A study including 302 PBC patients utilized an ambispective cohort design, incorporating a retrospective review of diagnoses prior to January 1, 2019, and a prospective follow-up component afterwards. The study's patient distribution across follow-up locations was as follows: 101 (33%) in Novara, 86 (28%) in Turin, and 115 (38%) in Genoa. The study examined clinical characteristics at diagnosis, the biochemical effectiveness of therapy, and survival times.
During treatment with ursodeoxycholic acid (UDCA) and obeticholic acid, alkaline phosphatase (ALP) levels significantly decreased among 302 patients (88% women, median age 55 years, median follow-up 75 months), yielding a statistically significant result (P<0.00001). Analysis of multiple factors revealed that alkaline phosphatase (ALP) levels at the time of diagnosis were predictive of a one-year biochemical response to ursodeoxycholic acid (UDCA), with a substantial odds ratio of 357 and a 95% confidence interval ranging from 14 to 9. The statistical significance of this finding is indicated by a p-value less than 0.0001. An estimated median survival period of 30 years (95% confidence interval, 19-41) was observed for patients who did not require liver transplantation or develop hepatic complications. Based on the diagnostic bilirubin level, there was an independent risk for the combined endpoint of death, transplantation, or hepatic decompensation (hazard ratio 1.65, 95% CI 1.66-2.56, p=0.002). Patients presenting with total bilirubin at diagnosis six times the upper normal limit (ULN) experienced a considerably lower 10-year survival compared to patients whose bilirubin was below six times the ULN (63% versus 97%, P<0.00001).
At the time of diagnosis, simple, conventional disease severity biomarkers can be used to predict both the short-term response to UDCA and the long-term survival in patients with PBC.
Conventional biomarkers, evaluated at the commencement of PBC, are sufficiently reliable for anticipating both the short-term response to UDCA therapy and the long-term survival of individuals with PBC.
Whether metabolic dysfunction-associated fatty liver disease (MAFLD) carries clinical weight in patients with cirrhosis is not presently established. This research examined the correlation between MAFLD and adverse clinical results in patients with hepatitis B cirrhosis.
In total, 439 patients, having hepatitis B cirrhosis, were registered for the investigation. To ascertain liver fat content and assess for steatosis, both abdominal MRI and computed tomography were used. To illustrate survival patterns, the Kaplan-Meier method was used to generate survival curves. Prognosis-influencing independent risk factors were isolated using multiple Cox regression. The methodology of propensity score matching (PSM) was applied to decrease the impact of confounding factors. This investigation examined the connection between MAFLD and mortality, including initial decompensation and subsequent decompensation.
A majority of the patients in our study were characterized by decompensated cirrhosis (n=332, 75.6%). The ratio of decompensated cirrhosis cases between the non-MAFLD and MAFLD groups was 199:133. Management of immune-related hepatitis A noticeably worse liver function was observed in MAFLD patients in comparison to those without MAFLD, prominently reflected in the higher number of Child-Pugh Class C individuals and elevated MELD scores within the MAFLD group. The study population, observed for a median follow-up duration of 47 months, exhibited 207 adverse clinical events. These included 45 deaths, 28 instances of hepatocellular carcinoma, 23 first decompensations, and 111 subsequent decompensations. MAFLD was found to be an independent risk factor for death (hazard ratio [HR] 1.931; 95% confidence interval [CI], 1.019–3.660; P = 0.0044; HR 2.645; 95% CI, 1.145–6.115; P = 0.0023) and subsequent clinical worsening (HR 1.859; 95% CI, 1.261–2.741; P = 0.0002; HR 1.953; 95% CI, 1.195–3.192; P = 0.0008) in a Cox multivariate analysis, regardless of propensity score matching. In the decompensated MAFLD population, diabetes's impact on adverse outcomes was more pronounced than that of overweight, obesity, or other metabolic risk factors.
In individuals with hepatitis B cirrhosis, the presence of concomitant MAFLD is associated with a heightened risk of subsequent decompensation and mortality, particularly among those who have already experienced decompensation. For patients with MAFLD, diabetes appears to be a crucial factor in the development of adverse clinical events.
Among patients diagnosed with hepatitis B cirrhosis, the simultaneous presence of MAFLD can forecast a more substantial danger of subsequent decompensation and mortality, particularly for those who have already decompensated. Among individuals with MAFLD, diabetes can be a primary driver in the development of unfavorable clinical consequences.
Renal function improvement by terlipressin in hepatorenal syndrome (HRS) prior to liver transplantation is well-documented, but its effect on post-transplant renal function remains poorly characterized. The study seeks to delineate the effects of HRS and terlipressin on renal function and survival outcomes following liver transplantation.
