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Li S, Li Y, Zhou C, Li H, Zhao Y, Yi X, Chen C, Peng C, Wang T, Liu F, Xiao J, Shi L. Muscle fat content correlates with postoperative survival of viral-related cirrhosis patients after the TIPS: a retrospective study. Ann Med 2025; 57:2484460. [PMID: 40146662 PMCID: PMC11951314 DOI: 10.1080/07853890.2025.2484460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 02/09/2025] [Accepted: 03/18/2025] [Indexed: 03/29/2025] Open
Abstract
PURPOSE Early prediction of the prognosis of viral-related cirrhosis patients after transjugular intrahepatic portosystemic shunt (TIPS) is beneficial for clinical decision-making. The aim of this study is to explore a comprehensive prognostic assessment model for evaluating the survival outcomes of patients post-TIPS. MATERIALS AND METHODS A total of 155 patients treated with TIPS were included in the study. The data were collected from electronic records. The nutritional status of the patient is evaluated using imaging examinations measuring by the axial CT images from the L3 vertebral level. The primary endpoint was set as death within 1 year after TIPS. Multivariate Cox regression was performed to determine the factors associated with mortality. RESULTS The Cox regression analysis revealed that the lower PMFI was associated with a lower risk of all-cause mortality after TIPS (hazard ratio [HR] 1.159, 95% confidence interval [CI] 1.063-1.263, p = 0.001). Furthermore, subgroup analyses according to gender revealed the PMFI was associated with postoperative death both in male (HR 2.125, 95% CI, 1.147-3.936, p = 0.017) and female patients (HR 1.070, 95% CI, 1.001-1.144, p = 0.047). The area under the curve (AUC) for predicting death within 1 year was 0.807. The clinical impact curve analysis showed that PMFI had higher levels of risk threshold probability and a smaller gap between actual and predicted curves. CONCLUSIONS In viral-related cirrhosis patients with portal hypertension, increased muscle fat content might be a potential prognostic marker and associated with postoperative death after TIPS.
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Affiliation(s)
- Sai Li
- Interventional Radiology Center, Department of Radiology, The Third Xiangya Hospital of Central South Hospital, Changsha, Hunan, China
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Yong Li
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chunhui Zhou
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Haiping Li
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Yazhuo Zhao
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Xiaoping Yi
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Changyong Chen
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Changli Peng
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Tianming Wang
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Fei Liu
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Juxiong Xiao
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Liangrong Shi
- Interventional Radiology Center, Department of Radiology, Xiangya Hospital Central South University, Changsha, Hunan, China
- Research Center for Geriatric Disorder, Xiangya Hospital Central South, Changsha, Hunan, China
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Akabane M, Imaoka Y, Nakayama T, Esquivel CO, Sasaki K. Effect of sarcopenia on the survival of patients undergoing liver transplantation: a meta-analysis. Surg Today 2025; 55:803-813. [PMID: 39928119 DOI: 10.1007/s00595-025-03008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 10/18/2024] [Indexed: 02/11/2025]
Abstract
PURPOSE The relationship between sarcopenia and post-liver transplant (LT) mortality is still not well understood. This study aims to provide an updated and comprehensive meta-analysis evaluating the impact of sarcopenia on the survival of LT patients. METHODS We conducted searches in PubMed, Web of Science, and EMBASE up until May 2, 2024, without language restrictions. The primary outcome measured was the overall post-LT mortality risk associated with sarcopenia. The DerSimonian-Laird random effects model was used to calculate pooled adjusted hazard ratios (HRs). RESULTS Eighteen cohort studies comprising a total 6297 LT patients were included. The overall prevalence of sarcopenia was 27% (95% CI: 26%-28%), and this rate was lower when sarcopenia was defined using the third lumbar-skeletal muscle index in men, and among patients with lower Child-Pugh class. Sarcopenia remained significantly associated with higher mortality, with a pooled adjusted HR of 1.55 (95% CI 1.28-1.89). This association held across subgroups based on sex, study location, sarcopenia definition, study quality, and living donor LT recipients. A sensitivity analysis excluding groups with a high proportion of hepatocellular carcinoma patients showed similar findings (HR 1.63, 95% CI 1.13-2.35). No significant heterogeneity was identified in any of the analyses. CONCLUSIONS This meta-analysis shows that sarcopenia is significantly associated with increased mortality after LT. Thus, the risk of sarcopenia should be factored into the initial evaluation of LT candidates.
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Affiliation(s)
- Miho Akabane
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Yuki Imaoka
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Toshihiro Nakayama
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Carlos O Esquivel
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Kazunari Sasaki
- Division of Abdominal Transplant, Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA.
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Johnston HE, Mayr HL, Andelkovic M, Takefala TG, Chen Y, Thrift AP, Macdonald GA, Hickman IJ. Comparing the performance of 3 sarcopenia definitions for predicting adverse events prior to liver transplant. Hepatol Commun 2025; 9:e0701. [PMID: 40434634 DOI: 10.1097/hc9.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 03/06/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Sarcopenia is a syndrome of severe muscle wasting, associated with adverse outcomes related to liver transplantation (LT). There are several approaches used to identify sarcopenia. We aimed to investigate the prevalence of sarcopenia using 3 different criteria and determine how these performed in relation to clinical outcomes. METHODS The cohort study included 237 adults with cirrhosis referred for LT. Sarcopenia was identified using (1) CT-defined; and the (2) original and (3) updated European Working Group on Sarcopenia in Older People criteria (EWGSOP1 and 2). Logistic regression was used to estimate OR and 95% CI for the relationships between sarcopenia and receiving an LT, unplanned admissions pre-LT, surgical complications, and length of stay for the LT admission. Fine-Gray competing risk analysis explored the impact of sarcopenia on receiving an LT and unplanned admissions. The AUC determined the predictive utility of the criteria. RESULTS The prevalence of CT-defined sarcopenia (52%) was more than twice and 4-fold that of EWGSOP1-defined (22%) and EWGSOP2-defined (11%) sarcopenia, respectively. No criteria demonstrated a significant association with time to LT nor the time to unplanned admissions pre-LT. Similarly, none of the 3 criteria had superior predictive utility for the clinical outcomes for unplanned hospital admissions pre-LT of receiving an LT, with all 3 criteria having identical moderate AUCs for unplanned admissions (0.70) and similar weak AUCs (≤0.55) for the likelihood of receiving an LT. CONCLUSIONS Sarcopenia in patients undergoing LT evaluation is prevalent. EWGSOP criteria appear to offer no advantage over CT-only criteria in identifying patients at increased risk of adverse LT outcomes. Bedside measures of muscle function may be of benefit in tracking the effectiveness of interventions targeting sarcopenia.
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Affiliation(s)
- Heidi E Johnston
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Hannah L Mayr
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Melita Andelkovic
- Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Tahnie G Takefala
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia
| | - Yanyan Chen
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Graeme A Macdonald
- Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ingrid J Hickman
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- ULTRA Team, The University of Queensland Clinical Trial Capability, Brisbane, Queensland, Australia
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Yao S, Yang Z, Li J, Peng B, Wang H, Liang J, Sun C. Prevalence and prognostic significance of cachexia diagnosed by novel definition for Asian population among Chinese cirrhotic patients. Arch Gerontol Geriatr 2025; 133:105833. [PMID: 40120202 DOI: 10.1016/j.archger.2025.105833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Revised: 03/10/2025] [Accepted: 03/16/2025] [Indexed: 03/25/2025]
Abstract
BACKGROUND & AIMS Cachexia is a multifaceted metabolic disorder often linked to chronic illnesses, characterized by substantial weight reduction, inflammatory states, and loss of appetite. The novel diagnostic criteria concerning cachexia established by the Asian Working Group for Cachexia (AWGC) have not been fully validated in Chinese populations with cirrhosis. To assess the prognostic impact of AWGC-defined cachexia among hospitalized cirrhotic patients and explore the synergistic impact of Model for End-Stage Liver Disease 3.0 (MELD 3.0) scores with cachexia status on prognosis. METHODS We retrospectively analyzed clinical data from patients with decompensated cirrhosis admitted to our tertiary hospital between January 2021 and December 2023. Cachexia was identified according to AWGC criteria, and disease severity was assessed using MELD 3.0 scores. The study's primary outcome was all-cause mortality within one year. RESULTS A total of 368 patients were included in the analyses. The prevalence of cachexia was 61.7 %, and patients with cachexia had a significantly higher one-year all-cause mortality rate (26.4 % vs. 7.8 %, P < 0.001). Multivariate Cox regression analysis showed that cachexia (HR 2.68, 95 %CI 1.40-5.13, P = 0.003), along with MELD 3.0 (HR 1.18, 95 %CI 1.13-1.23, P < 0.001), were independent predictors of one-year mortality. The combined assessment of cachexia and MELD 3.0 scores yielded a higher discriminative ability for predicting one-year mortality compared to either metric alone. CONCLUSIONS AWGC-defined cachexia is a significant prognostic factor in hospitalized patients with cirrhosis. The integration of cachexia with MELD 3.0 scoring enhances prognostic prediction, underscoring the importance to introduce cachexia evaluation during clinical practice for this vulnerable setting.
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Affiliation(s)
- Shuangzhe Yao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, PR China
| | - Ziyi Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, PR China
| | - Jia Li
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, PR China
| | - Binbin Peng
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, PR China
| | - Han Wang
- Department of Health Management, Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin 300211, PR China
| | - Jing Liang
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, No.83 Jintang Road, Hedong District, Tianjin 300170, PR China.
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, PR China; Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, East Street 6, Tianjin Airport Economic Area, Tianjin 300308, PR China.
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Suárez M, Martínez R, Gómez-Molina R, Mateo J. Infection risk and management in patients with cirrhosis: A critical overview. World J Hepatol 2025; 17:104468. [DOI: 10.4254/wjh.v17.i5.104468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Revised: 02/27/2025] [Accepted: 03/13/2025] [Indexed: 05/27/2025] Open
Abstract
In this paper, we analyze the article published by El Labban et al, which explores the impact of cirrhosis on patients with necrotizing fasciitis. The authors conclude that cirrhosis is a significant risk factor for increased in-hospital morbidity and mortality in this patient population. Building upon their final observation regarding the importance of understanding this association, we will delve into the topic of infections in patients with liver cirrhosis. These patients exhibit intrinsic characteristics that make them particularly susceptible to infections, both bacterial and fungal. This heightened risk not only increases the likelihood of severe infections but also makes them a common trigger for acute decompensations, including the development of acute-on-chronic liver failure, which markedly worsens prognosis and mortality. Infections in patients with cirrhosis often require a more aggressive and rapid diagnostic and therapeutic approach due to the higher risk of nosocomial infections, multidrug-resistant organisms, and atypical clinical presentations. Delayed or inadequate management can lead to unfavorable outcomes, further complicating the course of their underlying liver disease. The aim of this article is to emphasize the importance of early and appropriate management in patients with cirrhosis with infections. Evidence supports that timely and tailored interventions not only improve clinical outcomes but also reduce mortality. By raising awareness among clinicians about the complexity of these cases, we hope to contribute to optimizing the care of this high-risk population.
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Affiliation(s)
- Miguel Suárez
- Department of Gastroenterology, Virgen de la Luz Hospital, Cuenca 16002, Castille-La Mancha, Spain
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca 16071, Castille-La Mancha, Spain
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo 45071, Castille-La Mancha, Spain
| | - Raquel Martínez
- Department of Gastroenterology, Virgen de la Luz Hospital, Cuenca 16002, Castille-La Mancha, Spain
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca 16071, Castille-La Mancha, Spain
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo 45071, Castille-La Mancha, Spain
| | - Raquel Gómez-Molina
- Department of Laboratory Medicine, Virgen de la Luz Hospital, Cuenca 16002, Castille-La Mancha, Spain
| | - Jorge Mateo
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca 16071, Castille-La Mancha, Spain
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo 45071, Castille-La Mancha, Spain
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Kobayashi S. Importance of comprehensive nutritional assessment in predicting survival in cirrhosis. World J Hepatol 2025; 17:106606. [DOI: 10.4254/wjh.v17.i5.106606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Revised: 03/20/2025] [Accepted: 04/02/2025] [Indexed: 05/27/2025] Open
Abstract
Carteri et al reaffirmed the value of the Child-Turcotte-Pugh score in predicting survival in patients with cirrhosis. However, the lack of association with nutritional markers warrants careful interpretation. In cirrhosis, complex conditions often lead to malnutrition and individual markers may not be fully captured. Comprehensive assessments such as Subjective Global Assessment, handgrip strength, muscle mass measurements, and bioelectrical impedance analysis can improve risk stratification and inform personalized nutritional management. This letter emphasizes the need for standardized nutritional assessments for patients with cirrhosis and further research to clarify their impact on long-term outcomes, potentially improving patient care.
