelet function in liver cirrhosis: A shift from quantity to quality
Vibhuti Jakhmola, Sukriti Baweja, Chhagan Bihari
Clin Mol Hepatol 2025;31(4):1384-1386.
Published online July 29, 2025
DOI: https://doi.org/10.3350/cmh.2025.0809
  • 2,416 View
  • 62 Download

Original Article

Human cytomegalovirus reactivation in cirrhosis patients with acute decompensation
Changze Hong, Zuxiong Huang, Yingli He, Rongqi Wang, Jiaying Lin, Yushan Liu, Baicheng Liu, Xiaoqin Lan, Qinjun He, Wenfan Luo, Qintao Lai, Ling Zhou, Tingting Qi, Yali Ji, Miaoxia Liu, Qiaoping Wu, Yichen Yao, Weihao Liang, Xianbo Wang, Guohong Deng, Yanhang Gao, Yan Huang, Feng Liu, Xiaobo Lu, Zhongji Meng, Yuemin Nan, Hai Li, Beiling Li, Rajiv Jalan, Jinjun Chen
Clin Mol Hepatol 2025;31(4):1316-1332.
Published online July 4, 2025
DOI: https://doi.org/10.3350/cmh.2025.0332
Background/Aims
The role of reactivation of human cytomegalovirus (HCMV) in determining outcomes of cirrhotic patients with acute decompensation (AD) is unknown. We aimed to investigate HCMV incidence and potential correlation with hepatic outcomes in AD patients.
Methods
Two prospective multicentre cohorts with AD patients were investigated. Patients in cohort 1 were recruited from 4 centres, while patients in cohort 2 were randomly selected from a second multicentre cohort. HCMV reactivation was established with quantitative real-time polymerase chain reaction assay in seropositive patients.
Results
HCMV reactivation was found in 35 patients from cohort 1 (n=722) and 14 from cohort 2 (n=291), with an incidence of 4.8% in both cohorts. Bacterial infection and liver failure were independently correlated with HCMV reactivation. HCMV reactivation was an independent predictor of 90-day mortality. Among bacterial infection populations in these two cohorts, patients with HCMV reactivation had worse prognosis compared to those without. Incidence of acute-on-chronic liver failure (ACLF) was higher in patients with HCMV reactivation compared to those without and was also independently correlated with development of ACLF. In a total of 49 HCMV reactivation cases, 8 patients were treated with ganciclovir, in whom a significantly lower 90-day mortality compared with those not treated was observed. All 3 patients who underwent liver transplantation with reactivation of HCMV died.
Conclusions
In AD patients, HCMV reactivation was common, especially in those with bacterial infection or liver failure, and they were more prone to having ACLF and 90‑day mortality. The data propose the need for active surveillance for HCMV infection in AD patients.
  • 2,900 View
  • 110 Download

Editorial

vibraA non-invasive risk stratification tool for hepatitis B-related liver cirrhosis: The Baveno VI-SSM combined model: Editorial on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
Ruiling He, Bingtian Dong, Xiaolong Qi
Received March 11, 2025  Accepted March 15, 2025  Published online March 19, 2025  
DOI: https://doi.org/10.3350/cmh.2025.0281    [Epub ahead of print]

Citations

Citations to this article as recorded by  Crossref logo
  • Correspondence to editorial 2 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
    Haiyu Wang, Jinjun Chen
    Clinical and Molecular Hepatology.2025;[Epub]     CrossRef
  • Revisiting the role of liver cirrhosis in surgical treatment for hepatocellular carcinoma
    Qi Ke, Bujiangcun Luo, Zunyi Zhang, Zhiyong Huang, Erlei Zhang
    Medicine Plus.2025; 2(3): 100096.     CrossRef
  • 2,772 View
  • 60 Download
  • Crossref

Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

TIPS insertion and systemic inflammation: Is it ever too late to lower portal pressure? Correspondence to editorial on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis”
Anja Tiede, Benjamin Maasoumy
Clin Mol Hepatol 2025;31(2):e176-e179.
Published online February 10, 2025
DOI: https://doi.org/10.3350/cmh.2025.0135

Citations

Citations to this article as recorded by  Crossref logo
  • Decreasing systemic inflammation after TIPS: Still hope for the liver: Reply to correspondence on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrh
    Georg Semmler, Lorenz Balcar, Mattias Mandorfer
    Clinical and Molecular Hepatology.2025; 31(2): e224.     CrossRef
  • Advancing our understanding of recompensated cirrhosis - the new “holy grail” of decompensated cirrhosis
    Thomas Reiberger, Benjamin Maasoumy
    Journal of Hepatology.2025; 83(3): 615.     CrossRef
  • TIPS Outcomes in Cirrhosis with Sarcopenia: Overt Hepatic Encephalopathy, Improvement in Sarcopenia and Mortality— Systematic Review and Meta-analysis
    Maria de Brito Nunes, Maria Gabriela Delgado, Jaume Bosch, Annalisa Berzigotti
    JHEP Reports.2025; : 101699.     CrossRef
  • 4,617 View
  • 26 Download
  • 1 Web of Science
  • Crossref

Original Article

Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis
Haiyu Wang, Weihao Liang, Ling Zhou, Jiankang Song, Biao Wen, Qiaoping Wu, Yuanjian Zhang, Xiaofeng Zhang, Haoran Ke, Yujun Tang, Fuyuan Zhou, Youfu Zhu, Weiqun Wen, Zhihua Liu, Yali Ji, Qintao Lai, Qinjun He, Wenfan Luo, Tingting Qi, Miaoxia Liu, Xiaoqin Lan, Yongpeng Chen, Ranran Xi, Junting Wan, Lin Dai, Yuan Li, Jinjun Chen
Clin Mol Hepatol 2025;31(3):866-880.
Published online February 5, 2025
DOI: https://doi.org/10.3350/cmh.2024.0609
Background/Aims
Cirrhotic patients with liver stiffness measurement (LSM) <20 kPa and platelet count ≥150×109/L (Baveno VI criteria), otherwise spleen stiffness measurement (SSM) ≤40 kPa (Baveno VI-SSM criteria) can avoid endoscopy screening; however, no prospective data for their hepatic outcomes.
Methods
Compensated cirrhosis with HBV were prospectively enrolled from April 2019 to April 2022 and followed until July 2023. All patients underwent LSM, SSM and esophagogastroduodenoscopy assessment.
Results
Among 1,224 patients enrolled with median follow-up of 30 months (interquartile range, 21–42), the incidence of decompensation was greater in 560 patients with unfavored Baveno VI criteria (0.5 vs. 20.4 per 1,000 person-years, P=0.0004) than that in 664 patients with favored Baveno VI-SSM criteria. The Baveno VI-SSM model identified more patients (54.2%) as low-risk for decompensation than Baveno VII-SSM model (single cutoff) (48.4%, P=0.004) and than Baveno VI criteria (34.6%, P<0.0001) did. Patients with high-risk varices diagnosed via endoscopy following Baveno VI-SSM model assessment had greater probability of decompensation compared to those identified by the Baveno VII-SSM model (single cutoff) (42.8 vs. 21.1 per 1,000 person-years, P=0.0088). Additionally, among the 493 patients who underwent endoscopic re-assessment, 242 patients with favored Baveno VI-SSM criteria had much lower incidence of EV progression (2.6 vs. 99.5 per 1,000 person-years, P=0.0004) and lower risk of decompensation compared to 140 patients with unfavored Baveno VI-SSM model (0 vs. 34.2 per 1,000 person-years, P=0.0256).
Conclusions
Baveno VI-SSM model could identify HBV-related cirrhosis patients at low risk of decompensation, which was greatly improved upon Baveno VI-SSM reassessment.

Citations

Citations to this article as recorded by  Crossref logo
  • Correspondence to editorial 1 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
    Haiyu Wang, Jinjun Chen
    Clinical and Molecular Hepatology.2025;[Epub]     CrossRef
  • Correspondence to editorial 2 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
    Haiyu Wang, Jinjun Chen
    Clinical and Molecular Hepatology.2025;[Epub]     CrossRef
  • Correspondence to editorial 3 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
    Haiyu Wang, Jinjun Chen
    Clinical and Molecular Hepatology.2025;[Epub]     CrossRef
  • Ammonia‐to‐Urea Ratio: A Noninvasive First‐Line Tool for Detecting Clinically Significant Portal Hypertension
    Hatime Ouahbi, Vincent Haghnejad, Alexia Audouy, Maël Silva Rodriguez, Françoise Barbé, Jean‐Louis Guéant, Jean‐Pierre Bronowicki, Abderrahim Oussalah
    JGH Open.2025;[Epub]     CrossRef
  • 7,622 View
  • 193 Download
  • 1 Web of Science
  • Crossref

Editorial

Steatotic liver disease

Vibration-controlled transient elastography in shaping the epidemiology and management of steatotic liver disease: Editorial on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017–2023”
Xiao-Dong Zhou, Terry Cheuk-Fung Yip, Daniel Q Huang, Mark Dhinesh Muthiah, Mazen Noureddin, Ming-Hua Zheng
Clin Mol Hepatol 2025;31(2):620-624.
Published online December 26, 2024
DOI: https://doi.org/10.3350/cmh.2024.1131

Citations

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  • Statins in MASLD: Challenges and Future
    Xiao-Dong Zhou, Mark D. Muthiah, Ming-Hua Zheng
    JHEP Reports.2025; : 101372.     CrossRef
  • Addressing the burden of steatotic liver disease: The role of transient elastography: Correspondence to editorial on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017-2023”
    Donghee Kim, Pojsakorn Danpanichkul, Karn Wijarnpreecha, George Cholankeril, Rohit Loomba, Aijaz Ahmed
    Clinical and Molecular Hepatology.2025; 31(2): e180.     CrossRef
  • The association of advanced lung cancer inflammation index with non-alcoholic fatty liver disease in NHANES 2017–2020
    Lin Cheng, Shumeng Li, Hui Li, Jiafeng You, Mingwei Yu, Guowang Yang
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Liver Fibrosis and the Risk of Coronary Artery Disease, Stent Thrombosis, Restenosis and Adverse Clinical Outcomes
    Na Tian, Tie Xiao, Tianyi Xia, Hai‐Yang Yuan, Michael D. Shapiro, Gregory Y. H. Lip, Cheng‐Han Fanren, Li‐You Lian, Chen‐Xiao Huang, Yi‐Xuan Wei, Giovanni Targher, Christopher D. Byrne, Cheng‐Lv Hong, Shenghong Ju, Ming‐Hua Zheng
    Alimentary Pharmacology & Therapeutics.2025;[Epub]     CrossRef
  • Editorial: Does Metabolic Dysfunction‐Associated Steatotic Liver Disease With Advanced Fibrosis Also Equate to Risk of Advanced Coronary Artery Disease? Authors' Reply
    Xiao‐Dong Zhou, Yusuf Yilmaz, Ming‐Hua Zheng
    Alimentary Pharmacology & Therapeutics.2025;[Epub]     CrossRef
  • Long-Term Glycemic Control and the Risk of Liver Stiffness Progression and Liver-Related Events in MASLD
    Xiao-Dong Zhou, Qin-Fen Chen, Seung Up Kim, Terry Cheuk-Fung Yip, Salvatore Petta, Atsushi Nakajima, Emmanuel Tsochatzis, Jérôme Boursier, Elisabetta Bugianesi, Hannes Hagström, Wah-Kheong Chan, Manuel Romero-Gomez, José Luis Calleja, Victor de Lédinghen,
    Clinical Gastroenterology and Hepatology.2025;[Epub]     CrossRef
  • 5,999 View
  • 74 Download
  • 5 Web of Science
  • Crossref

Review

Hepatic neoplasm

Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment
Soo Young Hwang, Pojsakorn Danpanichkul, Vatche Agopian, Neil Mehta, Neehar D. Parikh, Ghassan K. Abou-Alfa, Amit G. Singal, Ju Dong Yang
Clin Mol Hepatol 2025;31(Suppl):S228-S254.
Published online December 26, 2024
DOI: https://doi.org/10.3350/cmh.2024.0824
Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated magnetic resonance imaging (MRI) are being investigated. Multiphasic computed tomography or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease, immune checkpoint inhibitor-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.