A retrospective, observational, single-center study assessed post-transplant outcomes in patients with hepatorenal syndrome (HRS) undergoing liver transplantation (HRS cohort) and those transplanted for non-HRS, non-hepatocellular carcinoma cirrhosis (comparator cohort), from January 1997 to March 2020. The primary outcome variable was the serum creatinine, observed 180 days subsequent to the liver transplant procedure. The study's secondary measures included overall survival and additional renal results.
A liver transplant operation involved 109 patients with hepatorenal syndrome (HRS) and 502 patients of the comparison group. A younger average age (53 years) was found in the comparator cohort compared to the HRS cohort (57 years), with statistical significance (P<0.0001). A statistically significant difference (P<0.0001) in median creatinine levels (119 mol/L in the HRS transplant group versus 103 mol/L in the control group) was observed at 180 days post-transplant, yet this association lost its statistical validity upon applying multivariate analysis. Of the patients within the HRS cohort, seven (7%) received simultaneous liver and kidney transplants. FOT1 Analysis of 12-month post-transplant survival yielded no significant distinction between the two groups; both groups achieved a 94% survival rate (P=0.05).
Following liver transplantation, patients previously treated for HRS with terlipressin achieve renal and survival outcomes similar to those of patients transplanted solely for cirrhosis. This investigation validates the approach of undertaking liver-only transplantation in this sample, and the subsequent allocation of renal transplants to those with pre-existing kidney disease.
Post-transplant renal and survival outcomes in patients with HRS, treated with terlipressin before transplantation, are on par with those seen in patients with cirrhosis undergoing liver transplantation without HRS. This study affirms the efficacy of a liver-only transplant approach within this specific group of patients, and simultaneously recommends reserving renal allografts for those with primary renal conditions.
A non-invasive approach to identify individuals with non-alcoholic fatty liver disease (NAFLD), leveraging clinical and routine lab data, was the focus of this study.
Against a backdrop of established NAFLD scoring tools, the newly developed 'NAFLD test' model was benchmarked and subsequently validated in three groups of patients with NAFLD, recruited from five centers in Egypt, China, and Chile. Patients were categorized into two groups: the discovery cohort, consisting of 212 patients, and the validation study, encompassing 859 individuals. The development and validation of the NAFLD test leveraged ROC curves and stepwise multivariate discriminant analysis. This was followed by a comparative evaluation of its diagnostic performance against other NAFLD scores.
Elevated C-reactive protein (CRP), cholesterol, BMI, and alanine aminotransferase (ALT) levels were found to be significantly linked to NAFLD, as indicated by a P-value of less than 0.00001. This formula depicts a method for identifying NAFLD patients and separating them from healthy subjects: (-0.695 + 0.0031 * BMI + 0.0003 * cholesterol + 0.0014 * ALT + 0.0025 * CRP). Using the receiver operating characteristic (ROC) curve, the NAFLD test's area under the curve (AUC) was 0.92, with a 95% confidence interval from 0.88 to 0.96. When assessing NAFLD, the NAFLD test proved the most accurate diagnostic indicator, outperforming commonly employed NAFLD indices. The validation of the NAFLD test yielded an AUC (95% CI) of 0.95 (0.94-0.97) for Egyptian, 0.90 (0.87-0.93) for Chinese, and 0.94 (0.91-0.97) for Chilean NAFLD patients, respectively, in discriminating between NAFLD patients and healthy controls.
The NAFLD test, a newly validated diagnostic biomarker, demonstrates high diagnostic performance in facilitating early NAFLD diagnosis.
The NAFLD test, a newly validated diagnostic biomarker, provides high diagnostic performance for early NAFLD detection.
Evaluating the impact of body composition on the prognosis of patients with advanced hepatocellular carcinoma treated using the concurrent administration of atezolizumab and bevacizumab.
In a cohort study, the effects of atezolizumab combined with bevacizumab were assessed on 119 patients with unresectable hepatocellular carcinoma. We scrutinized the association between physical structure and time until disease worsening or resolution. Body composition was calculated based on the values of visceral fat index, subcutaneous fat index, and skeletal muscle index. biogenic nanoparticles The median of these indices determined whether an index score was categorized as high or low.
Individuals with low visceral fat index and low subcutaneous fat index showed a poor prognosis outcome. In the low visceral and subcutaneous fat index groups, progression-free survival times were 194 and 270 days, respectively, when compared to other groups (95% confidence interval [CI], 153-236 and 230-311 days, respectively; P=0.0015). Mean overall survival in these groups was 349 and 422 days, respectively, compared to other groups (95% CI, 302-396 and 387-458 days, respectively; P=0.0027).