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Affiliation(s)
- Shinichiro Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagagasaki 852-8501, Nagasaki, Japan
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Losasso MR, Parussolo MLC, Oliveira Silva A, Direito R, Quesada K, Penteado Detregiachi CR, Bechara MD, Méndez-Sánchez N, Abenavoli L, Araújo AC, de Alvares Goulart R, Guiger EL, Fornari Laurindo L, Maria Barbalho S. Unraveling the Metabolic Pathways Between Metabolic-Associated Fatty Liver Disease (MAFLD) and Sarcopenia. Int J Mol Sci 2025; 26:4673. [PMID: 40429815 DOI: 10.3390/ijms26104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2025] [Revised: 05/10/2025] [Accepted: 05/12/2025] [Indexed: 05/29/2025] Open
Abstract
Metabolic-Associated Fatty Liver Disease (MAFLD) is a public health concern that is constantly expanding, with a fast-growing prevalence, and it affects about a quarter of the world's population. This condition is a significant risk factor for cardiovascular, hepatic, and oncologic diseases, such as hypertension, hepatoma, and atherosclerosis. Sarcopenia was long considered to be an aging-related syndrome, but today, it is acknowledged to be secondarily related to chronic diseases such as metabolic syndrome, cardiovascular conditions, and liver diseases, among other comorbidities associated with insulin resistance and chronic inflammation, besides inactivity and poor nutrition. The physiopathology involving MAFLD and sarcopenia has still not been solved. Inflammation, oxidative stress, mitochondrial dysfunction, and insulin resistance seem to be some of the keys to this relationship since this hormone target is mainly the skeletal muscle. This review aimed to comprehensively discuss the main metabolic and physiological pathways involved in these conditions. MAFLD and sarcopenia are interconnected by a complex network of pathophysiological mechanisms, such as insulin resistance, skeletal muscle tissue production capacity, chronic inflammatory state, oxidative stress, and mitochondrial dysfunction, which are the main contributors to this relationship. In addition, in a clinical analysis, patients with sarcopenia and MAFLD manifest more severe hepatitis fibrosis when compared to patients with only MAFLD. These patients, with both disorders, also present clinical improvement in their MAFLD when treated for sarcopenia, reinforcing the association between them. Lifestyle changes accompanied by non-pharmacological interventions, such as dietary therapy and increased physical activity, undoubtedly improve this scenario.
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Affiliation(s)
- Marina Ribas Losasso
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Maria Luiza Cesto Parussolo
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Antony Oliveira Silva
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Rosa Direito
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines, Universidade de Lisboa (iMed.ULisboa), Av. Prof. Gama Pinto, 1649-003 Lisbon, Portugal
| | - Karina Quesada
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Claudia Rucco Penteado Detregiachi
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Marcelo Dib Bechara
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico
| | - Ludovico Abenavoli
- Department of Health Sciences, University "Magna Graecia", Viale Europa, 88100 Catanzaro, Italy
| | - Adriano Cressoni Araújo
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Ricardo de Alvares Goulart
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Elen Landgraf Guiger
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
- Department of Biochemistry and Nutrition, School of Food and Technology of Marília (FATEC), Marília 17500-000, SP, Brazil
- Research Coordinator, UNIMAR Charity Hospital, Universidade de Marília (UNIMAR), Marília 17525-902, SP, Brazil
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Tantai X, Wen Z, Tuo S, Ran Q, Li C, Li Y, Yuan J, Wang J, Li L, Dai S. Associations of Serum Vitamin D with Sarcopenia in Patients with Chronic Liver Disease: A Population-Based Cross-Sectional Study. Calcif Tissue Int 2025; 116:69. [PMID: 40325227 DOI: 10.1007/s00223-025-01376-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 04/15/2025] [Indexed: 05/07/2025]
Abstract
The association between vitamin D and sarcopenia in patients with chronic liver disease (CLD) has yet to be conclusively established, particularly in Western populations. We investigated the association between serum 25(OH)D levels and sarcopenia in adult CLD patients in the USA. We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey III. Weighted logistic regression was used to determine the association between sarcopenia and serum 25(OH)D in participants with CLD. CLD was defined as chronic hepatitis B or C, non-alcoholic fatty liver disease, alcohol-related liver disease, and other liver diseases. A serum 25(OH)D level of less than 75 nmol/L was defined as vitamin D insufficiency. This study included 1402 participants with CLD. The serum 25(OH)D concentration was significantly lower in the sarcopenia group (45.3 nmol/l) compared to the non-sarcopenia group (50.6 nmol/l). The prevalence of vitamin D insufficiency was as high as 91.3% in participants with CLD, and the proportion of vitamin D insufficiency was higher in those with sarcopenia. In the full multivariate model, each 10-nmol/L increase in 25(OH)D concentration was significantly associated with a decreased risk of sarcopenia (OR 0.89; 95%CI 0.79-0.99). Conversely, participants with insufficient vitamin D levels had a significantly increased risk of sarcopenia (OR, 2.07; 95% CI 1.08-4.00). Subgroup analyses suggested a sex difference in the association between vitamin D levels and sarcopenia, with a significant association only observed in females. Restricted cubic spline curves indicated a linear inverse association between serum 25(OH)D concentration and risk of sarcopenia in all participants and in females. Low serum 25(OH)D levels were significantly associated with an increased risk of sarcopenia in individuals with CLD, with the observed gender differences in this association warranting further validation in future studies.
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Affiliation(s)
- Xinxing Tantai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhang Wen
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuyue Tuo
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiuju Ran
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chan Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yong Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jia Yuan
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jinhai Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lu Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China.
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Shejiao Dai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi Province, China.
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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9
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Brunetto B, Saraiva L, Callegari-Jacques SM, Ferri H, Lizott HB, Valões R, Fernandes SA, Hoppe L, Fornari F. Reduced Mastication Is Associated With Dynapenia Markers in Patients With Cirrhosis: A Cross-Sectional Study. Int J Hepatol 2025; 2025:5842659. [PMID: 40365525 PMCID: PMC12069846 DOI: 10.1155/ijh/5842659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 04/09/2025] [Indexed: 05/15/2025] Open
Abstract
Background and Aim: Dental diseases are common in patients with cirrhosis. In these patients, reduced mastication might interfere with protein intake and contribute to malnutrition. We addressed the relationship between reduced mastication and dynapenia in patients with cirrhosis. Methods: This cross-sectional study involved patients with cirrhosis treated in a Brazilian center. Trained dentists performed oral examinations and tested the patients for nutritional parameters such as handgrip strength (HGS) and gait speed test (GST). Reduced mastication was presumed when a patient had molar edentulism (≥ 3 teeth), bad dental occlusion, or ill-fitting denture. Associations between mastication status and malnutrition were evaluated using multivariate linear regression analysis for continuous measures and adjusted prevalence ratio (PR (95% confidence interval)) for binary measures. Results: We included 149 patients with cirrhosis (60 ± 13 years old, 76% men, 64% Child A, 60% due to alcoholism only). Reduced mastication affected 107 patients (72%), low muscle strength (decreased HGS) occurred in 45 (30%), and decreased GST was observed in 58 (41%, among 143 patients able to walk). Thirty-one out of 143 (22%) presented decreased HGS and GST, characterizing dynapenia. Reduced mastication was associated either with decreased HGS [PR = 2.28 (1.08-4.81), p = 0.030; reduced mastication decreases the HGS mean by 12.5 kg for men (p < 0.001) and 8.1 kg for women (p = 0.065)] or with decreased GST [PR 1.97 (1.09-3.55), p = 0.024; reduced mastication increased the time of GST by 1.1 s on average (p = 0.005)], adjusting for age, alcoholic etiology, and Child-Pugh classification. Conclusions: Reduced mastication is associated with dynapenia markers in patients with cirrhosis. Further studies are needed to assess whether oral rehabilitation can change the curse of malnutrition in this population.
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Affiliation(s)
- Bruna Brunetto
- Post Graduate Program in Dentistry, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Leonardo Saraiva
- Post Graduate Program in Dentistry, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | | | - Hérica Ferri
- Post Graduate Program in Dentistry, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | | | - Ricardo Valões
- School of Medicine, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
- Hepatology Department, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
| | - Sabrina Alves Fernandes
- Post Graduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lisia Hoppe
- School of Medicine, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
- Hepatology Department, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
| | - Fernando Fornari
- Post Graduate Program in Dentistry, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
- School of Medicine, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
- Hepatology Department, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
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10
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Li SX, Huang W, Li JX, An TZ, Li HZ, Hu C, Xiao YD, Wang TC. Skeletal muscle index/systemic immune-inflammation index (SMI/SII) ratio predicts prognosis in patients with hepatocellular carcinoma. World J Surg Oncol 2025; 23:178. [PMID: 40320549 PMCID: PMC12051346 DOI: 10.1186/s12957-025-03826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Accepted: 04/25/2025] [Indexed: 05/08/2025] Open
Abstract
BACKGROUND Systemic inflammation and skeletal muscle are associated with prognosis in hepatocellular carcinoma (HCC). The prognostic value of a combination of skeletal muscle index (SMI) and systemic immune-inflammation index (SII) remains unclear. The present study aims to investigate the prognostic value of combined SMI and SII in predicting overall survival (OS) for HCCs after liver resection (LR) or transarterial chemoembolization (TACE). METHODS This multi-institutional study included three retrospective datasets and one prospective dataset. The SMI/SII was calculated for each cohort. The performance of SMI/SII in predicting recurrence after LR was evaluated in the training cohort, and the optimal cut-off value was calculated. Based on optimal cut-off value, patients were stratified into low and high SMI/SII groups. Cox regression analysis were performed to determine the independent prognostic factors for poor OS. In prospective validation-3 cohort, peripheral blood samples were analyzed for correlation between SMI/SII and distribution of immune cells. RESULTS A total of 1504 patients were included. The AUC of SMI/SII was 0.701. The OS was significantly better in the high SMI/SII group than that in the low SMI/SII group in the training, validation-1, validation-2 cohorts, and combined those three cohorts. Furthermore, low SMI/SII level was an independent prognostic factor for poor OS. Additionally, findings in validation-3 cohort indicated that patients with HCCs and high SMI/SII display anti-tumor attributes in their peripheral blood composition. CONCLUSION A decreased SMI/SII may be a distinct biomarker of unfavorable prognosis in patients with HCCs, which may be practical to develop personalized treatment strategies for HCC.
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Affiliation(s)
- Shu-Xian Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, 410011, China
| | - Wei Huang
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, 410011, China
| | - Jun-Xiang Li
- Department of Interventional Radiology, Guizhou Medical University Affiliated Cancer Hospital, Guiyang, 550004, China
| | - Tian-Zhi An
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550032, China
| | - Hui-Zhou Li
- Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Chao Hu
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, 410011, China
| | - Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, 410011, China
| | - Tian-Cheng Wang
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, 410011, China.
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11
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Alqahtani SA, Shpoliansky M, Vandriel SM, Johara F, Quammie C, Lurz E, Alonso EM, Daniel JF, Venkat VL, Leung DH, Economides J, Hsu EK, Loomes KM, Gupta NA, Mannino D, Menendez J, Ng VL, Kamath BM. Frailty in Pediatric Liver Disease May Be Associated With an Increased Incidence of Readmissions After Pediatric Liver Transplantation. Pediatr Transplant 2025; 29:e70077. [PMID: 40230032 DOI: 10.1111/petr.70077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 03/24/2025] [Accepted: 03/27/2025] [Indexed: 04/16/2025]
Abstract
BACKGROUND Frailty is a phenotype of cumulative decline leading to decreased physiologic reserve and vulnerability to stressors. Frailty is associated with adverse outcomes after liver transplantation (LT) in adults, but similar data are not available in children. A prospective multicenter study previously determined that frailty is present in 46% of children with end-stage liver disease (ESLD). We utilized this cohort to evaluate the impact of pre-transplant frailty on post-LT outcomes. METHODS The study included pediatric participants from the original frailty study across 10 North American transplant centers who had subsequently undergone LT. Clinical outcomes were collected up to 1 year post LT. Participants were stratified by their pre-transplant frailty score (defined by a pre-LT frailty score of ≥ 6.0) and long-term outcomes were compared between groups. RESULTS 28 (60.7% female, 46.4% biliary atresia) pediatric LT recipients were included, and 54% of children met criteria for frailty (n = 15). Baseline characteristics were comparable between groups; however, those with frailty were significantly more likely to have pre-transplant failure to thrive (33.3% vs. 0%, p = 0.044). Thirty-four hospital readmissions (22 in frail and 12 in non-frail children) occurred in 20 patients. Higher pre-transplant frailty scores were also significantly associated with an increased number of readmissions after transplantation (p = 0.034). CONCLUSIONS Pediatric frailty may be associated with the adverse outcome of increased frequency of hospitalization in the first year after pediatric liver transplantation. These data support the concept that frail children should be identified and targeted for prehabilitation prior to LT.