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    Journal of Clinical and Experimental Hepatology.2026; 16(1): 103203.     CrossRef
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    Analytica Chimica Acta.2026; 1382: 344834.     CrossRef
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    Boran Huang, Chenglin Zhu, Xinyu Zhang, Qi Zhang, Honggang Wang
    Cellular Signalling.2026; 138: 112212.     CrossRef
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    Anqi Wang, Sitong Yan, Weijia Jiang, Xiang Chen, Yuhan Huang, Xiangyu Zu, Xiao Du, Lulu Fan, Jiatao Liu, Guoping Sun
    BMC Cancer.2025;[Epub]     CrossRef
  • Progress in the Application of Novel Nanomaterials in Targeted Therapy for Liver Cancer
    Xin Wei, Weihua Cao, Shiyu Wang, Yaqin Zhang, Zixuan Gao, Shuojie Wang, Linmei Yao, Ziyu Zhang, Xinxin Li, Wen Deng, Yao Xie, Minghui Li
    International Journal of Nanomedicine.2025; Volume 20: 2623.     CrossRef
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    Cancers.2025; 17(7): 1133.     CrossRef
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    Oncology Letters.2025; 29(6): 1.     CrossRef
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    Frontiers in Oncology.2025;[Epub]     CrossRef
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    Frontiers in Immunology.2025;[Epub]     CrossRef
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    Frontiers in Pharmacology.2025;[Epub]     CrossRef
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    Ling Wu, Hongyao Chen, Jingting Zhang, Jincheng Tang, Zhibin Wang, Peisen Xue, Wenhui Gao, Renyi Yang, Puhua Zeng
    Frontiers in Pharmacology.2025;[Epub]     CrossRef
  • An Artificial Intelligence Pipeline for Hepatocellular Carcinoma: From Data to Treatment Recommendations
    Xuebing Zhang, Liuxin Yang, Chengxiang Liu, Xingxing Yuan, Yali Zhang
    International Journal of General Medicine.2025; Volume 18: 3581.     CrossRef
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    Janthakan Wongsuwan, Teeravut Tubtawee, Sitang Nirattisaikul, Pojsakorn Danpanichkul, Wisit Cheungpasitporn, Sitthichok Chaichulee, Apichat Kaewdech
    BMJ Open Gastroenterology.2025; 12(1): e001832.     CrossRef
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    BMC Geriatrics.2025;[Epub]     CrossRef
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    Discover Oncology.2025;[Epub]     CrossRef
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    Mohamed El-Kassas, Hend Shousha, Lewis R Roberts
    The Lancet Gastroenterology & Hepatology.2025; 10(11): 966.     CrossRef
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    Luca Filippi
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    European Journal of Nuclear Medicine and Molecular Imaging.2025;[Epub]     CrossRef
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    Sultan R. Alharbi
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    Bioorganic Chemistry.2025; 166: 109073.     CrossRef
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    Kyoung A Ko, Hyunwoo Oh, Myung Sub Kim, Hyun Pyo Hong, Yong Kyun Cho, Byung Ik Kim, Won Sohn
    Journal of Gastroenterology and Hepatology.2025; 40(11): 2758.     CrossRef
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    Biomedicines.2025; 13(10): 2439.     CrossRef
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    Jaejun Lee, Keungmo Yang, Ji Won Han, Pil Soo Sung, Jeong Won Jang, Seung Kew Yoon, Hee Sun Cho, Hyun Yang, Si Hyun Bae, Ji Hoon Kim, Heechul Nam, Chang Wook Kim, Hae Lim Lee, Hee Yeon Kim, Sung Won Lee, Ahlim Lee, Do Seon Song, Myeong Jun Song, Soon Woo
    Clinical Cancer Research.2025; 31(20): 4323.     CrossRef
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    Frontiers in Immunology.2025;[Epub]     CrossRef
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    Yu.M. Stepanov, N.Yu. Zavhorodnia, O.M. Vlasova
    GASTROENTEROLOGY.2025; 59(3): 206.     CrossRef
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    Fabiana Crispo, Antonio Vassallo, Immacolata Faraone, Alessandro Santarsiere, Lucia Chiummiento, Mara Martinelli, Nicoletta Cascelli, Xavier Fernàndez-Busquets, Rocchina Miglionico, Ilaria Nigro, Carla Caddeo, Maria Francesca Armentano
    International Journal of Molecular Sciences.2025; 26(21): 10305.     CrossRef
  • The multidimensional role of SLC16A4 in hepatocellular carcinoma in silico analysis: prognostic significance, metabolic pathways, and immune microenvironment regulation
    Lili Jiang, Yi Shen, Zhengyang Feng, Yong Wang, Yaqun Zhu, Yuntian Shen, Qiliang Peng
    European Journal of Medical Research.2025;[Epub]     CrossRef
  • MRI-based Habitat Imaging Enhances the Preoperative Prediction of Microvascular Invasion in Hepatocellular Carcinoma
    Xiaogang Li, Anbin Hu
    Academic Radiology.2025;[Epub]     CrossRef
  • The potential of soluble programmed cell death-ligand 1 and soluble programmed cell death 1 as diagnostic and prognostic biomarkers for hepatocellular carcinoma: a meta-analysis
    Jie Li, Xiangyang He, Tingting Gao, Qingjun Zhang, Xu Han
    Irish Journal of Medical Science (1971 -).2025;[Epub]     CrossRef
  • Multi-omics analysis reveals the role of tumor-infiltrating CD4+CCR7+ T cells in EGFR antibody resistance and prognosis of hepatocellular carcinoma
    Zizhong Yang, Lupeng Qiu, Guhe Jia, Zhuoya Sun, Yixin Gong, Yin Chen, Yu Wang, Lai Song, Xiao Zhao, Shunchang Jiao
    BMC Cancer.2025;[Epub]     CrossRef
  • Identification and validation of icaritin-associated prognostic genes in hepatocellular carcinoma through network pharmacology, bioinformatics analysis, and cellular experiments
    Yaru Shi, Yanan Bai, Jianglan Wu, Yunfeng Yu, Xinyu Yang, Haobo Yang, Weixiong Jian, Jun Qing
    Frontiers in Immunology.2025;[Epub]     CrossRef
  • Enhancing cancer risk awareness and screening management through artificial intelligence: a narrative review
    Jiaxuan Wu, Xiaolong Tang, Qian Zheng, Xinhang Gu, Li Ma, Jinghong Xian, Hui Mao, Jiadi Gan, Guiyi Ji
    Frontiers in Oncology.2025;[Epub]     CrossRef
  • miR-122-5p Regulates Ferroptosis through Targeting the Glutamine Transporter SLC1A5 in Hepatocellular Carcinoma
    Mingxuan Lei, Jiayin Xu, Xiaoying Hu, Lin Feng, Baoping Luo
    BIOCELL.2025; 0: 1.     CrossRef
  • Targeting endoplasmic reticulum stress-induced CLGN resensitizes hepatocellular carcinoma to apoptosis: paeonol synergistically enhances efficacy by dual inhibition of CLGN and NF-κB
    Sitong Yan, Anqi Wang, Xiang Chen, Weijia Jiang, Xiao Du, Yuhan Huang, Xiangyu Zu, Yue Zhu, Jiatao Liu, Lulu Fan, Lingling Zhang, Guoping Sun
    Frontiers in Oncology.2025;[Epub]     CrossRef
  • Lactylation in Cancer: Unlocking the Key to Drug Resistance and Therapeutic Breakthroughs
    Xiangnan Feng, Dayong Li, Pingyu Wang, Xinyu Li, Guangyao Li
    Oncology Research.2025; 33(11): 3327.     CrossRef
  • Organokine-Mediated Crosstalk: A Systems Biology Perspective on the Pathogenesis of MASLD—A Narrative Review
    Sandra Maria Barbalho, Lucas Fornari Laurindo, Vitor Engracia Valenti, Nahum Méndez-Sánchez, Mariana M. Ramírez-Mejía, Ricardo de Alvares Goulart
    International Journal of Molecular Sciences.2025; 26(23): 11547.     CrossRef
  • Systematic analysis of the expression profiles and prognostic values of the FAM72 family in liver cancer
    Weihao Kong, Long Teng, Kangjie Zhang, Yajun Zou, Xingyu Wang, Jianlin Zhang
    Biochemistry and Biophysics Reports.2025; 44: 102358.     CrossRef
  • Bioinformatics Analysis Reveals the Role of DLGAP4 in the Development and Progression of Hepatocellular Carcinoma
    Feng Yang, Shoufeng Chang, Ruxia Li, Jing Wei, Hua Zhang, Qiqi Wang, Zhenjun Li, Yamei Dang
    Journal of Gastrointestinal Cancer.2025;[Epub]     CrossRef
  • Early screening for liver cancer must be performed
    Zi-Han Liu, Wen-Jun Wang, Shuang-Suo Dang
    World Journal of Hepatology.2025;[Epub]     CrossRef
  • –A novel peptide SMIM45-107aa promotes HCC progression via MTDH pathways and its anticancer peptide derivative
    Yan An, Xiangyang Shi, Wentao Huang, Mingyi Shang, Guang-Zhi Jin
    Journal of Translational Medicine.2025;[Epub]     CrossRef
  • 23,965 View
  • 1,036 Download
  • 50 Web of Science
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Original Articles

Liver fibrosis, cirrhosis, and portal hypertension

Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis
Anja Tiede, Lena Stockhoff, Zhaoli Liu, Hannah Rieland, Jim B. Mauz, Valerie Ohlendorf, Birgit Bremer, Jennifer Witt, Anke Kraft, Markus Cornberg, Jan B. Hinrichs, Bernhard C. Meyer, Heiner Wedemeyer, Cheng-Jian Xu, Christine S. Falk, Benjamin Maasoumy
Clin Mol Hepatol 2025;31(1):240-255.
Published online November 21, 2024
DOI: https://doi.org/10.3350/cmh.2024.0587
Background/Aims
Systemic Inflammation (SI) is considered a key mechanism in disease progression and development of complications in decompensated liver cirrhosis. SI is mainly driven by portal hypertension and bacterial translocation. Transjugular intrahepatic portosystemic shunt (TIPS) insertion represents an effective treatment for portal hypertension. This study aims to investigate the impact of TIPS insertion on SI and bacterial translocation.
Methods
We prospectively included 59 cirrhotic patients undergoing TIPS insertion. Blood samples were collected at TIPS insertion and follow-up (FU) 1, 3, 6, and 12 months thereafter. At all time points, we performed a comprehensive analysis of SI including 43 soluble inflammatory markers (SIMs), and surrogates of bacterial translocation (sCD14, sCD163). To investigate long-term kinetics of SI, C-reactive protein (CRP) and white blood cells (WBC) were retrospectively analyzed in a cohort of 177 patients up to 3 years after TIPS insertion.
Results
At TIPS insertion, 30/43 SIMs, sCD14, and sCD163 measured significantly higher in cirrhotic patients compared to healthy controls. By FU6 25 SIMs and sCD14 measured at significantly lower levels compared to baseline. Interestingly, in patients with TIPS indication of refractory ascites, IL-6 decreased to levels documented in earlier stages of cirrhosis. In long-term follow-up, CRP levels significantly decreased after TIPS insertion, which translated into lower mortality in Cox regression analysis (HR 0.968, p=0.042). Notably, patients with residual ascites post-TIPS showed significantly higher CRP and IL-6 levels across all follow-ups compared to patients with resolved ascites.
Conclusions
Decreasing portal hypertension via TIPS insertion leads to a significant attenuation of SI and bacterial translocation over time.