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Affiliation(s)
- Saleh A Alqahtani
- Department of Pediatrics, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Michael Shpoliansky
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shannon M Vandriel
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Fatema Johara
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Claudia Quammie
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Eberhard Lurz
- Department of Pediatrics, Division of Gastroenterology and Hepatology, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Estella M Alonso
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - James F Daniel
- Division of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Veena L Venkat
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel H Leung
- Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, Texas, USA
| | - Julie Economides
- Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, Texas, USA
| | - Evelyn K Hsu
- Division of Gastroenterology and Hepatology, University of Washington-Seattle Children's Hospital, Seattle, Washington, USA
| | - Kathleen M Loomes
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nitika A Gupta
- Division of Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dana Mannino
- Division of Solid Organ Transplantation, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Jerome Menendez
- Division of Pediatric Gastroenterology, Levine Children's Hospital Carolinas Health Care Center, Charlotte, North Carolina, USA
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Binita M Kamath
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Santos BC, Alves BC, Fonseca ALF, Ferreira SC, Mizubuti YGG, Saueressig C, Boulhosa RSDSB, Santos LAA, Cunha CDM, Lyra AC, Oliveira LPM, de Jesus RP, Romeiro FG, Dall'Alba V, Luft VC, Correia MITD, Ferreira LG, Anastácio LR. Cutoff points for handgrip strength in patients with liver cirrhosis: a multicenter study. Eur J Clin Nutr 2025; 79:484-489. [PMID: 39810007 DOI: 10.1038/s41430-024-01563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/10/2024] [Accepted: 12/27/2024] [Indexed: 01/16/2025]
Abstract
OBJECTIVES This study aimed to define handgrip strength (HGS) cutoff points to predict 1-year mortality in adult patients with liver cirrhosis. METHODS This is an analysis of cohort databases from four reference centers in Brazil. Inpatients or outpatients with cirrhosis and aged ≥18 years were included. The best cutoff values of HGS (highest value from three attempts with the non-dominant hand) for predicting 1-year mortality, stratified by sex and age, were established based on the sensitivity and specificity analyses. Adjusted Cox regression models were used to test the predictive value of low HGS. RESULTS The study included 724 patients with cirrhosis, with a median age of 57.0 years (IQR: 50.0-63.0), 66.4% (n = 481) male. Most patients had alcoholic cirrhosis (n = 281; 38.8%), 400 (55.3%) were classified as Child-Pugh B or C, and 134 (18.5%) patients died after 1-year. The HGS cutoffs were ≤33 kgf and ≤12 kgf for men and women aged <60 years, respectively, and ≤22 kgf and ≤10 kgf for older men and women, respectively (sensitivity: 70.9%; specificity: 61.2%). Low HGS was associated with a 2.5-fold increase in the risk of 1-year mortality. CONCLUSION These cutoff points could be used to identify patients with a higher mortality risk.
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Affiliation(s)
- Bárbara Chaves Santos
- Food Science Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruna Cherubini Alves
- Gastroenterology and Hepatology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Camila Saueressig
- Gastroenterology and Hepatology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Lívia Alves Amaral Santos
- Gastroenterology Division, Department of Internal Medicine, Universidade Estadual Paulista, Botucatu, Brazil
| | | | - Andre Castro Lyra
- Gastro-Hepatology Service, Hospital Universitario Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Fernando Gomes Romeiro
- Gastroenterology Division, Department of Internal Medicine, Universidade Estadual Paulista, Botucatu, Brazil
| | - Valesca Dall'Alba
- Gastroenterology and Hepatology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Food, Nutrition, and Health Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vivian Cristine Luft
- Food, Nutrition, and Health Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Epidemiology Graduate Program, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Lívia Garcia Ferreira
- Nutrition and Health Graduate Program, Universidade Federal de Lavras, Lavras, Brazil
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13
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Limon-Miro AT, Sekulic K, Isley S, Prado CM, Tandon P. The association of frailty and bedside body composition tools with total body potassium and body cell mass: a pilot study in adults with cirrhosis. Eur J Clin Nutr 2025; 79:494-497. [PMID: 39825192 DOI: 10.1038/s41430-024-01562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 12/11/2024] [Accepted: 12/17/2024] [Indexed: 01/20/2025]
Abstract
The accurate assessment of body composition in cirrhosis is challenging as fluid accumulation affects most techniques. The whole-body counter is a state-of-the-art method that measures total body potassium (TBK) unbiased by fluid, from which body cell mass (BCM) is derived. This pilot study in 20 patients with cirrhosis evaluated bedside tools including the liver frailty index (LFI), bioimpedance analysis-based phase angle, calf circumference (CC), and BMI (body mass index)/edema-adjusted CC, and explored their association with TBK and BCM. Stepwise multiple linear regression analysis and Pearson's correlation tests were conducted. Adjusted for sex, BCM and TBK were inversely associated with frailty (p < 0.0001). LFI r = -0.568 (p = 0.009), CC r = 0.484 (p = 0.031), and edema-adjusted CC r = 0.467 (p = 0.038), demonstrated moderate correlations with BCM. Further research involving a larger sample of participants is needed to confirm these findings associating these bedside tools and gold-standard body composition measures.
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Affiliation(s)
- Ana Teresa Limon-Miro
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, Faculty of Agricultural, Life, & Environmental Sciences, University of Alberta, Edmonton, AB, Canada
- Division of Gastroenterology (Liver Unit), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Karolina Sekulic
- School of Life and Health Sciences, Whitelands College, University of Roehampton, London, UK
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Serena Isley
- Division of Gastroenterology (Liver Unit), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food, and Nutritional Science, Faculty of Agricultural, Life, & Environmental Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Yang S, Ren X, Guo X, Yu J, Niu L, Niu Y, Zhang L, Jin L. Decreased Subcutaneous Adipose Tissue Correlates With Higher Portal Hypertension and Poor Survival in Patients With Cirrhosis: A Retrospective Binary-Center Study. Clin Transl Gastroenterol 2025; 16:e00836. [PMID: 40042206 PMCID: PMC12101926 DOI: 10.14309/ctg.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 02/26/2025] [Indexed: 05/07/2025] Open
Abstract
INTRODUCTION The aim of this study was to investigate the impact of hepatic venous portal gradient (HVPG) on body composition (BC) values and the prognostic value of BC value in cirrhotic patients. METHODS A total of 173 cirrhotic patients with HVPG and computed tomography scan were screened retrospectively from a binary-center database. Seven BC values, including skeletal muscle index, subcutaneous adipose tissue index (SATI), deep SATI (dSATI), superficial SATI (sSATI), visceral adipose tissue index, and ratio of visceral adipose tissue index and SATI along with skeletal muscle radiodensity, were analyzed. The correlation analyses and multiple linear regression were used to assess the impact of HVPG on BC values. The cumulative survival rate was assessed, and risk factors of survival were identified by competing risk analysis using Fine-Gray model. RESULTS Among 173 patients with a mean age of 53.7 ± 10.5 years, there were 111 male patients (64.2%) and 62 female patients (35.8%). In male patients, SATI, dSATI, and sSATI inversely correlated with HVPG, respectively (SATI: rho = -0.227; dSATI: rho = -0.229; sSATI: rho = -0.219; all P < 0.05), especially in patients aged 60 years or younger or with compensated cirrhosis; male patients with clinically significant portal hypertension had a lower SATI, dSATI, sSATI, and skeletal muscle radiodensity than those without clinically significant portal hypertension. After adjusted multiple linear models, male sex, Child-Pugh class B or C, and elevated HVPG contributed to decreased SATI. Multiple competing survival analysis showed a lower SATI (male: <38 cm 2 /m 2 ; female: <23 cm 2 /m 2 ), and Child-Pugh B or C predict mortality. DISCUSSION Decreased SATI, dSATI, and sSATI were more closely associated with increased HVPG. A lower SATI and Child-Pugh B or C predicted mortality.
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Affiliation(s)
- Siwei Yang
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China;
| | - Xiuwan Ren
- Department of Interventional Radiology, Third People's Hospital of Taiyuan, Taiyuan, China;
| | - Xiaoqing Guo
- Department of Hepatology, Third People's Hospital of Taiyuan, Taiyuan, China;
| | - Jianan Yu
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China;
| | - Lizhen Niu
- Department of Imaging, Third People's Hospital of Taiyuan, Taiyuan, China.
| | - Yao Niu
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China;
| | - Linpeng Zhang
- Department of Interventional Radiology, Third People's Hospital of Taiyuan, Taiyuan, China;
| | - Long Jin
- Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China;
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15
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Shi Y, Chien N, Fong A, Nguyen VH, Gudapati ST, Chau A, Tran S, Henry L, Cheung R, Zhao C, Jin M, Nguyen MH. Differential Characteristics and Survival Outcomes of Patients With Cirrhosis According to Underlying Liver Aetiology. Aliment Pharmacol Ther 2025; 61:1622-1634. [PMID: 40013475 DOI: 10.1111/apt.70059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 01/21/2025] [Accepted: 02/18/2025] [Indexed: 02/28/2025]
Abstract
BACKGROUND AND AIMS Updated data on the survival of patients with cirrhosis are limited, especially for subgroups by specific liver disease aetiology. To inform practice, future modelling studies, and public health planning, our study aimed to provide updated and granular data on survival outcomes of patients with cirrhosis stratified by liver disease aetiology. We also assessed their changes over time. METHODS We analysed 8726 consecutive adult patients with cirrhosis who presented at Stanford university medical center during 1/2005-1/2022. RESULTS 8726 Patients had the following etiologies: hepatitis C virus (HCV) (28.1%), hepatitis B virus (HBV) (4.8%), alcohol-associated (ALD, 33.3%), metabolic-associated steatotic liver disease (MASLD) (9.5%), autoimmune (9.6%), cryptogenic (8.2%) and other etiologies (6.5%). Patients with cryptogenic cirrhosis had the lowest overall 5-, 10-, and 15-year cumulative survival (57.5%, 34.3% and 21.4%), as well as for liver and nonliver-related death, followed by ALD, MASLD, HCV, and autoimmune, while HBV patients had the best survival (86.0%, 70.1% and 65.1%), respectively. On multivariable Cox regression, cryptogenic cirrhosis (vs. HBV) was associated with the highest risk of all-cause death (aHR: 2.24, 95% CI 1.67-3.00), followed by MASLD and ALD (all p < 0.001). Post-2010 time was associated with a 33% lower risk of all-cause death (p = 0.0011); While in the post-2010 period, MASLD (vs. HBV) was associated with the highest risk of all-cause death (aHR: 1.92, 95% CI 1.32-2.80, p < 0.001) followed by cryptogenic and ALD. CONCLUSIONS Survival outcomes in patients with cirrhosis varied by aetiology and have changed over time, which should be taken into account for future practice guidelines and modelling studies.
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Affiliation(s)
- Yu Shi
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Nicholas Chien
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Ashley Fong
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Vy H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Surya Teja Gudapati
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Angela Chau
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Sally Tran
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Changqing Zhao
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, China
| | - Minjuan Jin
- Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hang Zhou, China
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California, USA
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Atay K, Aydin S, Canbakan B. Sarcopenia and Frailty in Cirrhotic Patients: Evaluation of Prevalence and Risk Factors in a Single-Centre Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:821. [PMID: 40428779 DOI: 10.3390/medicina61050821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 04/01/2025] [Accepted: 04/16/2025] [Indexed: 05/29/2025]
Abstract
Background and Objectives: Sarcopenia and frailty adversely affect morbidity and mortality in patients with liver cirrhosis. This study aimed to investigate the prevalence of sarcopenia and frailty in cirrhotic patients and to identify the contributing factors. Materials and Methods: This study was conducted in adult patients diagnosed with cirrhosis in a single-center cohort study who were under follow-up in the gastroenterology outpatient clinic. Patients were evaluated using the SARC-F questionnaire, FRAIL index, handgrip strength measurements, and various biochemical parameters. Results: Of the 100 patients included in the study, 58.7% were male, with a median age of 66.5 years. The prevalence of sarcopenia was 32%. Patients with sarcopenia had significantly lower body mass index (BMI) and higher model for end-stage liver disease (MELD)-Na and Child-Turcotte-Pugh (CTP) scores. According to the FRAIL scale, pre-frailty was highly prevalent among patients (60%). Significant negative correlations were observed between the SARC-F score and BMI, handgrip strength, albumin, vitamin D, and sodium levels. Conversely, significant positive correlations were identified between the SARC-F score and age, CTP score, MELD-Na score, bilirubin, AST, ALT, and ferritin levels. Conclusions: This study demonstrated a high prevalence of sarcopenia and frailty among cirrhotic patients. These findings warrants further investigation in longitudinal studies for hard clinical outcome and mortality.
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Affiliation(s)
- Kadri Atay
- Department of Gastroenterology, Mardin Research and Training Hospital, Mardin 47100, Türkiye
| | - Seval Aydin
- Division of Biochemistry, Cerrahpasa Faculty of Medicine, İstanbul 34098, Türkiye
| | - Billur Canbakan
- Division of Gastroenterology, Cerrahpasa Faculty of Medicine, İstanbul 34098, Türkiye
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17
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Memel Z, Gold SL, Pearlman M, Muratore A, Martindale R. Impact of GLP- 1 Receptor Agonist Therapy in Patients High Risk for Sarcopenia. Curr Nutr Rep 2025; 14:63. [PMID: 40289060 DOI: 10.1007/s13668-025-00649-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2025] [Indexed: 04/29/2025]
Abstract
PURPOSE OF REVIEW Glucagon-like peptide- 1 receptor agonists (GLP- 1 RA) are a rapidly expanding class of medications used to treat many chronic diseases. This review explores factors that may contribute to accelerated muscle loss among higher-risk patient populations and describes tailored interventions to reduce the risk of accelerated sarcopenia and frailty. RECENT FINDINGS While GLP- 1 RA can result in total weight loss upwards of 25%, recent studies show that they can also lead to significant loss of lean body mass, reaching as high as 15-40% of total weight lost. This rapid and significant decline in muscle mass while taking GLP- 1 RA places certain patient populations already predisposed to sarcopenia at higher risk for muscle loss and adverse events. Currently, there is insufficient evidence delving into the impact of GLP- 1 RA on body composition among older adults, patients with chronic kidney disease, liver disease, and inflammatory bowel disease. However, research suggests that a high protein diet and resistance training may help prevent loss of muscle mass during GLP- 1 RA usage. A targeted and individualized nutrition and physical activity regimen should be instituted for each patient with a focus on optimizing protein intake and performing frequent resistance training in order to minimize loss of muscle mass while promoting the loss of fat mass. Future research should evaluate the impact of GLP- 1 RA on sarcopenia in high-risk patient populations.
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Affiliation(s)
- Zoe Memel
- Department of Gastroenterology, University of California San Francisco, San Francisco, California, USA
| | - Stephanie L Gold
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Michelle Pearlman
- Gastroenterologist and Obesity Medicine Specialist, Co-Founder Prime Institute, Coral Gables, Florida, USA
| | - Alicia Muratore
- Department of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert Martindale
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
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18
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Hosoi Y, Kawakami M, Ito D, Kamimoto T, Kamimura H, Kawaguchi T, Terai S, Tsuji T. Mapping of rehabilitation interventions and assessment methods for patients with liver cirrhosis: a scoping review. BMC Gastroenterol 2025; 25:291. [PMID: 40269747 PMCID: PMC12020051 DOI: 10.1186/s12876-025-03881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 04/10/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND This scoping review aimed to delineate the detailed components of exercise therapy and the evaluation methods used for patients with liver cirrhosis. METHODS The methodology involved searching the original PubMed, Web of Science, and Scopus for studies published between January 1975 and March 2025. The search was completed on 13 March 2025. Studies describing exercise therapy for liver cirrhosis patients were selected. Relevant information matching the study objectives, such as intervention duration, content, intensity setting, evaluation criteria, and outcomes, was extracted and documented. RESULTS Of the 2314 articles identified, 18 fit the inclusion and exclusion criteria, with a total of 950 participants. The most prevalent form of exercise therapy was a combined aerobic exercise and strength training program (55.6%). Commonly used assessment criteria included the 6-minute walking distance for endurance evaluation (44.4%) and the Chronic Liver Disease Questionnaire for quality of life assessment (33.3%). Intervention durations ranged from 30 to 60 min per day, 2 to 7 days per week, and 8 to 12 weeks. Concerning intensity setting, subjective fatigue levels and heart rate were frequently used (38.9%), though detailed descriptions were limited. CONCLUSIONS For the establishment of effective exercise therapy for patients with liver cirrhosis, future research should concentrate on tailoring intensity settings according to individual patient needs. Additionally, standardized reporting of intervention details and assessment methods is crucial for improving the quality and comparability of studies in this field.
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Affiliation(s)
- Yuichiro Hosoi
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Daisuke Ito
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takayuki Kamimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata city, 951-8510, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, 830-0011, Fukuoka, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata city, 951-8510, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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19
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Gischewski MDR, Araujo FLC, Siqueira AIDAN, Wallraf AJDS, Neto JAB, Nassib NBB, Santos JCDF, Moura FA. Evaluating sarcopenia and nutritional status in outpatients with liver cirrhosis: concordance of diagnostic methods. NUTR HOSP 2025; 42:292-301. [PMID: 39898452 DOI: 10.20960/nh.05585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025] Open
Abstract
Introduction Introduction and objectives: malnutrition and sarcopenia are prevalent in individuals with cirrhosis, but their diagnosis remains challenging due to limited access to suitable methods across different levels of healthcare. This study aimed to identify the most effective method for diagnosing sarcopenia in outpatients with liver cirrhosis and to evaluate the concordance between subjective and objective diagnostic methods. Patients and methods: patients aged ≥ 18 years with a diagnosis of cirrhosis (regardless of etiology) under outpatient care were included. Exclusion criteria were: a) neoplasia, b) acute liver failure, c) pregnancy/lactation, d) HIV infection, e) special situations requiring liver transplantation, and f) history of organ failure. Nutritional and sarcopenia assessments used subjective methods, including the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), SARC-F, SARC-Calf, and RFH-Global Assessment (RFH-GA); and objective methods, including anthropometry, handgrip strength (HGS), the sit-and-stand test (15s), and appendicular skeletal muscle mass index (ASMI) by Dual-Energy X-ray Absorptiometry (DXA). Concordance between ASMI and traditional methods was analyzed. Significance was set at p < 0.05. Results: a total of 45 patients were analyzed, with alcoholic liver disease being the most frequent etiology (44.4 %). The sit-and-stand test (15s) combined with muscle depletion by DXA diagnosed the most cases of sarcopenia (42.2 %). Moderate agreement was found between muscle depletion and isolated calf circumference (CC) (κ = 0.581; p < 0.001). Conclusions: our study suggests excluding SARC-F and SARC-CalF from sarcopenia screening in outpatients with cirrhosis. While ASMI remains the most reliable diagnostic method, CC may serve as a feasible alternative when DXA is unavailable.
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20
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Jiao H, Wang H, Li J, Yang Z, Sun C. The Molecular Pathogenesis of Sarcopenia/Frailty in Cirrhosis. Semin Liver Dis 2025. [PMID: 40239708 DOI: 10.1055/a-2564-7551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2025]
Abstract
Cirrhosis is an important cause of morbidity and death in patients with chronic liver disease. It can be divided into compensatory and decompensated stages. During the decompensation period, complications such as esophageal and gastric varices hemorrhage, hepatic encephalopathy, infection, and hepatorenal syndrome are often incurred, which has a high mortality rate and leverages huge economic burden on society, healthcare resources, and individuals. Sarcopenia and frailty are common in patients with cirrhosis. The pathogenesis of sarcopenia and frailty in the context of cirrhosis is complicated and multifactorial, including overwhelming systemic inflammation, imbalance of muscle protein metabolism, malnutrition, endocrine and metabolic dysfunctions, intestinal microecological disorders, lack of physical exercise, and other aspects. Notably, accumulating evidence implicates that many patients experience sarcopenia/frailty even before the onset of liver cirrhosis. In this regard, the magnitude of liver fibrosis is closely linked to the progression of sarcopenia with reciprocal impact. In conclusion, this review article will shed light on the pathogenesis of cirrhosis complicated with sarcopenia/frailty, aimed at facilitating early diagnosis and effective management.
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Affiliation(s)
- Huanli Jiao
- Department of Health Management, Tianjin Hospital, Hexi District, Tianjin, People's Republic of China
| | - Han Wang
- Department of Health Management, Tianjin Hospital, Hexi District, Tianjin, People's Republic of China
| | - Jia Li
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China
| | - Ziyi Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, People's Republic of China
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21
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Tantai X, Li L, Dai S. Letter to the Editor: Considerations on the use of LPCN 1148 in cirrhotic patients with sarcopenia. Hepatology 2025:01515467-990000000-01235. [PMID: 40198305 DOI: 10.1097/hep.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 01/06/2025] [Indexed: 04/10/2025]
Affiliation(s)
- Xinxing Tantai
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Lu Li
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Shejiao Dai
- Department of Gastroenterology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
- Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
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22
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Jin L, Dong YY, Xu JP, Chen MS, Zeng RX, Guo LH. Relationship between the laboratory test-based frailty index and overall mortality in critically ill patients with acute pancreatitis: a retrospective study based on the MIMIC-IV database. Front Med (Lausanne) 2025; 12:1524358. [PMID: 40265180 PMCID: PMC12011769 DOI: 10.3389/fmed.2025.1524358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Accepted: 03/25/2025] [Indexed: 04/24/2025] Open
Abstract
Background and aims The frailty index, based on laboratory assessments, helps identify individuals at risk for adverse health outcomes. However, its relationship with overall mortality in acute pancreatitis patients in ICUs remains unclear. This study aims to investigate the association between the frailty index and all-cause mortality and assess its prognostic value for these patients. Methods We carried out a retrospective observational investigation utilizing data from the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database. Extract data from the database for all ICU patients (first-time ICU admissions, age ≥ 18 years) who meet the diagnostic criteria for acute pancreatitis. The frailty index derived from laboratory tests (FI-lab) encompassed three vital sign indicators and 30 laboratory test indicators. Patients were categorized into four groups based on quartiles of the FI-lab score. To assess the differences in 28-day all-cause mortality among these groups, we employed Kaplan-Meier analysis, whereas the relationship between FI-lab scores and 28-day mortality was explored through Cox proportional hazards analysis. In addition, we applied Harrell's C statistic, Integrated Discrimination Improvement (IDI), and Net Reclassification Improvement (NRI) to assess the additional predictive capability of FI-lab scores compare to traditional disease severity metrics. Results The study included a total of 741 patients (all age ≥ 18 years, 19.84% age > 75 years, 41.16% Female). The Kaplan-Meier analysis demonstrated that individuals with elevated FI-lab scores exhibited a significantly heightened risk of all-cause mortality (log-rank p < 0.0001). The multivariate Cox regression analysis suggested that treating FI-lab as a continuous variable (per 0.01 increment) was linked to an increased risk of 28-day all-cause mortality [hazard ratio (HR) 1.072, 95% confidence interval (CI) (1.055-1.089), p < 0.001]. Moreover, when FI-lab was analyzed as a categorical variable, patients in the fourth quartile of FI-lab had a notably greater risk of 28-day all-cause mortality in comparison to those in the first quartile [HR 9.933, 95% CI (4.676-21.104), p < 0.001]. Additionally, the integration of FI-lab scores with conventional disease severity scores improved the predictive performance for 28-day mortality. Conclusion In patients in the ICU who have been diagnosed with acute pancreatitis, the FI-lab score functions as a reliable indicator of short-term mortality. Early detection of patients at high risk for acute pancreatitis through the implementation of the FI-lab score, along with prompt interventions, is essential for enhancing these individuals' prognoses.
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Affiliation(s)
- Li Jin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Yan Dong
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun-Peng Xu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Mao-Sheng Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Rui-Xiang Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Li-Heng Guo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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23
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Simpson MA, Lin MV. Frailty in Liver Transplant Recipients: A Serious Issue That Would Benefit From a Redefinition of "Successful" Intervention. Transplantation 2025; 109:580-581. [PMID: 39702330 DOI: 10.1097/tp.0000000000005294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Affiliation(s)
- Mary Ann Simpson
- Division of Transplantation and Hepatobiliary Diseases, Lahey Hospital and Medical Center, Burlington, MA
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24
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Villanueva C, Tripathi D, Bosch J. Preventing the progression of cirrhosis to decompensation and death. Nat Rev Gastroenterol Hepatol 2025; 22:265-280. [PMID: 39870944 DOI: 10.1038/s41575-024-01031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2024] [Indexed: 01/29/2025]
Abstract
Two main stages are differentiated in patients with advanced chronic liver disease (ACLD), one compensated (cACLD) with an excellent prognosis, and the other decompensated (dACLD), defined by the appearance of complications (ascites, variceal bleeding and hepatic encephalopathy) and associated with high mortality. Preventing the progression to dACLD might dramatically improve prognosis and reduce the burden of care associated with ACLD. Portal hypertension is a major driver of the transition from cACLD to dACLD, and a portal pressure of ≥10 mmHg defines clinically significant portal hypertension (CSPH) as the threshold from which decompensating events may occur. In recent years, innovative studies have provided evidence supporting new strategies to prevent decompensation in cACLD. These studies have yielded major advances, including the development of noninvasive tests (NITs) to identify patients with CSPH with reasonable confidence, the demonstration that aetiological therapies can prevent disease progression and even achieve regression of cirrhosis, and the finding that non-selective β-blockers can effectively prevent decompensation in patients with cACLD and CSPH, mainly by reducing the risk of ascites, the most frequent decompensating event. Here, we review the evidence supporting new strategies to manage cACLD to prevent decompensation and the caveats for their implementation, from patient selection using NITs to ancillary therapies.
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Affiliation(s)
- Càndid Villanueva
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Ministerio de Sanidad, Madrid, Spain.
| | - Dhiraj Tripathi
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham Health Partners, Birmingham, UK
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jaume Bosch
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Ministerio de Sanidad, Madrid, Spain
- Department of Visceral Surgery and Medicine (Hepatology), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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25
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Allen JL, Sterling RK. Palliative care & management of symptoms in advanced liver disease: an expert review. Expert Rev Gastroenterol Hepatol 2025; 19:515-526. [PMID: 40200429 DOI: 10.1080/17474124.2025.2491529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 03/07/2025] [Accepted: 04/07/2025] [Indexed: 04/10/2025]
Abstract
INTRODUCTION Chronic liver disease (CLD) is a leading cause of death worldwide. End-stage liver disease (ESLD) causes a rapid and progressive decline in health and quality of life (QOL) and creates significant suffering and burdens for patients, families, and health systems alike. These patients have significant physical, psychological, and complex social needs that benefit from the support of an interdisciplinary palliative care (PC) team. AREAS COVERED This review of the English literature analyzes general palliative care principles for the CLD and ESLD populations including factors affecting QOL and review of symptom management per AASLD and AGA Guidelines. We have also reviewed the impacts of palliative support on QOL, caregiver burden, and healthcare-related outcomes. EXPERT OPINION ESLD causes significant suffering and burdens for patients, families, and healthcare systems. PC is an essential component of ESLD care; it improves QOL, reduces caregiver burdens, and shows benefits of reduced healthcare costs and aggressive care at end of life. Provider and community misunderstanding or inexperience of PC is often a barrier to PC involvement. There is a clear lack of standardization in medical training and lack of clear guidelines on when to involve PC in the ESLD population that must be addressed.