Citations

Citations to this article as recorded by  Crossref logo
  • Systemic inflammatory indexes as predictors of 18-month mortality among cirrhotic patients receiving transjugular intrahepatic portosystemic shunt
    Jie Cheng, Xiaobing Wang, Lihua Zhou, Xiaojia Chen, Nuer Tang, Feng Zhou, Feng Ding, Yuan Yang, Jun Lin, Liping Chen
    Annals of Medicine.2025;[Epub]     CrossRef
  • Advancing our understanding of recompensated cirrhosis - the new “holy grail” of decompensated cirrhosis
    Thomas Reiberger, Benjamin Maasoumy
    Journal of Hepatology.2025; 83(3): 615.     CrossRef
  • Transjugular Intrahepatic Portosystemic Shunt (TIPS) Promotes Wound Healing in Cirrhotic Patients With Post‐Splenectomy Complications
    Na Han, Xulong Yuan, Zhengcai Liu, Yuanping Xu, Shuqiang Yue, Yongquan Shi, Jun Tie
    Portal Hypertension & Cirrhosis.2025; 4(3): 189.     CrossRef
  • TIPSEMS‐VB Trial Reappraised: Infection Control, HE Prophylaxis, and Ischemic Hepatitis Considerations
    Kaiyu Bian, Yujie Zhang, Xiang Ma
    Liver International.2025;[Epub]     CrossRef
  • Refining Prognosis in Cirrhosis Patients With Ascites: Impact of Acute vs. Non‐Acute Decompensation
    Lucie Simonis, Lorenz Balcar, Anna Schedlbauer, Marta Tonon, Nikolaj Torp, Valeria Santori, Katharina Stopfer, Jan Embacher, Christian Sebesta, Leonie Hafner, Benedikt Silvester Hofer, Nina Dominik, Georg Kramer, Paul Thöne, Michael Trauner, Aleksander Kr
    Alimentary Pharmacology & Therapeutics.2025; 62(11-12): 1202.     CrossRef
  • Reply
    Martin A. Kabelitz, Lisa Sandmann, Benjamin Maasoumy
    Clinical Gastroenterology and Hepatology.2025;[Epub]     CrossRef
  • Editorial: Redefining Decompensation in Cirrhosis—More Than an Academic Playground?
    Anja Tiede, Benjamin Maasoumy
    Alimentary Pharmacology & Therapeutics.2025; 62(11-12): 1230.     CrossRef
  • Editorial: Redefining Decompensation in Cirrhosis—More Than an Academic Playground? Authors' Reply
    Lucie Simonis, Lorenz Balcar, Georg Kramer, Thomas Reiberger, Georg Semmler
    Alimentary Pharmacology & Therapeutics.2025; 62(11-12): 1233.     CrossRef
  • Effectiveness of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) in an interdisciplinary setting at a large tertiary center
    Marlene Hintersteininger, Julia Kappel, Theresa Müllner-Buscics, Susanna Riegler, Nina Dominik, Georg Kramer, Christian Sebesta, Paul Thöne, Albert Friedrich Stättermayer, Lukas Reider, Maria Schoder, Catharina Klausenitz, Raoul Varga, Fredrik Waneck, Mic
    Wiener klinische Wochenschrift.2025;[Epub]     CrossRef
  • Prävention der Dekompensation bei einer fortgeschrittenen Lebererkrankung
    Marlene Reincke, Lukas Sturm, Robert Thimme, Dominik Bettinger
    DMW - Deutsche Medizinische Wochenschrift.2025; 150(21): 1267.     CrossRef
  • Treatment response to bulevirtide is linked to amelioration of portal hypertension in patients with chronic hepatitis D☆
    Lisa Sandmann, Mathias Jachs, Tammo L. Tergast, Lukas Hartl, Birgit Bremer, Martin A. Kabelitz, Michael Schwarz, Julius F.M. Egge, Lorenz Balcar, Benedikt Silvester Hofer, Christine S. Falk, Albert Friedrich Stättermayer, Markus Cornberg, Michael Trauner,
    JHEP Reports.2025; : 101643.     CrossRef
  • Neurofilament Light Chains in Serum Predict Post—Transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy
    Christian Labenz, Eva Maria Schleicher, Myriam Meineck, Martin A. Kabelitz, Alena F. Ehrenbauer, Anja Tiede, Jim B. Mauz, Sven Danneberg, Michael Bernhard Pitton, Falk Steffen, Julia Weinmann‐Menke, Peter Robert Galle, Stefan Bittner, Felix Lüssi, Jens Uw
    MedComm.2025;[Epub]     CrossRef
  • Decreasing interleukin-6 levels after TIPS predict outcomes in decompensated cirrhosis
    Andrea Kornfehl, Anja Tiede, Paul Hemetsberger, Julia Kappel, Theresa Müllner-Bucsics, Lena Stockhoff, Hannah Rieland, Lukas Reider, Nina Dominik, Georg Kramer, Michael Trauner, Mattias Mandorfer, Christine Falk, Benjamin Maasoumy, Thomas Reiberger, Lukas
    JHEP Reports.2024; : 101308.     CrossRef
  • 6,544 View
  • 282 Download
  • 16 Web of Science
  • Crossref

Steatotic liver disease

Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis
Nicholas A. Rouillard, Scott D. Barnett, Xinrong Zhang, Leslie Kam, Richie Manikat, Ramsey Cheung, Mindie H. Nguyen
Clin Mol Hepatol 2025;31(1):227-239.
Published online November 14, 2024
DOI: https://doi.org/10.3350/cmh.2024.0564
Background/Aims
With the obesity pandemic, metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease and a leading cause of end-stage liver disease and liver-related deaths in the USA. Therefore, we aimed to compare the long-term outcomes of patients with MASLD and cirrhosis with and without bariatric surgery.
Methods
Patients were retrospectively identified from the California Department of Healthcare Access and Information database, 2005 to 2019, for a population-based cohort study. Propensity score matching (PSM) was used to balance background risks between patients with cirrhosis who underwent bariatric surgery and those who did not. Overall, liver-related and non-liver-related mortality were analyzed.
Results
Of 91,708 eligible patients with MASLD and cirrhosis, PSM yielded 2,107 patients who underwent bariatric surgery and 8,428 non-bariatric controls. Compared to matched controls, patients who underwent bariatric surgery had lower 5-year overall (24.9% vs. 37.1%; p<0.0001), liver-related (3.3% vs. 14%; p<0.0001), and non-liver-related mortality (22.3% vs. 26.9%; p=0.046). In multivariable analysis, bariatric surgery was associated with decreased overall mortality (adjusted hazard ratio [aHR]=0.63; p<0.0001), liver-related (aHR=0.24; p<0.0001), and non-liverrelated (aHR=0.81; p=0.0026) mortality. However, only laparoscopic surgeries were associated with lower overall mortality (aHR=0.39; p<0.0001) whereas open surgeries were associated with higher overall mortality (aHR=1.24; p=0.022).
Conclusions
Patients with MASLD and cirrhosis who underwent bariatric surgery, specifically laparoscopic approaches, had significantly lower mortality risk than non-surgical counterparts.

Citations

Citations to this article as recorded by  Crossref logo
  • Differential Characteristics and Survival Outcomes of Patients With Cirrhosis According to Underlying Liver Aetiology
    Yu Shi, Nicholas Chien, Ashley Fong, Vy H. Nguyen, Surya Teja Gudapati, Angela Chau, Sally Tran, Linda Henry, Ramsey Cheung, Changqing Zhao, Minjuan Jin, Mindie H. Nguyen
    Alimentary Pharmacology & Therapeutics.2025; 61(10): 1622.     CrossRef
  • A leap in the dark: Bariatric surgery for treatment of metabolic dysfunction-associated steatotic liver disease related cirrhosis: Editorial on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic live
    Jing Zeng, Jian-Gao Fan
    Clinical and Molecular Hepatology.2025; 31(2): 610.     CrossRef
  • Letter to the editor on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Wei Wang, Yating Xie, Ailei Xu
    Clinical and Molecular Hepatology.2025; 31(2): e143.     CrossRef
  • Advancing precision medicine in metabolic dysfunction-associated steatotic liver disease
    Bryan A. Priego-Parra, Rocío Gallego-Durán, Berenice M. Román-Calleja, José Antonio Velarde-Ruiz Velasco, Manuel Romero-Gómez, Jordi Gracia-Sancho
    Trends in Endocrinology & Metabolism.2025; 36(11): 1000.     CrossRef
  • Correspondence to editorial on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Nicholas A. Rouillard, Linda Henry, Mindie H. Nguyen
    Clinical and Molecular Hepatology.2025; 31(2): e173.     CrossRef
  • Reply to correspondence on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Jing Zeng, Jian-Gao Fan
    Clinical and Molecular Hepatology.2025; 31(2): e218.     CrossRef
  • Letter to the editor on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Weixiong Zhu, Xuefan Zeng, Zengxi Yang, Yusheng Cheng, Wence Zhou
    Clinical and Molecular Hepatology.2025; 31(3): e252.     CrossRef
  • Association between body roundness index and risks of all-cause and cardiovascular mortality in adults with metabolic dysfunction-associated steatotic liver disease: NHANES 1999–2018
    Yanshan Yi, Li Yang
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • Letter to the editor on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Chi-Kuei Hsu, Po-Yu Huang, Chih-Cheng Lai
    Clinical and Molecular Hepatology.2025; 31(3): e247.     CrossRef
  • Efficacy and Safety of Bariatric Surgery in Well-Compensated Liver Cirrhosis: A Systematic Review and a Single-Arm Meta-analysis
    Pandora Fonseca, Leonardo Pereira, João Gabriel Braga, Giovanna Macanhã Scremin, Luísa de Araujo, Julia Alves, Gabriel de França, Pedro Bregion, Rafael Rego, Maria Farias, Victor Ivano
    Obesity Surgery.2025; 35(10): 4246.     CrossRef
  • Metabolic Dysfunction Associated to Steatotic Liver Disease: A Review
    Janna Vanessa Diaz Torres, Vanessa Rocío Villanueva Guerrero, Jennifer Patricia Vargas Gómez, Fredy Javier Pacheco Miranda, Lorena Rocío Orozco Álvarez, Joseph David León Insignares, Marian Mares, Héctor Mario Rodríguez Ortiz, Evelyn Mendoza-Torres
    Metabolic Syndrome and Related Disorders.2025; 23(10): 427.     CrossRef
  • Endoscopic Bariatric Therapies for Metabolic Dysfunction-Associated Steatotic Liver Disease: Mechanistic Insights and Metabolic Implications
    Wissam Ghusn, Mira Sridharan, Rachel Fromer, Muhammet Ozdemir, Madeleine G. Haff, Eric J. Vargas
    Biomedicines.2025; 13(10): 2437.     CrossRef
  • 5,671 View
  • 177 Download
  • 10 Web of Science
  • Crossref

Review

Hepatitis E as a trigger for acute-on-chronic liver failure
Maria Buti, Juan Carlos Ruiz-Cobo, Rafael Esteban, Mar Riveiro-Barciela
Clin Mol Hepatol 2025;31(Suppl):S196-S204.
Published online November 11, 2024
DOI: https://doi.org/10.3350/cmh.2024.0758
Acute hepatitis E virus (HEV) infection is typically self-limiting and has a favourable prognosis. However, certain populations such as patients with pre-existing chronic liver disease may experience severe manifestations, including progression to acute-on-chronic liver failure (ACLF). Among viral hepatitis types, hepatitis A, E, and B are major causes of ACLF. Active screening and early diagnosis of HEV infection in patients with cirrhosis, especially those who develop ACLF, can improve management and enable timely antiviral therapy. Preventive measures, including HEV vaccination for high-risk groups, could reduce the morbidity and mortality associated with hepatitis E.

Citations

Citations to this article as recorded by  Crossref logo
  • Efficacy and safety of mesenchymal stem cell therapy in acute on chronic liver failure: a systematic review and meta-analysis of randomized controlled clinical trials
    Wenming Lu, Longxiang Yan, Lulu Peng, Xuesong Wang, Xingkun Tang, Jing Du, Jing Lin, Zhengwei Zou, Lincai Li, Junsong Ye, Lin Zhou
    Stem Cell Research & Therapy.2025;[Epub]     CrossRef
  • Hepatitis A and E Viruses Are Important Agents of Acute Severe Hepatitis in Asia: A Narrative Review
    Reina Sasaki-Tanaka, Tatsuo Kanda, Takeshi Yokoo, Hiroyuki Abe, Kazunao Hayashi, Akira Sakamaki, Hiroteru Kamimura, Shuji Terai
    Pathogens.2025; 14(5): 454.     CrossRef
  • The role of bacterial outer membrane vesicles in inflammatory response of acute-on-chronic liver failure
    Xiaojing Qin, Shuang Wang, Zhanyao Yan, Ninghui Zhao, Jia Yao
    Frontiers in Microbiology.2025;[Epub]     CrossRef
  • Ribavirina como tratamiento de hepatitis E aguda grave sobre hepatopatía crónica: experiencia clínica
    Alba Rabadán Mata, María Dolores Antón Conejero, José María Paredes Arquiola
    Medicina Clínica.2025; 165(6): 107187.     CrossRef
  • Ribavirin as a treatment for severe acute hepatitis E on chronic liver disease: Clinical experience
    Alba Rabadán Mata, María Dolores Antón Conejero, José María Paredes Arquiola
    Medicina Clínica (English Edition).2025; : 107187.     CrossRef
  • 5,520 View
  • 170 Download
  • 4 Web of Science
  • Crossref

Editorials

Liver fibrosis, cirrhosis, and portal hypertension

Unveiling the distinctive gut microbiota and metabolites in liver cirrhosis and its complications: Novel diagnostic biomarkers: Editorial on “Gut microbiome and metabolome signatures in liver cirrhosis-related complications”
Soon Kyu Lee, Jong Young Choi
Clin Mol Hepatol 2025;31(1):301-303.
Published online August 30, 2024
DOI: https://doi.org/10.3350/cmh.2024.0716

Citations

Citations to this article as recorded by  Crossref logo
  • Correspondence to editorial on: “Gut microbiome and metabolome signatures in liver cirrhosis-related complications”
    Satya Priya Sharma, Ki Tae Suk
    Clinical and Molecular Hepatology.2025; 31(1): e74.     CrossRef
  • The crosstalk between gut microbiota and microbiota-derived metabolites in hepatocellular carcinoma
    Sang Jun Yoon, Seul Ki Han, Tae Suk Kim, Ki Tae Suk, Dae Hee Choi, Young Don Kim, Moon Young Kim, Gab Jin Cheon, Soon Koo Baik, Dong Joon Kim
    Critical Reviews in Microbiology.2025; : 1.     CrossRef
  • Gut-Liver Axis: The Role of Intestinal Microbiota and Their Metabolites in the Progression of Metabolic Dysfunction-Associated Steatotic Liver Disease
    Chao Cui, Shuai Gao, Jingfei Shi, Kai Wang
    Gut and Liver.2025; 19(4): 479.     CrossRef
  • 6,075 View
  • 94 Download
  • 2 Web of Science
  • Crossref