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Affiliation(s)
- Jessica L Allen
- Division of Hematology, Oncology & Palliative Care, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Richard K Sterling
- Division of Gastroenterology, Hepatology & Nutrition, Virginia Commonwealth University Health System, Richmond, VA, USA
- Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University Health System, Richmond, VA, USA
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26
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Wang M, Chiou SH, Ganger D, Ruck J, Huang CY, Kappus MR, King EA, Ladner DP, Rahimi RS, Duarte-Rojo A, Volk ML, Tevar AD, Verna EC, Lai JC. Liver transplantation provides survival benefit at all levels of frailty: From the Multicenter Functional Assessment in Liver Transplantation Study. Hepatology 2025; 81:1269-1275. [PMID: 39047086 PMCID: PMC11757801 DOI: 10.1097/hep.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND AIMS Offering LT to frail patients may reduce waitlist mortality but may increase post-LT mortality. LT survival benefit is the concept of balancing these risks. We sought to quantify the net survival benefit with LT by liver frailty index (LFI). APPROACH AND RESULTS We analyzed data in the multicenter Functional Assessment in LT (FrAILT) study from 2012 to 2021. Pre-LT cohort included ambulatory patients with cirrhosis awaiting LT, without HCC; the post-LT cohort included those who underwent LT. Primary outcomes were pre-LT and post-LT mortality. We computed 1-, 3-, and 5-year restricted mean survival times (RMSTs) from adjusted Cox models. The survival benefit was calculated as a net gain in life-years with LT. Pre-LT cohort included 2628 patients: median Model for End-Stage Liver Disease-Sodium was 18 (IQR: 14-22); 731 (28%) were frail; 440 (17%) died before LT. Post-LT cohort included 1335 patients: median Model for End-Stage Liver Disease-Sodium was 20 (IQR: 14-24); 325 (24%) were frail; 103 (8%) died after LT. Pre-LT RMST decreased substantially as LFI increased. Post-LT RMST also decreased as LFI increased but only modestly. There was no LFI threshold at which pre-LT and post-LT RMST intersected-patients had net survival benefits at all LFI values. CONCLUSIONS Pre-LT and, to a lesser degree, post-LT mortality increased as LFI increased. Transplant offered a survival benefit at all LFI values, driven by a reduction in pre-LT mortality. No threshold of LFI was identified at which the risk of post-LT mortality exceeded pre-LT mortality. LT offers net survival benefits even in the presence of advanced frailty among those selected for LT.
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Affiliation(s)
- Melinda Wang
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Sy Han Chiou
- Department of Statistics and Data Science, Southern Methodist University, Dallas, Texas, USA
| | - Daniel Ganger
- Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Jessica Ruck
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Matthew R. Kappus
- Department of Medicine, Division of Gastroenterology and Hepatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth A. King
- Department of Surgery, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniela P. Ladner
- Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Robert S. Rahimi
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas, USA
| | - Andres Duarte-Rojo
- Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Michael L. Volk
- Department of Medicine, Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California, USA
| | - Amit D. Tevar
- Department of Surgery and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer C. Lai
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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27
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Wang B, Huang Q, Xiong Y, Huang N, Li J, Zhang S. Association between sarcopenia and the prevalence of gallstone in US adults: a cross-sectional analysis of NHANES. BMC Gastroenterol 2025; 25:207. [PMID: 40158173 PMCID: PMC11955117 DOI: 10.1186/s12876-025-03808-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Accepted: 03/20/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUD Gallstones are a common disease that imposes a significant burden on public health resources. Sarcopenia is an age-related condition characterized by a decline in muscle mass, strength, and function. However, its relationship with gallstones remains unclear. METHODS This cross-sectional study included 2,167 US adults from the National Health and Nutrition Examination Survey. We used the multivariable logistic regression models and restricted cubic spline regression to to assess the relationship between sarcopenia and gallstones. Additionally, subgroup analyses and propensity score matching (PSM) were conducted to account for potential confounding factors. RESULTS We found a significant negative association between the sarcopenia index and the prevalence of gallstones (OR: 0.253, 95% CI: 0.132-0.471, P < 0.001). In Model 4, which integrated all covariates, sarcopenia was associated with approximately a 100% increased prevalence of gallstones compared to non-sarcopenia patients (OR: 1.995, 95% CI: 1.340-2.948, P < 0.001). The results of PSM also confirmed the association between sarcopenia and gallstones (OR: 1.982, 95% CI: 1.217-3.285, P = 0.007). Notably, this association was more pronounced in subgroups including females, non-Hispanic whites, married individuals, and higher education level. CONCLUSION In summary, our findings suggest a positive association between sarcopenia and the prevalence of gallstones in US adults. This suggests that we should increase the emphasis on gallstone disease screening in sarcopenia patients. However, this finding needs to be validated through further large-scale prospective studies.
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Affiliation(s)
- Bo Wang
- Department of Geriatric General Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Qianxi Huang
- Chang'an District Yangzhuang Community Health Service Center, Xi'an, 710103, China
| | - Yongqiang Xiong
- Department of Geriatric General Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Na Huang
- National & Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Jun Li
- National & Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Shu Zhang
- Department of Geriatric General Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
- Experimental Teaching Center for Clinical Skills, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
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28
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Guo Y, Wang Y, Liu R, Li H, Yin G, Tuo H, Zhu Y, Wang Y, Yang W, Liu Z. Impact of preoperative malnutrition, based on albumin level and body mass index, on operative outcomes in noncirrhosis patients with colorectal liver metastasis. Front Surg 2025; 12:1512843. [PMID: 40225113 PMCID: PMC11986716 DOI: 10.3389/fsurg.2025.1512843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 02/26/2025] [Indexed: 04/15/2025] Open
Abstract
Background Serum albumin level and body mass index (BMI), acting as indicators of nutritional status, are commonly applied to predict surgical outcomes in cancer patients. This study aimed to evaluate the impact of preoperative serum albumin level and BMI on the operative outcomes of noncirrhotic patients with colorectal cancer liver metastasis who underwent hepatectomy. Methods This was a retrospective study of medical records from the period between January 2013 and December 2022. Preoperative malnutrition was defined as hypoalbuminemia with a serum albumin level of <35 g/L before surgery or a BMI of <18.5 kg/m2 within 30 days before surgery. Multiple statistical methods were applied to analyze the data, including the two-independent sample t-test, analysis of variance, Chi-squared test, and multivariate analysis. Results Among the 159 eligible patients, 42 (26.4%) were classified into the preoperative malnutrition group. The incidence of blood transfusion (45.24% vs. 18.80%, P = 0.040) was significantly higher in the malnutrition group. The drainage volume was significantly higher on the first day [65 (115) vs. 60 (80), P < 0.05] and the second day [50 (95) vs. 40 (79) P < 0.05] in the malnutrition group than that in the nonmalnutrition group. Postoperative hemoglobin levels were significantly lower in the malnutrition group (101.20 ± 2.43 vs. 108.76 ± 1.61, P = 0.015). Therefore, the incidence of grade Ⅱ or Ⅲ/Ⅳ complications was significantly higher in the malnutrition group (16.67% vs. 5.31% or 11.9% vs. 3.42%, P = 0.001), and the length of hospital stay was significantly extended [18 (12) vs. 15 (8), P = 0.002]. In the multivariate analysis, preoperative malnutrition [odds ratio (OR) = 5.548, 95% CI 1.508-20.413, p = 0.010] and operation time (OR = 1.009, 95% CI 1.002-1.016, P = 0.0011) were identified as independent predictors of postoperative complications. Conclusion Preoperative malnutrition in patients who underwent hepatectomy for colorectal cancer liver metastasis was associated with worse surgical outcomes, especially aggrandizing the emergence of postoperative complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Wei Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhikui Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, Shaanxi, China
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Xu X, Ding H, Li W, Han Y, Guan Y, Xu J, Han Y, Jia J, Wei L, Duan Z, Nan Y, Zhuang H, Chinese Society of Hepatology, Chinese Medical Association. Chinese Guidelines on the Management of Hepatic Encephalopathy in Cirrhosis (2024). J Clin Transl Hepatol 2025; 13:253-267. [PMID: 40078200 PMCID: PMC11894390 DOI: 10.14218/jcth.2024.00484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/20/2025] [Accepted: 02/06/2025] [Indexed: 03/14/2025] Open
Abstract
With progress in basic and clinical research on hepatic encephalopathy in cirrhosis worldwide, the Chinese Society of Hepatology of the Chinese Medical Association has invited experts in relevant fields to revise the 2018 "Chinese Guidelines on the Management of Hepatic Encephalopathy in Cirrhosis." The updated guidelines provide recommendations for the clinical diagnosis, treatment, and both primary and secondary prevention of hepatic encephalopathy in cirrhosis.
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Affiliation(s)
- Xiaoyuan Xu
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Huiguo Ding
- Hepatology and Gastroenterology Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Wengang Li
- Comprehensive Liver Cancer Center, The Fifth Medical Center of the People’s Liberation Army General Hospital, Beijing, China
| | - Ying Han
- Hepatology and Gastroenterology Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Yujuan Guan
- Hepatology Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinghang Xu
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Yifan Han
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Jidong Jia
- Hepatology Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lai Wei
- Hepatobiliary and Pancreatic Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Zhongping Duan
- Hepatology Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Yuemin Nan
- Department of Integrated Traditional Chinese and Western Medicine Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hui Zhuang
- Department of Pathogenic Biology, Peking University Health Science Center, Beijing, China
| | - Chinese Society of Hepatology, Chinese Medical Association
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
- Hepatology and Gastroenterology Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
- Comprehensive Liver Cancer Center, The Fifth Medical Center of the People’s Liberation Army General Hospital, Beijing, China
- Hepatology Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Hepatology Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Hepatobiliary and Pancreatic Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
- Hepatology Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
- Department of Integrated Traditional Chinese and Western Medicine Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Pathogenic Biology, Peking University Health Science Center, Beijing, China
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30
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Lai JC, Shui AM, Molinari M, Rahimi RS, Ladner DP, Ganger DR, Kappus M, King EA, Tevar AD, Volk ML, Duarte-Rojo A, Verna EC. The Liver Transplant Comorbidity Index (LTCI): A composite index of ambulatory pre-LT factors to identify patients at increased risk of post-LT mortality. Hepatology 2025:01515467-990000000-01217. [PMID: 40132167 DOI: 10.1097/hep.0000000000001320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 03/10/2025] [Indexed: 03/27/2025]
Abstract
BACKGROUND AND AIMS Frailty is strongly associated with mortality after liver transplantation. However, national guidelines discourage its use as a sole reason to decline a patient for liver transplantation, as some frail patients have acceptable outcomes. We aimed to develop a composite index, the Liver Transplant Comorbidity Index (LTCI), integrating frailty and other comorbidities, as a risk factor for longer-term (3-year) posttransplant mortality. APPROACH AND RESULTS This 8-center prospective Functional Assessment in Liver Transplantation (FrAILT) Study included adult recipients of a primary deceased donor liver transplant from 2012 to 2022. Frailty was measured using the Liver Frailty Index (LFI ≥4.5=frail). Other candidate variables included demographics, laboratories, and comorbidities. Cox proportional hazards regression with best subset selection was used to identify risk factors of 3-year posttransplant death. The final model was selected based on Akaike Information Criterion and clinical pragmatism. Of 1472 liver transplant recipients, 290 (20%) were frail. Three-year posttransplant mortality was higher in frail versus non-frail patients (13% vs. 8%; p =0.03). The final LTCI included 5 variables: frailty, coronary artery disease, HCC, renal dysfunction, and diabetes. Three-year posttransplant mortality in low-risk, moderate-risk, and high-risk LTCI groups was 93%, 87%, and 80%, respectively. In multivariable analysis, after adjusting for donor factors (age and donation after circulatory death), both moderate-risk (HR: 2.23, 95% CI: 1.46-3.40; p <0.001) and high-risk (HR: 2.78, 95% CI: 1.67-4.64; p <0.001) status were associated with 3-year posttransplant mortality. CONCLUSIONS The LTCI, comprising 5 pretransplant clinical parameters, effectively identifies patients at increased risk of posttransplant mortality. By integrating frailty in the context of other comorbidities, the LTCI can help providers better weigh the relative transplant risks and benefits and standardize the selection of transplant candidates.