Liver fibrosis, cirrhosis, and portal hypertension

From invasive to intuitive: The emerging role of non-invasive models in hepatic decompensation: Editorial on “Carvedilol to prevent hepatic decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by new non-invasive model (CHESS2306)”
Akhil Deshmukh, Rakhi Maiwall
Clin Mol Hepatol 2025;31(2):577-580.
Published online August 19, 2024
DOI: https://doi.org/10.3350/cmh.2024.0661

Citations

Citations to this article as recorded by  Crossref logo
  • Correspondence to editorial on “Carvedilol to prevent hepatic decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by new non-invasive model (CHESS2306)”
    Chuan Liu, Ling Yang, Hong You, Gao-Jun Teng, Xiaolong Qi
    Clinical and Molecular Hepatology.2025; 31(2): e155.     CrossRef
  • 6,774 View
  • 52 Download
  • 1 Web of Science
  • Crossref

Acute liver injury and Acute liver failure

Modified quick-SOFA score: Can it enhance prognostic assessment for hospitalized patients with chronic liver diseases?: Editorial on “Dynamic analysis of acute deterioration in chronic liver disease patients using modified quick sequential organ failure assessment”
Simone Incicco, Salvatore Piano
Clin Mol Hepatol 2024;30(4):695-697.
Published online June 3, 2024
DOI: https://doi.org/10.3350/cmh.2024.0409

Citations

Citations to this article as recorded by  Crossref logo
  • RAC1 as a novel therapeutic target for acute liver failure
    Barbara Bueloni, Esteban Fiore, María José Cantero, Lucia Lameroli, Catalina Atorrasagasti, Matías Ciarlantini, Andrea Barquero, Lucía Gandolfi Donadio, Daiana Ganiewich, Francisco Orozco, Martín Fauda, Julieta Comin, Ali Canbay, Juan Bayo, Guillermo Mazz
    JHEP Reports.2025; 7(11): 101547.     CrossRef
  • Correspondence to editorial on “Dynamic analysis of acute deterioration in chronic liver disease patients using modified quick sequential organ failure assessment”
    Do Seon Song, Dong Joon Kim
    Clinical and Molecular Hepatology.2024; 30(4): 1012.     CrossRef
  • 4,808 View
  • 45 Download
  • 2 Web of Science
  • Crossref

Snapshot

Liver fibrosis, cirrhosis, and portal hypertension

Examining the therapeutic landscape of beta-blockers in portal hypertension
Anna Brujats, Càndid Villanueva
Clin Mol Hepatol 2024;30(4):1055-1059.
Published online March 6, 2024
DOI: https://doi.org/10.3350/cmh.2024.0144

Citations

Citations to this article as recorded by  Crossref logo
  • Decreasing systemic inflammation after TIPS: Still hope for the liver: Reply to correspondence on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrh
    Georg Semmler, Lorenz Balcar, Mattias Mandorfer
    Clinical and Molecular Hepatology.2025; 31(2): e224.     CrossRef
  • Principles of Non-selective Beta-blocker Usage for Cirrhosis-associated Complications
    Daisy K. Maclaine, Kosha J. Mehta
    SN Comprehensive Clinical Medicine.2025;[Epub]     CrossRef
  • Treating onychomycosis in diabetic patients: risk, therapy, and topical opportunity
    Aditya K. Gupta, Amanda Liddy, Tong Wang, Su Yong Choi, Elizabeth A. Cooper
    Journal of Dermatological Treatment.2025;[Epub]     CrossRef
  • 12,429 View
  • 106 Download
  • 2 Web of Science
  • Crossref

Original Article

Viral hepatitis

Prognostic role of computed tomography analysis using deep learning algorithm in patients with chronic hepatitis B viral infection
Jeongin Yoo, Heejin Cho, Dong Ho Lee, Eun Ju Cho, Ijin Joo, Sun Kyung Jeon
Clin Mol Hepatol 2023;29(4):1029-1042.
Published online August 29, 2023
DOI: https://doi.org/10.3350/cmh.2023.0190
Background/Aims
The prediction of clinical outcomes in patients with chronic hepatitis B (CHB) is paramount for effective management. This study aimed to evaluate the prognostic value of computed tomography (CT) analysis using deep learning algorithms in patients with CHB. Methods: This retrospective study included 2,169 patients with CHB without hepatic decompensation who underwent contrast-enhanced abdominal CT for hepatocellular carcinoma (HCC) surveillance between January 2005 and June 2016. Liver and spleen volumes and body composition measurements including subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle indices were acquired from CT images using deep learning-based fully automated organ segmentation algorithms. We assessed the significant predictors of HCC, hepatic decompensation, diabetes mellitus (DM), and overall survival (OS) using Cox proportional hazard analyses. Results: During a median follow-up period of 103.0 months, HCC (n=134, 6.2%), hepatic decompensation (n=103, 4.7%), DM (n=432, 19.9%), and death (n=120, 5.5%) occurred. According to the multivariate analysis, standardized spleen volume significantly predicted HCC development (hazard ratio [HR]=1.01, P=0.025), along with age, sex, albumin and platelet count. Standardized spleen volume (HR=1.01, P<0.001) and VAT index (HR=0.98, P=0.004) were significantly associated with hepatic decompensation along with age and albumin. Furthermore, VAT index (HR=1.01, P=0.001) and standardized spleen volume (HR=1.01, P=0.001) were significant predictors for DM, along with sex, age, and albumin. SAT index (HR=0.99, P=0.004) was significantly associated with OS, along with age, albumin, and MELD. Conclusions: Deep learning-based automatically measured spleen volume, VAT, and SAT indices may provide various prognostic information in patients with CHB.

Citations

Citations to this article as recorded by  Crossref logo
  • Reply to: “A machine learning model to predict liver-related outcomes after the functional cure of chronic hepatitis B: Is cirrhosis driving the performance?”
    Moon Haeng Hur, Jeong-Hoon Lee
    Journal of Hepatology.2025; 82(3): e143.     CrossRef
  • Early prediction of adverse outcomes in liver cirrhosis using a CT-based multimodal deep learning model
    Nanai Xie, Yiwen Liang, Zixin Luo, Jing Hu, Ruiquan Ge, Xiang Wan, Changmiao Wang, Guannan Zou, Feng Guo, Yi Jiang
    Abdominal Radiology.2025;[Epub]     CrossRef
  • Correspondence to editorial on “Hepatocellular carcinoma prediction model performance decreases with long-term antiviral therapy in chronic hepatitis B patients”
    Xiaoqian Xu, Hong You, Jidong Jia, Yuanyuan Kong
    Clinical and Molecular Hepatology.2024; 30(4): 994.     CrossRef
  • Deep learning assisted biomarker development in patients with chronic hepatitis B: Editorial on “Prognostic role of computed tomography analysis using deep learning algorithm in patients with chronic hepatitis B viral infection”
    Yong Eun Chung
    Clinical and Molecular Hepatology.2024; 30(4): 669.     CrossRef
  • Decreasing performance of HCC prediction models during antiviral therapy for hepatitis B: what else to keep in mind: Editorial on “Hepatocellular carcinoma prediction model performance decreases with long-term antiviral therapy in chronic hepatitis B pati
    Beom Kyung Kim
    Clinical and Molecular Hepatology.2024; 30(4): 656.     CrossRef
  • Assessment of body composition and prediction of infectious pancreatic necrosis via non-contrast CT radiomics and deep learning
    Bingyao Huang, Yi Gao, Lina Wu
    Frontiers in Microbiology.2024;[Epub]     CrossRef
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Correspondence

Artificial intelligence, epidemiology, methodology, or others

Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”
Ji Young Ryu, Seon Ha Baek, Sejoong Kim
Clin Mol Hepatol 2023;29(4):1048-1049.
Published online August 14, 2023
DOI: https://doi.org/10.3350/cmh.2023.0261
Correction in: Clin Mol Hepatol 2024;30(1):134
  • 5,832 View
  • 48 Download

Review

Artificial intelligence, epidemiology, methodology, or others

Evidence-based hyponatremia management in liver disease
Ji Young Ryu, Seon Ha Baek, Sejoong Kim
Clin Mol Hepatol 2023;29(4):924-944.
Published online June 5, 2023
DOI: https://doi.org/10.3350/cmh.2023.0090
Hyponatremia is primarily a water balance disorder associated with high morbidity and mortality. The pathophysiological mechanisms behind hyponatremia are multifactorial, and diagnosing and treating this disorder remains challenging. In this review, the classification, pathogenesis, and step-by-step management approaches for hyponatremia in patients with liver disease are described based on recent evidence. We summarize the five sequential steps of the traditional diagnostic approach: 1) confirm true hypotonic hyponatremia, 2) assess the severity of hyponatremia symptoms, 3) measure urine osmolality, 4) classify hyponatremia based on the urine sodium concentration and extracellular fluid status, and 5) rule out any coexisting endocrine disorder and renal failure. Distinct treatment strategies for hyponatremia in liver disease should be applied according to the symptoms, duration, and etiology of disease. Symptomatic hyponatremia requires immediate correction with 3% saline. Asymptomatic chronic hyponatremia in liver disease is prevalent and treatment plans should be individualized based on diagnosis. Treatment options for correcting hyponatremia in advanced liver disease may include water restriction; hypokalemia correction; and administration of vasopressin antagonists, albumin, and 3% saline. Safety concerns for patients with liver disease include a higher risk of osmotic demyelination syndrome.

Citations

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    Goce Spasovski
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  • Hyponatraemia—treatment standard 2024
    Goce Spasovski
    Nephrology Dialysis Transplantation.2024; 39(10): 1583.     CrossRef
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    Ji Young Ryu, Seon Ha Baek, Sejoong Kim
    Clinical and Molecular Hepatology.2023; 29(4): 1048.     CrossRef
  • Letter regarding “Evidence-based hyponatremia management in liver disease”
    Daphne J. Theodorou, Stavroula J. Theodorou, Ioannis V. Mitselos
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    Seul Ki Han, Soon Koo Baik, Moon Young Kim
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Correspondence

Artificial intelligence, epidemiology, methodology, or others

Correspondence on Letter 1 regarding “Assessing the performance of ChatGPT in answering questions regarding cirrhosis and hepatocellular carcinoma”
Yee Hui Yeo, Jamil S. Samaan, Wee Han Ng
Clin Mol Hepatol 2023;29(3):821-822.
Published online May 31, 2023
DOI: https://doi.org/10.3350/cmh.2023.0183

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Review

Liver fibrosis, cirrhosis, and portal hypertension

Hepatorenal syndrome: Current concepts and future perspectives
Chan-Young Jung, Jai Won Chang
Clin Mol Hepatol 2023;29(4):891-908.
Published online April 13, 2023
DOI: https://doi.org/10.3350/cmh.2023.0024
Hepatorenal syndrome (HRS), a progressive but potentially reversible deterioration of kidney function, remains a major complication in patients with advanced cirrhosis, often leading to death before liver transplantation (LT). Recent updates in the pathophysiology, definition, and classification of HRS have led to a complete revision of the nomenclature and diagnostic criteria for HRS type 1, which was renamed HRS-acute kidney injury (AKI). HRS is characterized by severe impairment of kidney function due to increased splanchnic blood flow, activation of several vasoconstriction factors, severe vasoconstriction of the renal arteries in the absence of kidney histologic abnormalities, nitric oxide dysfunction, and systemic inflammation. Diagnosis of HRS remains a challenge because of the lack of specific diagnostic biomarkers that accurately distinguishes structural from functional AKI, and mainly involves the differential diagnosis from other forms of AKI, particularly acute tubular necrosis. The optimal treatment of HRS is LT. While awaiting LT, treatment options include vasoconstrictor drugs to counteract splanchnic arterial vasodilation and plasma volume expansion by intravenous albumin infusion. In patients with HRS unresponsive to pharmacological treatment and with conventional indications for kidney replacement therapy (KRT), such as volume overload, uremia, or electrolyte imbalances, KRT may be applied as a bridging therapy to transplantation. Other interventions, such as transjugular intrahepatic portosystemic shunt, and artificial liver support systems have a very limited role in improving outcomes in HRS. Although recently developed novel therapies have potential to improve outcomes of patients with HRS, further studies are warranted to validate the efficacy of these novel agents.

Citations

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  • Paracentesis exceeding three liters increases risks of acute kidney injury even in cirrhotic patients with albumin infused refractory ascites
    Pei-Shan Wu, Kuei-Chuan Lee, Chih-Yu Li, Yun-Cheng Hsieh, Teh-Ia Huo, Han-Chieh Lin, Ming-Chih Hou
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    Shohei Asada, Tadashi Namisaki, Kosuke Kaji, Hiroaki Takaya, Takahiro Kubo, Takemi Akahane, Hideto Kawaratani, Norihisa Nishimura, Soichi Takeda, Hiroyuki Masuda, Akihiko Shibamoto, Takashi Inoue, Satoshi Iwai, Fumimasa Tomooka, Yuki Tsuji, Yukihisa Fujin
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Original Article

Hepatic neoplasm

Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma
Yi-Te Lee, Mohammad A. Karim, Hye Chung Kum, Sulki Park, Nicole E. Rich, Mazen Noureddin, Amit G. Singal, Ju Dong Yang
Clin Mol Hepatol 2023;29(2):453-464.
Published online February 1, 2023
DOI: https://doi.org/10.3350/cmh.2022.0450
Background/Aims
Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States.
Methods
HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEERMedicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis. Factors associated with unrecognized cirrhosis were identified using logistic regression analyses. Factors associated with overall survival were evaluated using Cox regression analyses.
Results
Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83–2.46), non-Hispanic Black race (aOR: 1.93, 95% CI: 1.45–2.57), and NAFLD etiology (aOR: 4.46, 95% CI: 3.68–5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR: 2.32, 95% CI: 1.71–3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR: 1.17, 95% CI: 1.08–1.27) compared to recognized cirrhosis.
Conclusions
Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male and Black patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes.

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Snapshot

Autoimmune liver disease

Epidemiology and updated management for autoimmune liver disease
Nae-Yun Heo, Haeryoung Kim
Clin Mol Hepatol 2023;29(1):194-196.
Published online December 14, 2022
DOI: https://doi.org/10.3350/cmh.2022.0387

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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

Non-invasive tests-based risk stratification: Baveno VII and beyond
Georg Semmler, Mathias Jachs, Mattias Mandorfer
Clin Mol Hepatol 2023;29(1):105-109.
Published online November 23, 2022
DOI: https://doi.org/10.3350/cmh.2022.0361

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Correspondences

Hepatic neoplasm

Correspondence on Editorial regarding “Impact of nationwide hepatocellular carcinoma surveillance on the prognosis in patients with chronic liver disease”
Won Sohn, Yong-Han Paik
Clin Mol Hepatol 2023;29(1):182-184.
Published online November 22, 2022
DOI: https://doi.org/10.3350/cmh.2022.0411

Citations

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  • Correspondence to editorial on “Multiomics profiling of buffy coat and plasma unveils etiology-specific signatures in hepatocellular carcinoma”
    Su Bin Lim, Hyo Jung Cho
    Clinical and Molecular Hepatology.2024; 30(4): 1009.     CrossRef
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Viral hepatitis

Correspondence on Editorial regarding “Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients”
Yu Jun Wong, Sanchit Sharma, Giulia Tosetti, Xiaolong Qi, Massimo Primignani
Clin Mol Hepatol 2023;29(1):188-190.
Published online November 22, 2022
DOI: https://doi.org/10.3350/cmh.2022.0408

Citations

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  • Prevention of Decompensation in Compensated Cirrhosis: Non-Selective Beta-Blockers for Everyone?
    Sanchit Sharma, Dhiraj Tripathi
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    Ujjal Poddar, Arghya Samanta, Moinak Sen Sarma, Basant Kumar, Richa Lal, Anshu Srivastava, Vijay Datta Upadhyaya, Surender Kumar Yachha, Ankur Mandelia
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  • Risk and predictors of hepatic decompensation in grey zone patients by the Baveno VII criteria: A competing risk analysis
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    Alimentary Pharmacology & Therapeutics.2023; 58(9): 920.     CrossRef
  • 6,143 View
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Letter to the Editor

Liver fibrosis, cirrhosis, and portal hypertension

Correspondence on Letter regarding “Impacts of muscle mass dynamics on prognosis of outpatients with cirrhosis”
Tae Hyung Kim, Young Kul Jung, Hyung Joon Yim
Clin Mol Hepatol 2023;29(1):173-175.
Published online November 15, 2022
DOI: https://doi.org/10.3350/cmh.2022.0372

Citations

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    Mingchong Liu, Yongheng Wang, Wentao Shi, Chensong Yang, Qidong Wang, Jingyao Chen, Jun Li, Bingdi Chen, Guixin Sun
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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

The rise of non-invasive tools in the diagnosis of portal hypertension: Validation of the Baveno VII consensus
Jeong-Ju Yoo, Sang Gyune Kim
Clin Mol Hepatol 2023;29(1):102-104.
Published online November 10, 2022
DOI: https://doi.org/10.3350/cmh.2022.0353

Citations

Citations to this article as recorded by  Crossref logo
  • Early portal hypertension in metabolic dysfunction-associated steatotic liver disease: a concise review
    Iván López-Méndez, Eva Juárez-Hernández, Juan Pablo Soriano-Márquez, Misael Uribe, Graciela Castro-Narro
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  • Correspondence on Letter regarding “Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune tolerant phase”
    Jeong-Ju Yoo, Sang Gyune Kim
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Original Articles

Impacts of muscle mass dynamics on prognosis of outpatients with cirrhosis
Tae Hyung Kim, Young Kul Jung, Hyung Joon Yim, Joo Won Baik, Sun Young Yim, Young-Sun Lee, Yeon Seok Seo, Ji Hoon Kim, Jong Eun Yeon, Kwan Soo Byun
Clin Mol Hepatol 2022;28(4):876-889.
Published online September 19, 2022
DOI: https://doi.org/10.3350/cmh.2022.0231
Background/Aims
Sarcopenia negatively affects the prognosis of cirrhotic patients, but clinical implications of changes in muscle mass remain unclear. We aimed to elucidate its role in the prognosis of outpatients with cirrhosis.
Methods
Patients with cirrhosis who underwent annual abdominal computed tomography (CT) for hepatocellular carcinoma surveillance were included in the prospective cohort. The L3 skeletal muscle index (SMI) was adopted as a proxy for the amount of skeletal muscle, and the rate of SMI change between inclusion and after 1 year (ΔSMI/yr%) was calculated.
Results
In total, 595 patients underwent a second CT after 1 year. Among them, 109 and 64 patients had sarcopenia and Child-Pugh class B/C decompensation at inclusion, which changed to 103 and 45 at the 1-year follow-up, respectively. During a median follow-up of 30.1 months after 1 year, 86 patients had at least one cirrhosis complication, and 18 died or received liver transplantation. In the development of cirrhosis complications, ΔSMI/yr% was independently associated, even after adjusting for the Child-Pugh and model for end stage liver disease (MELD)-Na scores. In addition, ΔSMI/yr% showed a good predictive performance for the development of cirrhosis complications within 6 months after 1-year follow-up in all subgroups, with a cut-off of -2.62 (sensitivity, 83.9%; specificity, 74.5%) in the overall population. SMI at 1-year and Child-Pugh score were independent factors associated with survival. In addition, changes in sarcopenia status significantly stratified survival.
Conclusion
ΔSMI/yr% was a good predictor of the development of cirrhosis complications in outpatients with cirrhosis, independent of Child-Pugh and MELD scores.

Citations

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  • Impact of year-to-year changes in skeletal muscle mass on the prediction of long-term survival in patients with liver cirrhosis
    Fulian Zhao, Ruojing Wang, Chengbin Zhu, Chang Zhang, Tianzhi Ni, Qijuan Zang, Yali Feng, Mengmeng Zhang, Li Zhu, Yage Zhu, Juan Du, Zhe Jiao, Chenxia Li, Taotao Yan, Yingli He, Yuchao Wu, Yingren Zhao, Yuan Yang
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Liver fibrosis, cirrhosis, and portal hypertension

Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients
Yu Jun Wong, Chen Zhaojin, Guilia Tosetti, Elisabetta Degasperi, Sanchit Sharma, Samagra Agarwal, Liu Chuan, Chan Yiong Huak, Li Jia, Qi Xiaolong, Anoop Saraya, Massimo Primignani
Clin Mol Hepatol 2023;29(1):135-145.
Published online September 5, 2022
DOI: https://doi.org/10.3350/cmh.2022.0181
Background/Aims
The utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation in an international real-world cohort of cACLD patients.
Methods
cACLD patients were stratified into three categories (CSPH excluded, grey zone, and CSPH). The risks of decompensation across different CSPH categories were estimated using competing risk regression for clustered data, with death and hepatocellular carcinoma as competing events. The performance of “treating definite CSPH” strategy to prevent decompensation using non-selective beta-blocker (NSBB) was compared against other strategies in decision curve analysis.
Results
One thousand one hundred fifty-nine cACLD patients (36.8% had CSPH) were included; 7.2% experienced decompensation over a median follow-up of 40 months. Non-invasive assessment of CSPH predicts a 5-fold higher risk of liver decompensation in cACLD patients (subdistribution hazard ratio, 5.5; 95% confidence interval, 4.0–7.4). “Probable CSPH” is suboptimal to predict decompensation risk in cACLD patients. CSPH exclusion criteria reliably exclude cACLD patients at risk of decompensation, regardless of etiology. Among the grey zone, the decompensation risk was negligible among viral-related cACLD, but was substantially higher among the non-viral cACLD group. Decision curve analysis showed that “treating definite CSPH” strategy is superior to “treating all varices” or “treating probable CSPH” strategy to prevent decompensation using NSBB.
Conclusions
Non-invasive assessment of CSPH may stratify decompensation risk and the need for NSBB in cACLD patients.

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    David Sooik Kim, Beom Kyung Kim, Jae Seung Lee, Hye Won Lee, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Nikolaos Pyrsopoulos, Seung Up Kim
    Journal of Gastroenterology and Hepatology.2023; 38(8): 1372.     CrossRef
  • Validation of non‐invasive diagnosis of CSPH in patients with compensated advanced chronic liver disease according to Baveno VII
    Byeong Geun Song, Myung Ji Goh, Wonseok Kang, Geum‐Youn Gwak, Yong‐Han Paik, Moon Seok Choi, Joon Hyeok Lee, Seung Woon Paik, Dong Hyun Sinn
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  • Non-Invasive Measurement of Hepatic Fibrosis by Transient Elastography: A Narrative Review
    Luca Rinaldi, Chiara Giorgione, Andrea Mormone, Francesca Esposito, Michele Rinaldi, Massimiliano Berretta, Raffaele Marfella, Ciro Romano
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  • Combination of Fibrosis-4, liver-stiffness measurement, and Fibroscan-AST score to predict liver-related outcomes in nonalcoholic fatty liver disease
    Yu Jun Wong, Esteban Urias, Michael W. Song, Tanvi Goyal, Wei Xuan Tay, Nicole Xinrong Han, Jing Hong Loo, Tian Yu Qiu, Karn Wijarnpreecha, Yiong Huak Chan, Vincent L. Chen
    Hepatology Communications.2023;[Epub]     CrossRef
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Impact of nationwide hepatocellular carcinoma surveillance on the prognosis in patients with chronic liver disease
Won Sohn, Danbee Kang, Minwoong Kang, Eliseo Guallar, Juhee Cho, Yong-Han Paik
Clin Mol Hepatol 2022;28(4):851-863.
Published online June 3, 2022
DOI: https://doi.org/10.3350/cmh.2022.0037
Background/Aims
This study aimed to investigate the effect of hepatocellular carcinoma (HCC) surveillance using the Korea National Liver Cancer Screening Program on the receipt of curative treatment for HCC and mortality in patients with chronic liver disease.
Methods
This population-based cohort study from the Korean National Health Insurance Service included 2003 to 2015 claims data collected from 1,209,825 patients aged ≥40 years with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis. Patients were divided according to HCC surveillance using ultrasonography and serum alpha-fetoprotein every 6–12 months. The study outcomes were the receipt of curative treatment (surgical resection, radiofrequency ablation, or liver transplantation) and all-cause mortality.
Results
The study population consisted of 1,209,825 patients with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis (median age, 52.0 years; interquartile range, 46–55 years; 683,902 men [56.5%]). The proportion of participants who underwent HCC surveillance was 52.7% (n=657,889). During 10,522,940 person-years of follow-up, 74,433 HCC cases developed, including 36,006 patients who underwent curative treatment. The surveillance group had a significantly higher proportion of curative treatment for HCC than the non-surveillance group after adjusting for confounding factors (adjusted hazard ratio [HR], 5.64; 95% confidence interval [CI], 5.48–5.81). The surveillance group had a significantly lower mortality rate than the non-surveillance group (adjusted HR, 0.56; 95% CI, 0.55–0.56).
Conclusions
HCC surveillance using the national screening program in patients with chronic viral hepatitis or liver cirrhosis provides better opportunity for curative treatment for HCC and improves overall survival.