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Affiliation(s)
- Jennifer C Lai
- Department of Medicine, University of California, San Francisco, USA
| | - Amy M Shui
- Department of Medicine, University of California, San Francisco, USA
| | - Michele Molinari
- Department of Surgery and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert S Rahimi
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Daniela P Ladner
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel R Ganger
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Matthew Kappus
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth A King
- Department of Surgery, Johns Hopkins Medical Institute, Baltimore, MD, USA
| | - Amit D Tevar
- Department of Surgery and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael L Volk
- Department of Medicine, Baylor Scott & White Health, Dallas, TX, USA
| | | | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY, USA
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Liu D, Ji D, Garrett JW, Zea R, Kuchnia A, Summers RM, Mezrich JD, Pickhardt PJ. Automated abdominal CT imaging biomarkers and clinical frailty measures associated with postoperative deceased-donor liver transplant outcomes. Eur Radiol 2025:10.1007/s00330-025-11523-2. [PMID: 40121592 DOI: 10.1007/s00330-025-11523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 01/22/2025] [Accepted: 02/19/2025] [Indexed: 03/25/2025]
Abstract
OBJECTIVE To quantify the potential of fully automated CT-based body composition metrics and clinical frailty data in predicting liver transplant recipient postoperative outcomes. METHODS AI-enabled body composition tools were applied to pre-transplant abdominal CT scans in a retrospective cohort of first-time deceased-donor liver transplant recipients. Clinical frailty data (Fried frailty score) was obtained from an established transplant database. Age- and sex-corrected hazard ratios (HRs) were analyzed according to highest-risk quartiles compared with the other three quartiles combined. Area under the receiver operating characteristic curve (ROC AUC) analysis in univariate and multivariate scenarios was also performed. RESULTS 598 liver transplant recipients (median age, 56 years [IQR, 49-61]; 383 men/215 women) were included from 2005 to 2021. Mean clinical follow-up interval after transplant was 8.6 ± 4.5 years, with 224 deaths (mean interval, 5.3 ± 3.9 years post-transplant) and 246 graft failures (mean interval, 4.7 ± 4.0 years post-transplant) observed. Univariate HRs for post-transplant survival included 1.53 (95% CI, 1.14-2.06) for muscle attenuation, 1.66 (95% Cl, 1.24-2.22) for aortic Agatston score, 1.35 (1.02-1.80) for SAT area, and 1.82 (1.35-2.46) for liver volume. For those meeting the frailty criteria, HR was 2.14 (1.08-4.22). Multivariate 10-year AUC for predicting mortality was 0.675 using liver volume, aortic Agatston score, and muscle attenuation. 10-year univariate AUC for clinical frailty assessment was 0.601 but increased to 0.878 when combined with CT measures. CONCLUSION Automated CT measurements of muscle density (myosteatosis), aortic calcification, subcutaneous fat, and liver volume are predictive of mortality in liver transplant recipients. Frailty was likewise predictive. Combining CT and clinical frailty assessment was complementary. KEY POINTS Question What is the prognostic value of pre-transplant CT-based body composition measures for deceased-donor liver transplant outcomes, and how do they correlate with frailty assessment? Findings Increased post-transplant mortality was associated with pre-transplant increased liver volume, increased abdominal aortic Agatston score, decreased skeletal muscle attenuation, and decreased subcutaneous adipose tissue area. Clinical relevance Pre-transplant AI-enabled body composition measures have predictive value for post-transplant survival, offering a novel and objective diagnostic tool to identify high-risk transplant recipients that are complementary to clinical assessments.
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Affiliation(s)
- Daniel Liu
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Ji
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John W Garrett
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ryan Zea
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Adam Kuchnia
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Joshua D Mezrich
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Goran LG, Liţă (Cofaru) FA, Fierbinţeanu-Braticevici C. Acute-on-Chronic Liver Failure: Steps Towards Consensus. Diagnostics (Basel) 2025; 15:751. [PMID: 40150093 PMCID: PMC11941433 DOI: 10.3390/diagnostics15060751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Revised: 03/09/2025] [Accepted: 03/14/2025] [Indexed: 03/29/2025] Open
Abstract
Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by organ failure and high short-term mortality. Since its first definition in 2013, many international organizations have defined this syndrome and, till now, there has been no agreement regarding definitions and diagnostic criteria. Although the precise mechanism of ACLF is unknown, precipitant factors and the systemic inflammation response play a major role. Specific management of this high-mortality syndrome is still under development, but a general consensus in the diagnosis and management of ACLF is needed.
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Affiliation(s)
- Loredana Gabriela Goran
- Emergency University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.A.L.); (C.F.-B.)
- Internal Medicine II and Gastroenterology Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Florina Alexandra Liţă (Cofaru)
- Emergency University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.A.L.); (C.F.-B.)
- Emergency Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Carmen Fierbinţeanu-Braticevici
- Emergency University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.A.L.); (C.F.-B.)
- Internal Medicine II and Gastroenterology Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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Tapper EB, Chen X, Parikh ND. Testosterone Replacement Reduces Morbidity and Mortality for Most Patients With Cirrhosis. Clin Gastroenterol Hepatol 2025:S1542-3565(25)00200-9. [PMID: 40097035 DOI: 10.1016/j.cgh.2025.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 01/15/2025] [Accepted: 02/05/2025] [Indexed: 03/19/2025]
Abstract
BACKGROUND & AIMS Many men with cirrhosis have low testosterone levels. This is associated with sarcopenia, anemia, and poor quality of life. Data are lacking, however, regarding the clinical impact of testosterone replacement. METHODS We conducted an emulated clinical trial evaluating the impact of testosterone replacement among men who were diagnosed with hypogonadism at the same time as their diagnosis of cirrhosis (new user design). We used nationally representative Medicare data (2008-2020) to examine the risk of death, decompensation events, and fractures in patients who did or did not receive testosterone. We balanced treated and untreated with inverse probability of treatment weighting and evaluated outcomes using an intention-to-treat design. RESULTS A total of 282 patients (7.4%) with testicular hypofunction and cirrhosis received testosterone replacement after diagnosis. Patients started on testosterone spent 28.6% of patient-days on therapy, and patients not started would spend 0.5% of patient-days on therapy (P < .0001). Testosterone use was associated with lower mortality (subdistribution hazard ratio [sHR], 0.92; 95% confidence interval [CI], 0.85-0.99). Testosterone also led to a lower risk of new decompensation events (sHR, 0.92; 95% CI, 0.86-0.99) and especially for ascites requiring paracentesis (sHR, 0.82; 95% CI, 0.76-0.89) and variceal hemorrhage (sHR, 0.67; 95% CI, 0.54-0.85) with less effect on hepatic encephalopathy requiring hospitalization (sHR, 0.92; 95% CI, 0.84-1.01) and fractures (sHR, 0.99; 95% CI, 0.91-1.08) and without increased risk of hepatocellular carcinoma (sHR, 1.09; 95% CI, 0.91-1.3). There was substantial heterogeneity of treatment effect across baseline subgroups. CONCLUSION In our target trial emulation of a nationally representative cohort of older patients with cirrhosis and hypogonadism, testosterone use improved clinical outcomes.
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Affiliation(s)
- Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
| | - Xi Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Neehar D Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
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Miwa T, Suda G, Tateishi R, Hanai T, Ohara M, Hagiwara Y, Unome S, Okushin K, Nakagawa M, Sakamoto N, Shimizu M. Cachexia is an independent predictor of mortality in patients with cirrhosis. Hepatol Res 2025. [PMID: 40317793 DOI: 10.1111/hepr.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 02/17/2025] [Accepted: 03/03/2025] [Indexed: 05/07/2025]
Abstract
AIM Cachexia is a systemic response syndrome characterized by disabling wasting during disease progression. This study aimed to elucidate factors associated with cachexia in patients with cirrhosis and to examine the impact of cachexia on patient survival. METHODS This multicenter retrospective cohort study included patients with cirrhosis admitted to two distinct institutes in Japan. Cachexia was diagnosed according to the criteria proposed by the Asian Working Group for Cachexia. Factors associated with cachexia and the prognostic impact of cachexia were assessed using logistic regression and Cox proportional hazards regression, respectively. RESULTS Of the 723 patients enrolled (median [interquartile range] age, 71 [64-77] years; 456 [63%] were male; and 390 [54%] had viral hepatitis), 200 (28%) met the criteria for cachexia diagnosis, with the prevalence increasing with Child-Pugh class from A (17%) to B (40%) and C (66%). Multivariable logistic regression analysis revealed that age and indices of liver function reserve, including Child-Pugh score, were associated with cachexia, whereas sex, etiology of cirrhosis, and complications with hepatocellular carcinoma (HCC) were not. During a median follow-up period of 3.2 years, 264 (37%) patients died. Multivariable Cox regression analyses showed that cachexia was independently associated with increased mortality (adjusted hazard ratio, 1.59; 95% confidence interval, 1.43-1.77), along with factors related to liver function, HCC, and alcohol-associated liver disease as the etiology. CONCLUSIONS Cachexia is associated with poor liver function in patients with cirrhosis and is an independent prognostic factor.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Goki Suda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Masatsugu Ohara
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuhiro Hagiwara
- Department of Biostatistics, School of Public Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Shinji Unome
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kazuya Okushin
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Mina Nakagawa
- Department of Gastroenterology and Hepatology, Science Tokyo Hospital, Bunkyo-ku, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
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Miwa T, Tsuruoka M, Ueda H, Abe T, Inada H, Yukawa-Muto Y, Ohara M, Arai T, Tamai Y, Isoda H, Tadokoro T, Hanai T, Ito T, Tamaki N, Sakamaki A, Aoki Y, Tada F, Yoshio S, Takahashi H, Morishita A, Ishikawa T, Inoue J, Suda G, Ogawa C, Atsukawa M, Hiraoka A, Kuroda H, Namisaki T, Honda T, Kawaguchi T, Tanaka Y, Terai S, Ikegami T, Yoshiji H, Iwasa M, Shimizu M. Current management and future perspectives of covert hepatic encephalopathy in Japan: a nationwide survey. J Gastroenterol 2025:10.1007/s00535-025-02232-0. [PMID: 40053108 DOI: 10.1007/s00535-025-02232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 02/16/2025] [Indexed: 04/20/2025]
Abstract
BACKGROUND Covert hepatic encephalopathy (CHE) leads to devastating outcomes in patients with cirrhosis. This study aims to elucidate the current management and future perspectives of CHE in Japan. METHODS A questionnaire-based cross-sectional study was conducted among physicians involved in managing cirrhosis in Japan. The primary aim was to elucidate the real-world management of CHE, including testing and treatment. Factors influencing the implementation of CHE testing were analyzed using a logistic regression model. Limitations and future perspectives for improving the management of CHE were also evaluated. RESULTS Of 511 physicians surveyed, 93.9% recognized CHE as a significant problem, and 86.9% agreed that it should be tested. Overall, 62.8% of physicians tested for CHE, whereas 37.2% did not. Multivariable analysis identified institutional factors and certifying board as significant determinants of CHE test implementation. The Stroop (68.2%) and neuropsychiatric tests (57.5%) were the most commonly used methods of identifying CHE. Among those who tested for CHE, 87.7% treated CHE; the most common treatments were lactulose (81.5%), rifaximin (76.3%), and branched-chain amino acids (70.4%). Among non-testers, the primary barrier was the time requirement for testing. Proposals to encourage CHE testing included the development of simple tests and integration of multidisciplinary teams. CONCLUSIONS Most physicians involved in cirrhosis care in Japan recognize CHE as a significant problem that warrants testing. However, testing for CHE remains limited by institutional factors and physician specialties. Time requirements for CHE testing are the primary barrier, and simple tests and multidisciplinary teams are recommended to enhance CHE management.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Mio Tsuruoka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Hajime Ueda
- Division of Gastroenterology and Hepatology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami-Machi, Inashiki-Gun, Ibaraki, 300-3095, Japan
| | - Tamami Abe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Hiroki Inada
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Yoshimi Yukawa-Muto
- Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Masatsugu Ohara
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-Ku, Sapporo-Shi, Hokkaido, 060-8638, Japan
| | - Taeang Arai
- Division of Gastroenterology and Hepatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yasuyuki Tamai
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Hiroshi Isoda
- Liver Center, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tomoko Tadokoro
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Takamatsu, Kagawa, 761-0793, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, 466-8550, Japan
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1Kyonan-Cho, Musashino-Shi, Tokyo, 180-8610, Japan
| | - Akira Sakamaki
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Yoshihiko Aoki
- Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, 272-8516, Japan
| | - Fujimasa Tada
- Gastroenterology Center, Ehime Prefectural Central Hospital, 83 Kasuga-Cho, Matsuyama, Ehime, 790-0024, Japan
| | - Sachiyo Yoshio
- Department of Human Immunology and Translational Research, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Hirokazu Takahashi
- Liver Center, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Takamatsu, Kagawa, 761-0793, Japan
| | - Tsuyoshi Ishikawa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube-Yamaguchi, 7558505, Japan
| | - Jun Inoue
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Goki Suda
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-Ku, Sapporo-Shi, Hokkaido, 060-8638, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, 4-1-3 Bancho, Takamatsu City, Kagawa Prefecture, 760-0017, Japan
| | - Masanori Atsukawa
- Division of Gastroenterology and Hepatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, 83 Kasuga-Cho, Matsuyama, Ehime, 790-0024, Japan
| | - Hidekatsu Kuroda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, 466-8550, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Tadashi Ikegami
- Division of Gastroenterology and Hepatology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami-Machi, Inashiki-Gun, Ibaraki, 300-3095, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Hasse J, Garibotto G, Moore LW. The Complex Nutrition Needs of Patients With Chronic Kidney Disease and Chronic Liver Disease. J Ren Nutr 2025; 35:245-247. [PMID: 40057007 DOI: 10.1053/j.jrn.2025.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Accepted: 02/28/2025] [Indexed: 03/19/2025] Open
Affiliation(s)
- Jeanette Hasse
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | | | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, Texas.