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Effect of moderate-to-severe hepatic steatosis on neutralising antibody response among BNT162b2 and CoronaVac recipients
Ka Shing Cheung, Lok Ka Lam, Rex Wan Hin Hui, Xianhua Mao, Ruiqi R Zhang, Kwok Hung Chan, Ivan FN Hung, Wai Kay Seto, Man-Fung Yuen
Clin Mol Hepatol 2022;28(3):553-564.
Published online May 11, 2022
DOI: https://doi.org/10.3350/cmh.2022.0082
Background/Aims
Studies of hepatic steatosis (HS) effect on COVID-19 vaccine immunogenicity are lacking. We aimed to compare immunogenicity of BNT162b2 and CoronaVac among moderate/severe HS and control subjects.
Methods
Two hundred ninety-five subjects who received BNT162b2 or CoronaVac vaccines from five vaccination centers were categorized into moderate/severe HS (controlled attenuation parameter ≥268 dB/m on transient elastography) (n=74) or control (n=221) groups. Primary outcomes were seroconversion rates of neutralising antibody by live virus Microneutralization (vMN) assay (titer ≥10) at day21 (BNT162b2) or day28 (CoronaVac) and day56 (both). Secondary outcome was highest-tier titer response (top 25% of vMN titer; cutoff: 160 [BNT162b2] and 20 [CoronaVac]) at day 56.
Results
For BNT162b2 (n=228, 77.3%), there was no statistical differences in seroconversion rates (day21: 71.7% vs. 76.6%; day56: 100% vs. 100%) or vMN geometric mean titer (GMT) (day21: 13.2 vs. 13.3; day56: 91.9 vs. 101.4) among moderate/severe HS and control groups respectively. However, lower proportion of moderate/severe HS patients had highest-tier response (day56: 5.0% vs. 15.5%; P=0.037). For CoronaVac (n=67, 22.7%), there was no statistical differences in seroconversion rates (day21: 7.1% vs. 15.1%; day56: 64.3% vs. 83.0%) or vMN GMT (5.3 vs. 5.8,) at day28. However, moderate/severe HS patients had lower vMN GMT (9.1 vs. 14.8, P=0.021) at day 56 with lower proportion having highest-tier response (21.4% vs. 52.8%, P=0.036).
Conclusions
While there was no difference in seroconversion rate between moderate/severe HS and control groups after two doses of vaccine, a lower proportion of moderate/severe HS patients achieved highest-tier response for either BNT162b2 or CoronaVac.

Citations

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  • Gut microbiota is associated with persistence of longer-term BNT162b2 vaccine immunogenicity
    Ho Yu Ng, Yunshi Liao, Ching Lung Cheung, Ruiqi Zhang, Kwok Hung Chan, Wai-Kay Seto, Wai K. Leung, Ivan F. N. Hung, Tommy T. Y. Lam, Ka Shing Cheung
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    Ka Shing Cheung, Lok Ka Lam, Xianhua Mao, Jing Tong Tan, Poh Hwa Ooi, Ruiqi Zhang, Kwok Hung Chan, Ivan F. N. Hung, Wai Kay Seto, Man Fung Yuen
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Reappraisal of sepsis-3 and CLIF-SOFA as predictors of mortality in patients with cirrhosis and infection presenting to the emergency department: A multicenter study
Ji Hyun Kim, Baek Gyu Jun, Minjong Lee, Hye Ah Lee, Tae Suk Kim, Jeong Won Heo, Da Hye Moon, Seong Hee Kang, Ki Tae Suk, Moon Young Kim, Young Don Kim, Gab Jin Cheon, Soon Koo Baik, Dong Joon Kim, Dae Hee Choi
Clin Mol Hepatol 2022;28(3):540-552.
Published online May 6, 2022
DOI: https://doi.org/10.3350/cmh.2021.0169
Background/Aims
Sepsis-3 criteria and quick Sequential Organ Failure Assessment (qSOFA) have been advocated to be used in defining sepsis in the general population. We aimed to compare the Sepsis-3 criteria and Chronic Liver Failure-SOFA (CLIF-SOFA) scores as predictors of in-hospital mortality in cirrhotic patients admitted to the emergency department (ED) for infections.
Methods
A total of 1,622 cirrhosis patients admitted at the ED for infections were assessed retrospectively. We analyzed their demographic, laboratory, and microbiological data upon diagnosis of the infection. The primary endpoint was inhospital mortality rate. The predictive performances of baseline CLIF-SOFA, Sepsis-3, and qSOFA scores for in-hospital mortality were evaluated.
Results
The CLIF-SOFA score proved to be significantly better in predicting in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.80; 95% confidence interval [CI], 0.78–0.82) than the Sepsis-3 (AUROC, 0.75; 95% CI, 0.72–0.77, P<0.001) and qSOFA (AUROC, 0.67; 95% CI, 0.64–0.70; P<0.001) score. The CLIF-SOFA, CLIF-C-AD scores, Sepsis-3 criteria, septic shock, and qSOFA positivity were significantly associated with in-hospital mortality (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.19–1.28; aHR, 1.13; 95% CI, 1.09–1.17; aHR, 1.19; 95% CI, 1.15–1.24; aHR, 1.88; 95% CI, 1.42–2.48; aHR, 2.06; 95% CI, 1.55–2.72; respectively; all P<0.001). For CLIF-SOFA scores ≥6, in-hospital mortality was >10%; this is the cutoff point for the definition of sepsis.
Conclusions
Among cirrhosis patients presenting with infections at the ED, CLIF-SOFA scores showed a better predictive performance for mortality than both Sepsis-3 criteria and qSOFA scores, and can be a useful tool of risk stratification in cirrhotic patients requiring timely intervention for infection.

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  • A Serum DLL1 and CRP dual-marker model for bacterial infection detection in patients with decompensated cirrhosis: A dual-cohort diagnostic study
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    Aryoung Kim, Byeong Geun Song, Wonseok Kang, Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Myung Ji Goh
    The Korean Journal of Internal Medicine.2024; 39(3): 448.     CrossRef
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    Do Seon Song, Hee Yeon Kim, Young Kul Jung, Tae Hyung Kim, Hyung Joon Yim, Eileen L Yoon, Ki Tae Suk, Jeong-ju Yoo, Sang Gyune Kim, Moon Young Kim, Young Chang, Soung Won Jeong, Jae Young Jang, Sung-Eun Kim, Jung-Hee Kim, Jung Gil Park, Won Kim, Jin Mo Ya
    Clinical and Molecular Hepatology.2024; 30(3): 388.     CrossRef
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    Do Seon Song, Dong Joon Kim
    Clinical and Molecular Hepatology.2024; 30(4): 1012.     CrossRef
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    Thomas N. Smith, Alice Gallo de Moraes, Douglas A. Simonetto
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Snapshot

Liver fibrosis, cirrhosis, and portal hypertension

Acute on chronic liver failure in cirrhosis
Marta Tonon, Salvatore Piano
Clin Mol Hepatol 2022;28(2):273-275.
Published online February 14, 2022
DOI: https://doi.org/10.3350/cmh.2022.0036

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    Jongman Kim
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    Barbara Bueloni, Esteban Fiore, María José Cantero, Lucia Lameroli, Catalina Atorrasagasti, Matías Ciarlantini, Andrea Barquero, Lucía Gandolfi Donadio, Daiana Ganiewich, Francisco Orozco, Martín Fauda, Julieta Comin, Ali Canbay, Juan Bayo, Guillermo Mazz
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Original Articles

Liver fibrosis, cirrhosis, and portal hypertension

U-shaped relationship between urea level and hepatic decompensation in chronic liver diseases
Huapeng Lin, Grace Lai-Hung Wong, Xinrong Zhang, Terry Cheuk-Fung Yip, Ken Liu, Yee Kit Tse, Vicki Wing-Ki Hui, Jimmy Che-To Lai, Henry Lik-Yuen Chan, Vincent Wai-Sun Wong
Clin Mol Hepatol 2022;28(1):77-90.
Published online November 5, 2021
DOI: https://doi.org/10.3350/cmh.2021.0188
Background/Aims
We aimed to determine the association between blood urea level and incident cirrhosis, hepatic decompensation, and hepatocellular carcinoma in chronic liver disease (CLD) patients.
Methods
The association between blood urea level and liver fibrosis/liver-related events were evaluated on continuous scale with restricted cubic spline curves based on generalized additive model or Cox proportional hazards models. Then, the above associations were evaluated by urea level within intervals.
Results
Among 4,282 patients who had undergone liver stiffness measurement (LSM) by transient elastography, baseline urea level had a U-shaped association with LSM and hepatic decompensation development after a median follow-up of 5.5 years. Compared to patients with urea of 3.6–9.9 mmol/L, those with urea ≤3.5 mmol/L (adjusted hazard ratio [aHR], 4.15; 95% confidence interval [CI], 1.68–10.24) and ≥10 mmol/L (aHR, 5.22; 95% CI, 1.86–14.67) had higher risk of hepatic decompensation. Patients with urea ≤3.5 mmol/L also had higher risk of incident cirrhosis (aHR, 3.24; 95% CI, 1.50–6.98). The association between low urea level and incident cirrhosis and hepatic decompensation was consistently observed in subgroups by age, gender, albumin level, and comorbidities. The U-shaped relationship between urea level and LSM was validated in another population screening study (n=917). Likewise, urea ≤3.5 mmol/L was associated with a higher risk of incident cirrhosis in a territory-wide cohort of 12,476 patients with nonalcoholic fatty liver disease at a median follow-up of 9.9 years (aHR, 1.27; 95% CI, 1.03–1.57).
Conclusions
We identified a U-shaped relationship between the urea level and liver fibrosis/incident cirrhosis/hepatic decompensation in patients with CLD.

Citations

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  • Aframomum alboviolaceum (Ridl.) K.Schum. leaf essential oil protects against Benzo(a)pyrene induced prostate cancer in Wistar rats
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    Journal of Ethnopharmacology.2026; 355: 120691.     CrossRef
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  • Reply to: Blood urea better than creatinine in prognosticating post‐TIPS outcomes: Hope or hype?
    Luisa Fürschuß, Florian Rainer, Angela Horvath, Vanessa Stadlbauer
    Liver International.2022; 42(7): 1702.     CrossRef
  • Blood urea better than creatinine in prognosticating post‐TIPS outcomes: Hope or hype?
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    Liver International.2022; 42(7): 1700.     CrossRef
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Liver fibrosis, cirrhosis, and portal hypertension

Cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis
Jihyun An, Hyung-Don Kim, Seon-Ok Kim, Ha Il Kim, Gi-Won Song, Han Chu Lee, Ju Hyun Shim
Clin Mol Hepatol 2022;28(1):67-76.
Published online October 12, 2021
DOI: https://doi.org/10.3350/cmh.2021.0202
Background/Aims
We aimed to investigate the silent atherosclerotic burden of cervicocephalic vessels in cirrhotic patients compared with the general population, as well as the relevant risk factors including coronary parameters.
Methods
This study included 993 stroke-free patients with liver cirrhosis (LC) who underwent magnetic resonance angiography (MRA) of the head and neck as a pre-liver transplant assessment and 6,099 health checkup participants who underwent MRA examination. The two cohorts were matched for cerebrovascular risk factors, and the prevalence of atherosclerosis in major intracranial and extracranial arteries was compared in 755 matched pairs. Moreover, traditional, hepatic, and coronary variables related to cerebral atherosclerosis were assessed in cirrhotic patients.
Results
Overall, intracranial atherosclerosis was significantly less prevalent in the LC group than in the matched control group (2.3% vs. 5.4%, P=0.002), whereas the prevalence of extracranial atherosclerosis was similar (4.4% vs. 5.8%, P=0.242). These results were maintained in multivariate analyses of the pooled samples, with corresponding adjusted odds ratios [ORs] of LC of 0.56 and 0.77 (95% confidence intervals [CIs], 0.36–0.88 and 0.55–1.09). In the LC group, lower platelet count was inversely correlated with intracranial atherosclerosis (adjusted OR, 0.31; 95% CI, 0.13–0.76). Coronary artery calcium (CAC) score ≥100 was the only predictive factor for both intracranial and extracranial atherosclerosis (adjusted ORs, 4.06 and 5.43, respectively).
Conclusions
LC confers protection against intracranial atherosclerosis, and thrombocytopenia may be involved in this protective effect. High CAC score could serve as a potential surrogate for cervicocerebral vascular screening in asymptomatic cirrhotic patients.

Citations

Citations to this article as recorded by  Crossref logo
  • Letter: cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis
    Yi-Chun Huang, Chih-Wei Chen, James Chun-Chung Wei
    Clinical and Molecular Hepatology.2022; 28(2): 265.     CrossRef
  • Reply: Letter: cervicocerebral atherosclerosis and its hepatic and coronary risk factors in patients with liver cirrhosis
    Jihyun An, Ju Hyun Shim
    Clinical and Molecular Hepatology.2022; 28(2): 267.     CrossRef
  • 7,979 View
  • 186 Download
  • 2 Web of Science
  • Crossref

Review

Liver fibrosis, cirrhosis, and portal hypertension

The role of transjugular intrahepatic portosystemic shunt in patients with portal hypertension: Advantages and pitfalls
Hae Lim Lee, Sung Won Lee
Clin Mol Hepatol 2022;28(2):121-134.
Published online September 27, 2021
DOI: https://doi.org/10.3350/cmh.2021.0239
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective interventional procedure to relieve portal hypertension, which is a main mechanism for the development of complications of liver cirrhosis (LC), such as variceal hemorrhage, ascites, and hepatorenal syndrome. However, the high incidence of adverse events after TIPS implementation limits its application in clinical practice. Esophageal variceal hemorrhage is one of the major indications for TIPS. Recently, preemptively performed TIPS has been recommended, as several studies have shown that TIPS significantly reduced mortality as well as rebleeding or failure to control bleeding in patients who are at high risk of treatment failure for bleeding control with endoscopic variceal ligation and vasoactive drugs. Meanwhile, recurrent ascites is another indication for TIPS with a proven survival benefit. TIPS may also be considered as an effective treatment for other LC complications, usually as an alternative therapy. Although there are concerns about the development of hepatic encephalopathy and hepatic dysfunction after TIPS implementation, careful patient selection using prognostic scores can lead to excellent outcomes. Assessments of cardiac and renal function prior to TIPS may also be considered to improve patient prognosis.

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Special Topic

COVID-19

Update on liver disease management during the pandemic of coronavirus disease 2019 (COVID-19): 2021 KASL guideline
Ju-Yeon Cho, Young-Sun Lee, Soon Sun Kim, Do Seon Song, Jeong-Hoon Lee, Ji Hoon Kim, on behalf of the Korean Association for the Study of the Liver
Clin Mol Hepatol 2021;27(4):515-523.
Published online September 17, 2021
DOI: https://doi.org/10.3350/cmh.2021.0293

Citations

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  • Correspondence on Letter regarding “COVID-19 vaccine immunogenicity among chronic liver disease patients and liver transplant recipients: A meta-analysis”
    Ka Shing Cheung, Chiu Hang Mok, Wai Kay Seto, Man Fung Yuen
    Clinical and Molecular Hepatology.2023; 29(1): 176.     CrossRef
  • SARS-CoV-2 Infection and Liver Disease: A Review of Pathogenesis and Outcomes
    Luke Baldelli, Thomas Marjot, Eleanor Barnes, A. Sidney Barritt, Gwilym J. Webb, Andrew M. Moon
    Gut and Liver.2023; 17(1): 12.     CrossRef
  • Analysis of Antibody Responses After COVID-19 Vaccination in Liver Transplant Recipients: A Single-Center Study
    Young Ju Oh, Jongman Kim, Eun-Suk Kang, Jinsoo Rhu, Gyu-Seong Choi, Jae-Won Joh
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Acute Budd‐Chiari syndrome with thrombotic thrombocytopenia after BNT162b2 mRNA vaccination
    Pil S. Sung, Jung S. Oh, Joon‐Il Choi
    Liver International.2022; 42(6): 1447.     CrossRef
  • Forms of cholangitis to be considered after SARS-CoV-2 infection
    Ju-Yeon Cho, Young-Sun Lee, Soon Sun Kim, Do Seon Song, Jeong-Hoon Lee, Ji Hoon Kim
    Clinical and Molecular Hepatology.2022; 28(4): 929.     CrossRef
  • Autoimmune liver disease represented as primary biliary cholangitis after SARS-CoV-2 infection: A need for population-based cohort study
    Soon Kyu Lee, Jung Hyun Kwon, Nara Yoon, Soon Woo Nam, Pil Soo Sung
    Clinical and Molecular Hepatology.2022; 28(4): 926.     CrossRef
  • 10,018 View
  • 95 Download
  • 6 Web of Science
  • Crossref

Editorial

Liver fibrosis, cirrhosis, and portal hypertension

Leaky gut-derived tumor necrosis factor-α causes sarcopenia in patients with liver cirrhosis
Takumi Kawaguchi, Takuji Torimura
Clin Mol Hepatol 2022;28(2):177-180.
Published online August 26, 2021
DOI: https://doi.org/10.3350/cmh.2021.0246

Citations

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  • Pathogenic Mechanisms of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-Associated Hepatocellular Carcinoma
    Toru Nakamura, Atsutaka Masuda, Dan Nakano, Keisuke Amano, Tomoya Sano, Masahito Nakano, Takumi Kawaguchi
    Cells.2025; 14(6): 428.     CrossRef
  • The Impact of Rifaximin on Hepatic Encephalopathy during Lenvatinib Therapy in Patients with Hepatocellular Carcinoma and Splenorenal Shunt
    Shigeo Shimose, Hideki Iwamoto, Takashi Niizeki, Tomotake Shirono, Etsuko Moriyama, Takumi Kawaguchi
    Internal Medicine.2025;[Epub]     CrossRef
  • Metabolic dysfunction-associated fatty liver disease is a ubiquitous latent cofactor in viral- and alcoholic-related hepatocellular carcinoma: Editorial on “Global prevalence of metabolic dysfunction-associated fatty liver disease-related hepatocellular c
    Toru Nakamura, Masahito Nakano, Tsubasa Tsutsumi, Keisuke Amano, Takumi Kawaguchi
    Clinical and Molecular Hepatology.2024; 30(4): 705.     CrossRef
  • Interaction between sarcopenia and nonalcoholic fatty liver disease
    Sae Kyung Joo, Won Kim
    Clinical and Molecular Hepatology.2023; 29(Suppl): S68.     CrossRef
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    Yamin Fu, Baohuan Fan, Shenzhen Chang, Dongyu Guo, Fuxiang Wang, Qinhe Pan
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  • Role of increased intestinal permeability in the development and progression of liver diseases
    S. N. Mekhtiyev, O. A. Mekhtiyeva, O. M. Berko, A. M. Kolodkin
    Experimental and Clinical Gastroenterology.2023; (12): 130.     CrossRef
  • 8,406 View
  • 195 Download
  • 6 Web of Science
  • Crossref

Review

Liver fibrosis, cirrhosis, and portal hypertension

Current knowledge about biomarkers of acute kidney injury in liver cirrhosis
Han Ah Lee, Yeon Seok Seo
Clin Mol Hepatol 2022;28(1):31-46.
Published online August 2, 2021
DOI: https://doi.org/10.3350/cmh.2021.0148
Acute kidney injury (AKI) is common in advanced cirrhosis. Prerenal azotemia, hepatorenal syndrome, and acute tubular necrosis are the main causes of AKI in patients with cirrhosis. Evaluation of renal function and differentiation between functional and structural kidney injury are important issues in the management of cirrhosis. However, AKI in cirrhosis exists as a complex clinical spectrum rather than concrete clinical entity. Based on current evidence, changes in serum creatinine (Cr) levels remain the most appropriate standard for defining AKI in cirrhosis. However, serum Cr has a limited role in assessing renal function in this population. This review examines previous studies that investigated the ability of recent biomarkers for AKI in cirrhosis from the perspective of earlier and accurate diagnosis, classification of AKI phenotype, and prediction of clinical outcomes. Serum cystatin C and urine neutrophil gelatinase-associated lipocalin have been extensively studied in cirrhosis, and have facilitated improved diagnosis and prognosis prediction in patients with AKI. In addition, urine N-acetyl-β-D-glucosaminidase, interleukin 18, and kidney injury molecule 1 are other promising biomarkers for advanced cirrhosis. However, the clinical significance of these markers remains unclear because there are no cut-off values defining the normal range and differentiating phenotypes of AKI. In addition, AKI has been defined in terms of serum Cr, and renal biopsy—the gold standard—has not been carried out in most studies. Further discovery of innovate biomarkers and incorporation of various markers could improve the diagnosis and prognosis prediction of AKI, and will translate into meaningful improvements in patient outcomes.

Citations

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Original Articles

Liver fibrosis, cirrhosis, and portal hypertension

Association between serum tumor necrosis factor-α and sarcopenia in liver cirrhosis
Ji Won Han, Da In Kim, Hee Chul Nam, U Im Chang, Jin Mo Yang, Do Seon Song
Clin Mol Hepatol 2022;28(2):219-231.
Published online July 20, 2021
DOI: https://doi.org/10.3350/cmh.2021.0082
Background/Aims
Sarcopenia is an independent prognostic factor of liver cirrhosis (LC). However, the association between LC-related systemic inflammation and sarcopenia is unclear.
Methods
Sprague-Dawley rats were treated with thioacetamide (TAA) or saline as a control. Rifaximin was administered to TAA-induced LC rats. Enzyme-linked immunosorbent assay was performed to measure inflammatory mediators in rat serum. RT-PCR was performed to measure the molecular expression in tissues. Hematoxylin and eosin (H&E) staining and immunohistochemistry were performed to investigate tissue pathology. Serum tumor necrosis factor-α levels, liver stiffness (LS), and the L3 skeletal muscle index (L3SMI) were measured in 60 patients with chronic liver disease.
Results
LC and sarcopenia were successfully induced by TAA. Serum TNF-α levels were increased in LC rats and correlated with myostatin expression, muscle weight, and myofiber diameter. The expression of intestinal occludin and zona occludens-1 was reduced in LC rats and associated with serum TNF-α levels and sarcopenia. In patients with LS ≥7 kPa or sarcopenia, serum TNF-α levels were significantly increased, which was also confirmed when we raised the LS cutoff to 10 kPa. The L3SMI was inversely correlated with serum TNF-α levels in patients with LS ≥7 kPa. TNF-α was reduced by rifaximin, which might have resulted in reduced expression of muscular MuRF1 and myostatin and improvements in myofiber diameters within muscle tissues.
Conclusions
These results suggest that serum TNF-α is associated with LC-related sarcopenia. Rifaximin might be effective in reducing serum TNF-α levels and improving sarcopenia in LC, but these results need to be validated in future studies.

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Viral hepatitis

Sofosbuvir/velpatasvir plus ribavirin for Child-Pugh B and Child-Pugh C hepatitis C virus-related cirrhosis
Chen-Hua Liu, Chi-Yi Chen, Wei-Wen Su, Chun-Jen Liu, Ching-Chu Lo, Ke-Jhang Huang, Jyh-Jou Chen, Kuo-Chih Tseng, Chi-Yang Chang, Cheng-Yuan Peng, Yu-Lueng Shih, Chia-Sheng Huang, Wei-Yu Kao, Sheng-Shun Yang, Ming-Chang Tsai, Jo-Hsuan Wu, Po-Yueh Chen, Pei-Yuan Su, Jow-Jyh Hwang, Yu-Jen Fang, Pei-Lun Lee, Chi-Wei Tseng, Fu-Jen Lee, Hsueh-Chou Lai, Tsai-Yuan Hsieh, Chun-Chao Chang, Chung-Hsin Chang, Yi-Jie Huang, Jia-Horng Kao
Clin Mol Hepatol 2021;27(4):575-588.
Published online July 13, 2021
DOI: https://doi.org/10.3350/cmh.2021.0155
Background/Aims
Real-world studies assessing the effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) plus ribavirin (RBV) for Child-Pugh B/C hepatitis C virus (HCV)-related cirrhosis are limited.
Methods
We included 107 patients with Child-Pugh B/C HCV-related cirrhosis receiving SOF/VEL plus RBV for 12 weeks in Taiwan. The sustained virologic response rates at off-treatment week 12 (SVR12) for the evaluable population (EP), modified EP, and per-protocol population (PP) were assessed. Thesafety profiles were reported.
Results
The SVR12 rates in the EP, modified EP and PP were 89.7% (95% confidence interval [CI], 82.5–94.2%), 94.1% (95% CI, 87.8–97.3%), and 100% (95% CI, 96.2–100%). Number of patients who failed to achieve SVR12 were attributed to virologic failures. The SVR12 rates were comparable regardless of patient characteristics. One patient discontinued treatment because of adverse events (AEs). Twenty-four patients had serious AEs and six died, but none were related to SOF/VEL or RBV. Among the 96 patients achieving SVR12, 84.4% and 64.6% had improved Child-Pugh and model for endstage liver disease (MELD) scores. Multivariate analysis revealed that a baseline MELD score ≥15 was associated with an improved MELD score of ≥3 (odds ratio, 4.13; 95% CI, 1.16–14.71; P=0.02). Patients with chronic kidney disease (CKD) stage 1 had more significant estimated glomerular filtration rate declines than patients with CKD stage 2 (-0.42 mL/min/1.73 m2/month; P=0.01) or stage 3 (-0.56 mL/min/1.73 m2/month; P<0.001).
Conclusions
SOF/VEL plus RBV for 12 weeks is efficacious and well-tolerated for Child-Pugh B/C HCV-related cirrhosis.