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Chen Y, Zhang Q, Hu Y, Liu E, Tan X, Yuan H, Jiang L. Semiquantitative muscle parameters derived from FAPI and FDG PET/CT in evaluating sarcopenia among patients with malignant tumors. Nucl Med Commun 2025; 46:260-267. [PMID: 39659222 DOI: 10.1097/mnm.0000000000001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2024]
Abstract
BACKGROUND The objective of this study is to explore and compare the potential utility of fibroblast activation protein inhibitor (FAPI) and fluorodeoxyglucose PET/computed tomography (CT) in assessing sarcopenia among patients with malignant tumors. METHODS A retrospective analysis was conducted on 127 patients with histologically confirmed malignant tumors who underwent both 18 F/ 68 Ga-FAPI and fluorine-18-fluorodeoxyglucose ( 18 F-FDG) PET/CT scans. Clinical characteristics and PET/CT parameters of maximum and mean standard uptake value (SUV max and SUV mean ) of muscle at the 3 rd lumbar (L3) level were reviewed. Skeletal muscle area at the L3 level was measured, and skeletal muscle index was calculated to determine sarcopenia. The association between sarcopenia and PET/CT parameters was analyzed. RESULTS The incidence of sarcopenia was 41.7% among these 127 patients. Higher age, male, lower BMI, lower SUV max and SUV mean of muscle from 18 F/ 68 Ga-FAPI PET/CT, and lower SUV max of muscle from 18 F-FDG PET/CT were correlated with a higher prevalence of sarcopenia ( P < 0.05). Besides, no significant differences in SUV max and SUV mean of muscle were noted between 18 F-FAPI and 68 Ga-FAPI groups. The best cutoff value of SUV max of muscle from 18 F/ 68 Ga-FAPI PET/CT was 1.17, yielding the area under the curve (AUC) of 0.764 and sensitivity and specificity of 74.3% and 71.7%, while the optimal cutoff value of SUV max of muscle from 18 F-FDG PET/CT was 0.76, with an AUC of 0.642 and sensitivity and specificity of 36.5% and 86.8%, respectively. CONCLUSION Patients with sarcopenia exhibit decreased muscle uptake of FAPI and fluorodeoxyglucose. FAPI PET/CT emerges as a more valuable tool for sarcopenia assessment in patients with malignant tumors compared to fluorodeoxyglucose PET/CT.
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Affiliation(s)
- Yang Chen
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Qing Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Yinting Hu
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Entao Liu
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Xiaoyue Tan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Hui Yuan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Lei Jiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangzhou, China
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Ma Y, Yuan Y, Lu Y, Li S. A pilot clinical trial of exercise program for elderly patients with cirrhosis and frailty: comprehensive exercise rehabilitation intervention. Eur J Gastroenterol Hepatol 2025; 37:313-319. [PMID: 39621864 DOI: 10.1097/meg.0000000000002864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2025]
Abstract
BACKGROUND AND AIM Comprehensive exercise rehabilitation has the potential to increase muscle mass and performance by stimulating protein synthesis and accelerating muscle catabolism. We developed the comprehensive exercise rehabilitation intervention (CERI) for elderly patients with cirrhosis, and we aimed to evaluate the safety and efficacy of CERI. METHODS Eligible were elderly patients with cirrhosis and frailty. Patients were randomized 1 : 1 to 12 weeks of CERI. Physical function were assessed using the gait speed, grip strength, 5 Sit-down Tests, and Balance Test, respectively. RESULTS Finally, 58 and 58 completed the study in CERI and SOC arms, respectively. The age range is 60-73. After 12 weeks, gait speed improved from 0.89 to 1.06 in CERI participants (Δgait speed 0.17) and 0.87-0.91 (Δgait speed 0.04) in SOC arm ( P = 0.001 for Δgait speed difference). Grip strength improved from 15.44 to 15.94 in CERI participants (Δgrip strength 0.50) and 15.52-15.16 (Δgrip strength -0.36) in SOC arm ( P = 0.044 for Δgrip strength difference). 5 Sit-down Tests Score improved from 16.17 to 15.46 in CERI participants (Δ5 Sit-down Tests 0.71) and 16.78-16.61 (Δ5 Sit-down Tests 0.17) in SOC arm ( P = 0.037 for Δ5 Sit-down Tests difference). Median Balance Test score improved from 26.11 to 28.82 in CERI participants (ΔBalance Test 2.71) and 25.94-26.13 (ΔBalance Test 0.19) in SOC arm ( P < 0.001 for ΔBalance Test difference); 92% of CERI participants adhered to the study for 12 weeks. No adverse events were reported by CERI participants. CONCLUSION CERI was safely administered at pilot randomized clinical trial, while all participants showed minimal improvement in gait speed, grip strength, 5 Sit-down Tests, and Balance Test. But multicenter, larger sample clinical trials are needed to track the effects of CERI.
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Affiliation(s)
- Yanmei Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Tapper EB, Nikirk S, Evon DM, Asrani S, Bloom P, Hynes JW, Alber JM, Gill A, Mehta S, Weinberg E, Alexander NB, Althuis K, Hoelscher A, Zhao L, Chen X, Burdzy A, Serper M. LIVE-SMART: A sequential, multiple assignment randomized trial to reduce falls in cirrhosis. Hepatol Commun 2025; 9:e0626. [PMID: 39969429 PMCID: PMC11841856 DOI: 10.1097/hc9.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 11/04/2024] [Indexed: 02/20/2025] Open
Abstract
INTRODUCTION Falls are a major threat to the well-being of patients with cirrhosis. We are performing a clinical trial to determine whether lactulose, TeleTai-Chi, or their combination will reduce falls in HE and improve health-related quality of life (HRQOL) among patients with cirrhosis. METHODS AND ANALYSIS Patients with cirrhosis and portal hypertension without HE will be enrolled in 3 US states and followed participants for 24 weeks. In stage 1 (12 wk), participants will be randomized to receive either lactulose therapy or enhanced usual care. In stage 2 (12 wk), participants will be randomized to either TeleTai-Chi or usual care. The primary outcome is a hierarchical composite: Injurious falls, noninjurious falls, incident HE, and death/transplantation. Secondary outcomes include cognitive function, days-alive and out-of-hospital, and HRQOL. After completion of the interventions, participants will be followed for 48 weeks for health and financial outcomes. ETHICS AND DISSEMINATION Our study has a central institutional review board with individual site IRB review. Dissemination includes the publication of study findings and patient-focused educational webinars.
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Affiliation(s)
- Elliot B. Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA
| | - Samantha Nikirk
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, USA
| | - Sumeet Asrani
- Baylor University Medical Center, Dallas, Texas, USA
| | - Patricia Bloom
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA
| | | | - J. Mark Alber
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA
| | - Anna Gill
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Neil B. Alexander
- Department of Veterans Affairs, Geriatric Research Education Clinical Center, Ann Arbor, USA
| | - Katie Althuis
- Department of Veterans Affairs, Geriatric Research Education Clinical Center, Ann Arbor, USA
| | - Alise Hoelscher
- Department of Veterans Affairs, Geriatric Research Education Clinical Center, Ann Arbor, USA
| | - Lili Zhao
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA
| | - Xi Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA
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Fan X, Peng Y, Li B, Wang X, Liu Y, Shen Y, Liu G, Zheng Y, Deng Q, Liu J, Yang L. Liver-Secreted Extracellular Vesicles Promote Cirrhosis-Associated Skeletal Muscle Injury Through mtDNA-cGAS/STING Axis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2025; 12:e2410439. [PMID: 39804962 PMCID: PMC11884600 DOI: 10.1002/advs.202410439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 12/15/2024] [Indexed: 01/16/2025]
Abstract
Skeletal muscle atrophy (sarcopenia) is a serious complication of liver cirrhosis, and chronic muscle inflammation plays a pivotal role in its pathologenesis. However, the detailed mechanism through which injured liver tissues mediate skeletal muscle inflammatory injury remains elusive. Here, it is reported that injured hepatocytes might secrete mtDNA-enriched extracellular vesicles (EVs) to trigger skeletal muscle inflammation by activating the cGAS-STING pathway. Briefly, injured liver secreted increased amounts of EVs into circulation, which are then engulfed primarily by macrophages in skeletal muscle and subsequently induce cGAS-STING signaling and its-mediated inflammatory response in muscles. In contrast, suppression of hepatic EV secretion or STING signaling significantly alleviated cirrhosis-induced skeletal muscle inflammation and muscle atrophy in vivo. Circulating EVs from cirrhotic patients showed higher levels of mtDNA, and the levels of EV-mtDNA positively correlated with the severity of liver injury. In injured hepatocytes, mitochondrial damage promoted the release of cytosolic mtDNA and the subsequent secretion of mtDNA-enriched EVs. This study reveals that injured hepatocyte-derived EVs induce skeletal muscle inflammation via the mtDNA‒STING axis, while targeted blockade of liver EV secretion or STING signaling represents a potential therapeutic approach for preventing cirrhosis-associated skeletal muscle atrophy.
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Affiliation(s)
- Xiaoli Fan
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
| | - Yunke Peng
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
| | - Bo Li
- Department of RadiologyWest China HospitalSichuan UniversityChengdu610041China
| | - Xiaoze Wang
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
| | - Yifeng Liu
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
| | - Yi Shen
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
| | - Guofeng Liu
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
| | - Yanyi Zheng
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
| | - Qiaoyu Deng
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
| | - Jingping Liu
- NHC Key Laboratory of Transplant Engineering and ImmunologyCenter for Disease‐related Molecular NetworkWest China Hospital of Sichuan UniversityChengdu610041China
| | - Li Yang
- Department of Gastroenterology and Hepatology and Laboratory of Gastrointestinal Cancer and Liver DiseaseWest China HospitalSichuan UniversityChengdu610041China
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Geng N, Kong M, Zhang J, Xu M, Chen H, Song W, Chen Y, Duan Z. Dynamic skeletal muscle loss and its predictive role on 90-day mortality in patients with acute-on-chronic liver failure. Front Nutr 2025; 12:1446265. [PMID: 40083884 PMCID: PMC11903284 DOI: 10.3389/fnut.2025.1446265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 02/06/2025] [Indexed: 03/16/2025] Open
Abstract
Background Low skeletal muscle mass is an independent risk factor for increased mortality in patients with acute-on-chronic liver failure (ACLF). However, no study has evaluated the temporal changes in muscle mass during the course of ACLF. Therefore, this study aimed to investigate the dynamic changes in muscle mass and their prognostic role in patients with ACLF. Methods A retrospective analysis was conducted on consecutive patients with ACLF who underwent two or more abdominal computed tomography examinations within 90 days of admission. The percentage change rates of the skeletal muscle index at the third lumbar vertebra (L3-SMI) were calculated as (L3-SMIfinal - L3-SMIinitial)/(L3-SMIinitial) × 100%. Results A total of 154 patients with ACLF were included. During the course of ACLF, the percentage change rates of L3-SMI at 2-7, 8-14, 15-30, 31-60, and 61-90 days were - 0.83 ± 4.43, -3.76 ± 4.40, -7.30 ± 5.89, -10.10 ± 7.45, and - 5.53 ± 9.26, respectively. Significant reductions in L3-SMI were noted in patients with severe conditions compared to other patients at 2-7 days and 15-30 days. Moreover, the rate of decrease in L3-SMI in patients with a lower respiratory quotient (RQ) was significantly greater than that in patients with a normal RQ at 2-7 days and 15-30 days. Additionally, high muscle loss (HR 2.059; 95% CI 1.122-3.780, p = 0.020), rather than pre-existing sarcopenia (HR 1.430; 95% CI 0.724-2.826, p = 0.303) at baseline, was independently associated with 90-day mortality. Conclusion Deterioration in muscle mass is associated with disease severity and poor nutritional status and serves as a more effective predictor of adverse short-term outcomes in patients with ACLF. These findings underscore the importance of dynamic evaluation of muscle loss and emphasize the necessity of reversing muscle loss in patients with ACLF.
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Affiliation(s)
- Nan Geng
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ming Kong
- Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Jiateng Zhang
- Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Manman Xu
- Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Huina Chen
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China
| | - Wenyan Song
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Zhongping Duan
- Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
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Miwa T, Hanai T, Nishimura K, Hirata S, Unome S, Nakahata Y, Imai K, Suetsugu A, Takai K, Shimizu M. Nutritional assessment using subjective global assessment identifies energy malnutrition and predicts mortality in patients with liver cirrhosis. Sci Rep 2025; 15:4831. [PMID: 39924549 PMCID: PMC11808070 DOI: 10.1038/s41598-025-89803-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 02/07/2025] [Indexed: 02/11/2025] Open
Abstract
This study aimed to evaluate whether the subjective global assessment (SGA) could effectively predict energy malnutrition, as assessed by indirect calorimetry, and mortality in hospitalized patients with cirrhosis. Energy malnutrition was defined by a nonprotein respiratory quotient (npRQ) < 0.85 using an indirect calorimetry. The usefulness of the SGA in identifying energy malnutrition and predicting mortality was assessed by the logistic regression and Cox proportional hazards models, respectively. Out of the 230 patients analyzed, 43% were found to have energy malnutrition. The distribution of SGA classifications was 54% for SGA-A, 32% for SGA-B, and 14% for SGA-C. Multivariable analysis indicated that both SGA-B (odds ratio, 3.59; 95% confidence interval [CI], 1.59-8.10) and SGA-C (odds ratio, 19.70; 95% CI, 3.46-112.00), along with free fatty acids (FFA), were independently linked to energy malnutrition. Regarding mortality, 125 patients (54%) died over a median follow-up period of 2.8 years. After adjustment, SGA-B (hazard ratio, 1.81; 95% CI, 1.08-3.03) and SGA-C (hazard ratio, 3.35; 95% CI, 1.28-8.76) were predictors of mortality in cirrhosis patients, while energy malnutrition and FFA were not. The SGA is a valuable tool for identifying energy malnutrition and predicting mortality in patients with cirrhosis.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Kayoko Nishimura
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Sachiyo Hirata
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Shinji Unome
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yuki Nakahata
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Atsushi Suetsugu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
- Division for Regional Cancer Control, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Fadlallah H, El Masri D, Bahmad HF, Abou-Kheir W, El Masri J. Update on the Complications and Management of Liver Cirrhosis. Med Sci (Basel) 2025; 13:13. [PMID: 39982238 PMCID: PMC11843904 DOI: 10.3390/medsci13010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2025] [Revised: 02/01/2025] [Accepted: 02/02/2025] [Indexed: 02/22/2025] Open
Abstract
Liver cirrhosis represents the advanced pathological stage of chronic liver disease, characterized by the progressive destruction and regeneration of the hepatic parenchyma over years, culminating in fibrosis and disruption of the vascular architecture. As a leading global cause of morbidity and mortality, it continues to affect millions worldwide, imposing a substantial burden on healthcare systems. Alcoholic/nonalcoholic fatty liver disease and chronic viral hepatitis infection, hepatitis C (HCV) in particular, remain leading causes of cirrhosis. Despite significant advances in understanding the pathogenesis of cirrhosis, its management is still complex due to the multifaceted complications, including ascites, hepatic encephalopathy, variceal bleeding, and hepatocellular carcinoma, all of which severely compromise the patient outcomes and quality of life. This review aims at filling a critical gap by providing a comprehensive summary of the latest evidence on the complications and management of liver cirrhosis. Evidence-based therapies targeting both the etiologies and complications of cirrhosis are essential for improving outcomes. While liver transplantation is considered a definitive cure, advancements in pharmacological therapies offer promising avenues for halting and potentially reversing disease progression. This review summarizes the latest management strategies for cirrhosis and its associated complications, emphasizing the importance of early intervention and novel therapeutic options for improving outcomes and quality of life in affected individuals.