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Review

Liver fibrosis, cirrhosis, and portal hypertension

Treatment of direct oral anticoagulants in patients with liver cirrhosis and portal vein thrombosis
Ho Soo Chun, A Reum Choe, Minjong Lee, Yuri Cho, Hwi Young Kim, Kwon Yoo, Tae Hun Kim
Clin Mol Hepatol 2021;27(4):535-552.
Published online June 16, 2021
DOI: https://doi.org/10.3350/cmh.2021.0109
Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.

Citations

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Editorial

Liver fibrosis, cirrhosis, and portal hypertension

A need for patient-centered care in managing patients with liver cirrhosis
Eileen L. Yoon
Clin Mol Hepatol 2021;27(2):270-272.
Published online January 27, 2021
DOI: https://doi.org/10.3350/cmh.2021.0001

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Review

Steatotic liver disease

Evaluation and management of extrahepatic manifestations of nonalcoholic fatty liver disease
Karn Wijarnpreecha, Elizabeth S. Aby, Aijaz Ahmed, Donghee Kim
Clin Mol Hepatol 2021;27(2):221-235.
Published online December 3, 2020
DOI: https://doi.org/10.3350/cmh.2020.0239
Nonalcoholic fatty liver disease (NAFLD) is a multisystemic disease and a rapidly growing cause of chronic liver disease in children and adults worldwide. Diagnosis and management of extrahepatic manifestations of NAFLD, including cardiovascular disease (CVD), type 2 diabetes mellitus, metabolic syndrome, chronic kidney disease, obstructive sleep apnea, polycystic ovarian syndrome, hypothyroidism, psoriasis, and extrahepatic malignancy are crucial for the treatment of patients with NAFLD. The leading cause of death in NAFLD is primarily from CVD, followed by liver-related mortality, extrahepatic cancer, liver cancer, and diabetes-related mortality. Therefore, clinicians need to identify high-risk patients earlier in the disease course and be aware of the extrahepatic manifestations of NAFLD to improve liver disease outcomes. In this review, we focus on the monitoring and management of the extrahepatic manifestations of NAFLD.

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Original Articles

Liver fibrosis, cirrhosis, and portal hypertension

Association between new-onset liver cirrhosis and suicide risk in South Korea: A nationwide cohort study
Suk-Yong Jang, Woo Sun Rou, Seok Hyun Kim, Byung Seok Lee, Hyuk Soo Eun
Clin Mol Hepatol 2021;27(2):283-294.
Published online December 3, 2020
DOI: https://doi.org/10.3350/cmh.2020.0227
Background/Aims
Current evidence suggests that liver cirrhosis (LC) causes severe psychological stress and depression, which are risk factors for suicide. Although previous studies reported the association between LC and suicidal thoughts, little is known of its effect on suicidal deaths. Therefore, this study was undertaken to investigate the effect of new-onset LC on suicide.
Methods
From the National Health Insurance Service-National Sample Cohort of South Korea, 5,809 incident LC patients and 11,618 risk-set controls matched by propensity score were selected for follow-up. The incidence rate of suicide was estimated using a generalized estimating equation with a Poisson distribution. Effect size was presented as a hazard ratio (HR) using Cox’s proportional hazards model.
Results
The incidence rate of suicide was 143.3 cases per 100,000 person years (95% confidence interval [CI], 100.2–205.1) among the LC cohort. The LC patients were 2.37 times more likely to commit suicide compared with matched controls (HR, 2.37; 95% CI, 1.44–3.88). Increased suicide risk was evident within the first 2 years of the follow-up period (HR, 2.59; 95% CI, 1.20–5.60) and among the 18–49-year-old age group (HR, 3.72; 95% CI, 1.45–9.56).
Conclusions
Our study found increased risk of suicide in patients with new onset LC, especially during the early period following diagnosis and in younger patients. To decrease this suicide risk, a regular and continuous social support system is required.

Citations

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  • Lower incidence of hepatocellular carcinoma with tenofovir alafenamide in chronic hepatitis B: Evidence from a large-scale cohort
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    Paula C. Zimbrean, Simona S. Jakab
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    Yoon-Kyung Chang, Ju-Young Park, Tae-Jin Song
    Journal of Clinical Medicine.2025; 14(3): 950.     CrossRef
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    Byung Sik Kim, Jiyeong Kim, Nayeon Choi, Hyun-Jin Kim, Jeong-Hun Shin
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    Bo-Yu Hsiao, Chun-Ju Chiang, Ya-Wen Yang, Wen-Chung Lee
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    Simone A. Jarrett, Edward Bley, Richard S. Kalman
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Liver fibrosis, cirrhosis, and portal hypertension

The cut-off value of transient elastography to the value of hepatic venous pressure gradient in alcoholic cirrhosis
Se Ri Ryu, Jeong-Ju Yoo, Seong Hee Kang, Soung Won Jeong, Moon Young Kim, Young Kyu Cho, Young Chang, Sang Gyune Kim, Jae Young Jang, Young Seok Kim, Soon Koo Baik, Yong Jae Kim, Su Yeon Park, Baigal Baymbajav
Clin Mol Hepatol 2021;27(1):197-206.
Published online December 3, 2020
DOI: https://doi.org/10.3350/cmh.2020.0171
Background/Aims
The hepatic venous pressure gradient (HVPG) reflects portal hypertension, but its measurement is invasive. Transient elastography (TE) is a noninvasive method for evaluating liver stiffness (LS). We investigated the correlation between the value of LS, LS to platelet ratio (LPR), LS-spleen diameter-to-platelet ratio score (LSPS) and HVPG according to the etiology of cirrhosis, especially focused on alcoholic cirrhosis.
Methods
Between January 2008 and March 2017, 556 patients who underwent HVPG and TE were consecutively enrolled. We evaluated LS, LPR, and LSPS according to the etiology of cirrhosis and analyzed their correlations with HVPG.
Results
The LS value was higher in patients with alcoholic cirrhosis than viral cirrhosis based on the HVPG (43.5 vs. 32.0 kPa, P<0.001). There were no significant differences in the LPR or LSPS between alcoholic and viral cirrhosis groups, and the areas under the curves for the LPR and LSPS in subgroups according to HVPG levels were not superior to that for LS. In alcoholic cirrhosis, the LS cutoff value for predicting an HVPG ≥10 mmHg was 32.2 kPa with positive predictive value (PPV) of 94.5% and 36.6 kPa for HVPG ≥12 mmHg with PPV of 91.0%.
Conclusions
The LS cutoff value should be determined separately for patients with alcoholic and viral cirrhosis. In alcoholic cirrhosis, the LS cutoff values were 32.2 and 36.6 kPa for predicting an HVPG ≥10 and ≥12 mmHg, respectively. However, there were no significant differences in the LPR or LSPS between alcoholic and viral cirrhosis groups.

Citations

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  • Assessment of liver stiffness measurement-related markers in predicting liver-related events in viral cirrhosis with clinically significant portal hypertension
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    Xue Li, Shi Liu, Jin Li, Ning Liu, Hui Li, An Ge, Liang Wang, Xie Dong, Hui Wang, Ju Liu, Lin Zhang, Hao Dong Zhang, Wei Gou
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    Georg Semmler, Mathias Jachs, Mattias Mandorfer
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COVID-19

Clinical outcomes of coronavirus disease 2019 in patients with pre-existing liver diseases: A multicenter study in South Korea
Yu Rim Lee, Min Kyu Kang, Jeong Eun Song, Hyun Jung Kim, Young Oh Kweon, Won Young Tak, Se Young Jang, Jung Gil Park, Changhyeong Lee, Jae Seok Hwang, Byoung Kuk Jang, Jeong Ill Suh, Woo Jin Chung, Byung Seok Kim, Soo Young Park
Clin Mol Hepatol 2020;26(4):562-576.
Published online October 1, 2020
DOI: https://doi.org/10.3350/cmh.2020.0126
Background/Aims
Although coronavirus disease 2019 (COVID-19) has spread rapidly worldwide, the implication of pre-existing liver disease on the outcome of COVID-19 remains unresolved.

Methods
A total of 1,005 patients who were admitted to five tertiary hospitals in South Korea with laboratory-confirmed COVID-19 were included in this study. Clinical outcomes in COVID-19 patients with coexisting liver disease as well as the predictors of disease severity and mortality of COVID-19 were assessed.

Results
Of the 47 patients (4.7%) who had liver-related comorbidities, 14 patients (1.4%) had liver cirrhosis. Liver cirrhosis was more common in COVID-19 patients with severe pneumonia than in those with non-severe pneumonia (4.5% vs. 0.9%, P=0.006). Compared to patients without liver cirrhosis, a higher proportion of patients with liver cirrhosis required oxygen therapy; were admitted to the intensive care unit; had septic shock, acute respiratory distress syndrome, or acute kidney injury; and died (P<0.05). The overall survival rate was significantly lower in patients with liver cirrhosis than in those without liver cirrhosis (log-rank test, P=0.003). Along with old age and diabetes, the presence of liver cirrhosis was found to be an independent predictor of severe disease (odds ratio, 4.52; 95% confidence interval [CI], 1.20–17.02;P=0.026) and death (hazard ratio, 2.86; 95% CI, 1.04–9.30; P=0.042) in COVID-19 patients.

Conclusions
This study suggests liver cirrhosis is a significant risk factor for COVID-19. Stronger personal protection and more intensive treatment for COVID-19 are recommended in these patients.

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Review

Liver fibrosis, cirrhosis, and portal hypertension

Managing liver cirrhotic complications: Overview of esophageal and gastric varices
Cosmas Rinaldi Adithya Lesmana, Monica Raharjo, Rino A. Gani
Clin Mol Hepatol 2020;26(4):444-460.
Published online October 1, 2020
DOI: https://doi.org/10.3350/cmh.2020.0022
Managing liver cirrhosis in clinical practice is still a challenging problem as its progression is associated with serious complications, such as variceal bleeding that may increase mortality. Portal hypertension (PH) is the main key for the development of liver cirrhosis complications. Portal pressure above 10 mmHg, termed as clinically significant portal hypertension, is associated with formation of varices; meanwhile, portal pressure above 12 mmHg is associated with variceal bleeding. Hepatic vein pressure gradient measurement and esophagogastroduodenoscopy remain the gold standard for assessing portal pressure and detecting varices. Recently, non-invasive methods have been studied for evaluation of portal pressure and varices detection in liver cirrhotic patients. Various guidelines have been published for clinicians’ guidance in the management of esophagogastric varices which aims to prevent development of varices, acute variceal bleeding, and variceal rebleeding. This writing provides a comprehensive review on development of PH and varices in liver cirrhosis patients and its management based on current international guidelines and real experience in Indonesia.

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Special topic: Alcoholic liver diseases
The 14th International Symposium on Alcoholic Liver and Pancreatic Diseases and Cirrhosis (ISALPDC)

Alcohol-related liver disease

The effect of moderate alcohol drinking in nonalcoholic fatty liver disease
Jong Hwa Choi, Won Sohn, Yong Kyun Cho
Clin Mol Hepatol 2020;26(4):662-669.
Published online September 25, 2020
DOI: https://doi.org/10.3350/cmh.2020.0163
Nonalcoholic fatty liver disease (NAFLD) is defined by fat accumulation in liver that is not caused by excessive alcohol consumption. Safe limits of alcohol consumption in NAFLD are usually defined as alcohol consumption of less than 210 g per week for men and 140 g per week for women (30 g/day in men, 20 g/day in women) and alcohol consumption below safe limits is generally regarded as moderate alcohol consumption. Many studies have investigated the effects of moderate alcohol consumption on NAFLD patients. Some studies showed that moderate alcohol consumption prevented the progression of fibrosis in the liver, whereas other reports showed worsening of fibrosis in the liver based on serologic, radiologic and liver biopsy findings compared with effects on total abstainers. NAFLD is also thought to be a hepatic manifestation of metabolic syndrome, and when combined with excessive alcohol consumption results in the development of components of metabolic syndrome and systemic harmful effects. The effects of moderate alcohol consumption on NAFLD have yet to be established.

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Editorial

Viral hepatitis

More evidence that direct acting antiviral therapy is safe and effective in cirrhosis and chronic kidney disease including peritoneal dialysis
Paul Kwo, Deepti Dronamraju
Clin Mol Hepatol 2020;26(4):489-491.
Published online September 24, 2020
DOI: https://doi.org/10.3350/cmh.2020.0228

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    The Korean Journal of Internal Medicine.2022; 37(6): 1167.     CrossRef
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