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Affiliation(s)
- Hiba Fadlallah
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon; (H.F.); (J.E.M.)
| | - Diala El Masri
- Faculty of Medicine, University of Balamand, Al-Kurah, Tripoli P.O. Box 100, Lebanon;
| | - Hisham F. Bahmad
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon; (H.F.); (J.E.M.)
| | - Jad El Masri
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut 1107-2020, Lebanon; (H.F.); (J.E.M.)
- Faculty of Medical Sciences, Lebanese University, Beirut 1107-2020, Lebanon
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Gan C, Yuan Y, Shen H, Gao J, Kong X, Che Z, Guo Y, Wang H, Dong E, Xiao J. Liver diseases: epidemiology, causes, trends and predictions. Signal Transduct Target Ther 2025; 10:33. [PMID: 39904973 PMCID: PMC11794951 DOI: 10.1038/s41392-024-02072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 10/06/2024] [Accepted: 11/12/2024] [Indexed: 02/06/2025] Open
Abstract
As a highly complex organ with digestive, endocrine, and immune-regulatory functions, the liver is pivotal in maintaining physiological homeostasis through its roles in metabolism, detoxification, and immune response. Various factors including viruses, alcohol, metabolites, toxins, and other pathogenic agents can compromise liver function, leading to acute or chronic injury that may progress to end-stage liver diseases. While sharing common features, liver diseases exhibit distinct pathophysiological, clinical, and therapeutic profiles. Currently, liver diseases contribute to approximately 2 million deaths globally each year, imposing significant economic and social burdens worldwide. However, there is no cure for many kinds of liver diseases, partly due to a lack of thorough understanding of the development of these liver diseases. Therefore, this review provides a comprehensive examination of the epidemiology and characteristics of liver diseases, covering a spectrum from acute and chronic conditions to end-stage manifestations. We also highlight the multifaceted mechanisms underlying the initiation and progression of liver diseases, spanning molecular and cellular levels to organ networks. Additionally, this review offers updates on innovative diagnostic techniques, current treatments, and potential therapeutic targets presently under clinical evaluation. Recent advances in understanding the pathogenesis of liver diseases hold critical implications and translational value for the development of novel therapeutic strategies.
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Affiliation(s)
- Can Gan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Yuan
- Aier Institute of Ophthalmology, Central South University, Changsha, China
| | - Haiyuan Shen
- Department of Oncology, the First Affiliated Hospital; The Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Anhui Medical University, Hefei, China
| | - Jinhang Gao
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangxin Kong
- Engineering and Translational Medicine, Medical College, Tianjin University, Tianjin, China
| | - Zhaodi Che
- Clinical Medicine Research Institute and Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yangkun Guo
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Hua Wang
- Department of Oncology, the First Affiliated Hospital; The Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Anhui Medical University, Hefei, China.
| | - Erdan Dong
- Research Center for Cardiopulmonary Rehabilitation, University of Health and Rehabilitation Sciences Qingdao Hospital, School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, China.
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China.
| | - Jia Xiao
- Clinical Medicine Research Institute and Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
- Department of Gastroenterology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao, China.
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Khan S, Sansoni S, Di Cola S, Lapenna L, Merli M. A Comparative Study of Dietary Intake, Nutritional Status, and Frailty in Outpatients and Inpatients with Liver Cirrhosis. Nutrients 2025; 17:580. [PMID: 39940438 PMCID: PMC11820514 DOI: 10.3390/nu17030580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 01/28/2025] [Accepted: 01/31/2025] [Indexed: 02/16/2025] Open
Abstract
Background: Liver cirrhosis is associated with significant nutritional challenges, including malnutrition, sarcopenia, and frailty, which impact clinical outcomes. The severity of these issues may vary between inpatient and outpatient settings, but there is a limited understanding of how these conditions manifest in these populations. This study aims to compare the nutritional status, dietary intake, and frailty in outpatients and inpatients with liver cirrhosis and to explore potential sex-specific differences. Methods: This prospective observational study enrolled 195 patients with liver cirrhosis from the Gastroenterology ward and Outpatient Clinic of Policlinico Umberto I, Sapienza University of Rome, between May 2023 and July 2024. Nutritional status was assessed using anthropometric measurements, dietary recall, and food frequency questionnaires. Sarcopenia was evaluated using the SARC-F questionnaire and handgrip strength. Frailty was assessed using the Liver Frailty Index (LFI). Data on clinical characteristics, comorbidities, and disease severity were also recorded. Results: The inpatient group (n = 69) had significantly lower BMI, mid-upper arm circumference, and triceps skinfold compared to outpatients (n = 126). Inpatients exhibited higher frailty, with 73.9% classified as frail according to the LFI, compared to 39.6% in outpatients (p < 0.001). Dietary intake revealed that 91% of inpatients had an energy intake deficit compared to 76% of outpatients (p = 0.009). Protein intake was inadequate in 84% of inpatients versus 61% of outpatients (p < 0.001). Sex-specific analysis showed that females had a higher prevalence of sarcopenia than males (64.4% vs. 38.2%, p < 0.001) and experienced more significant protein deficits (74.3% vs. 57.6%, p = 0.021). Females also had higher LFI score (4.77 ± 0.88 vs. 4.45 ± 0.91, p = 0.034). Multivariate analysis showed that CTP, LFI, and protein deficit are independently associated with hospitalization. Conclusions: Inpatients with liver cirrhosis are at higher risk for malnutrition, frailty, and inadequate nutrient intake compared to outpatients, emphasizing the need for targeted nutritional interventions in hospital settings. Additionally, females with cirrhosis are more prone to sarcopenia and frailty, requiring gender-specific approaches to nutrition.
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Affiliation(s)
| | | | | | | | - Manuela Merli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.K.); (S.S.); (S.D.C.); (L.L.)
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Vanderschueren E, Meersseman P, Wilmer A, Vandecaveye V, Dubois E, Van Eldere A, Clerick J, Peluso JP, Claus E, Bonne L, Verslype C, Maleux G, Laleman W. Sarcopenia in patients receiving TIPS is independently associated with increased risk of complications and mortality. Dig Liver Dis 2025; 57:549-557. [PMID: 39472174 DOI: 10.1016/j.dld.2024.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/16/2024] [Accepted: 10/11/2024] [Indexed: 01/28/2025]
Abstract
BACKGROUND Sarcopenia is an acknowledged risk factor for individuals with chronic liver disease, however, the influence on outcomes in patients receiving transjugular intrahepatic portosystemic shunt (TIPS) remains underexplored. AIMS This study aimed to investigate the association between sarcopenia and incidence of complications and mortality post-TIPS. METHODS A retrospective analysis was performed on 175 patients who underwent TIPS between 2011-2021 at a Belgian tertiary care center. Transverse psoas muscle thickness (TPMT) was measured at baseline, with a subset of 85 patients having a second TPMT after 1-2 years for assessment of evolution. RESULTS Over a median follow-up of 453 days (IQR 76-1179), sarcopenic patients exhibited a higher prevalence of complications (74.1% vs. 57.9%, p = 0.04) and one-year mortality (53.4% vs. 22.3%, p < 0.001) post-TIPS. Notably, 58.8% of patients showed an increase >10% from baseline TPMT/length post-TIPS, with the greatest improvement observed in severely sarcopenic patients (4.00 ± 4.55 mm/m vs. -0.82 ± 2.68 mm/m, p < 0.001) and in those patients free from TIPS-related complications (3.18 ± 4.09 mm/m vs. 1.31 ± 3.21 mm/m, p = 0.022). CONCLUSION Sarcopenia increases the risk of complications and mortality post-TIPS. Importantly, sarcopenia improves in patients receiving TIPS, particularly in those with severe sarcopenia at baseline and free of TIPS-related complications.
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Affiliation(s)
- Emma Vanderschueren
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Herestraat 49, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Aging (CHROMETA), Catholic University of Leuven, Herestraat 49, Leuven, Belgium.
| | - Philippe Meersseman
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Alexander Wilmer
- Department of General Internal Medicine, Medical Intensive Care Unit, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Vincent Vandecaveye
- Department of Radiology, Abdominal Radiology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Evelyne Dubois
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Anne Van Eldere
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Jan Clerick
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Jo P Peluso
- Department of Radiology, Interventional Radiology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Eveline Claus
- Department of Radiology, Interventional Radiology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, Interventional Radiology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Chris Verslype
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, Interventional Radiology, University Hospital Leuven, Herestraat 49, Leuven, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Herestraat 49, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Aging (CHROMETA), Catholic University of Leuven, Herestraat 49, Leuven, Belgium
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Utakata Y, Miwa T, Hanai T, Aiba M, Unome S, Imai K, Shirakami Y, Takai K, Shimizu M. Usefulness of Retinol-Binding Protein in Predicting Mortality in Patients With Chronic Liver Disease. JGH Open 2025; 9:e70087. [PMID: 39927287 PMCID: PMC11806657 DOI: 10.1002/jgh3.70087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 12/11/2024] [Accepted: 12/16/2024] [Indexed: 02/11/2025]
Abstract
Background and Aim Rapid turnover proteins (RTPs), including retinol-binding protein (RBP), prealbumin, and transferrin, are useful in evaluating dynamic nutritional status. This study aimed to investigate the relationship between serum RTP levels and mortality in patients with chronic liver disease (CLD). Methods We evaluated 341 patients with CLD admitted between October 2011 and December 2021. Those with RBP levels below 2.7 mg/dL for males and 1.9 mg/dL for females were included in the low RBP group. Factors associated with mortality and low RBP were evaluated using the Cox proportional hazard regression and logistic regression models. Results The median age of the included patients was 67 years, and 48% were male. The median model for end-stage liver disease (MELD) score was 8 points, and the median RBP, prealbumin, and transferrin levels were 1.5 mg/dL, 11 mg/dL, and 227 mg/dL, respectively. During a median observational period, 23% of the patients died. Multivariate analysis showed that the RBP level (hazard ratio, 0.62; 95% confidence interval [CI], 0.46-0.81) was independently associated with mortality, while prealbumin and transferrin were not. Additional analysis revealed that male sex (odds ratio, 8.62; 95% CI, 2.56-29.00) and albumin level (odds ratio, 0.10; 95% CI, 0.04-0.26) were significantly associated with the low RBP levels in patients with CLD. Conclusions The serum RBP level is a dynamic biomarker associated with mortality in patients with CLD, independent of liver functional reserve, and it may be a useful indicator for nutritional intervention in these patients.
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Affiliation(s)
- Yuki Utakata
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
- Department of GastroenterologyChuno Kosei HospitalSekiJapan
| | - Takao Miwa
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
- Center for Nutrition Support and Infection ControlGifu University HospitalGifuJapan
| | - Masashi Aiba
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
| | - Shinji Unome
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
| | - Kenji Imai
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
| | - Yohei Shirakami
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
| | - Koji Takai
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
- Division for Regional Cancer ControlGraduate School of Medicine, Gifu UniversityGifuJapan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal MedicineGifu University HospitalGifuJapan
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Santos KMS, Boulhosa RSDSB, Garcêz LS, Lyra AC, Bueno AA, de Jesus RP, Oliveira LPM. Nutritional risk assessment using the Nutritional Prognostic Index predicts mortality in Advanced Chronic Liver Disease patients. Nutrition 2025; 130:112612. [PMID: 39550839 DOI: 10.1016/j.nut.2024.112612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 09/08/2024] [Accepted: 10/18/2024] [Indexed: 11/19/2024]
Abstract
OBJECTIVES Early clinical prognosis and mortality reduction remains a challenge in chronic liver disease (CLD). The full potential of the Nutritional Prognostic Index (NPI) for nutritional assessment and management in CLD patients remains unexplored. The aim of this study was to establish an NPI cutoff point for the identification of nutritional risk in advanced CLD (ACLD) patients, as well as to assess the NPI's ability to predict ACLD-associated mortality. METHODS This ethically approved prospective cohort study investigated malnutrition risk using both the NPI and the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) in patients hospitalized for ACLD. NPI reference values were determined using a receiver operating characteristic curve. Associations between nutritional risk identified by the RFH-NPT and the NPI were assessed using Fisher's exact test, and agreement between tools was assessed using the Kappa index. The association between NPI-defined nutritional risk and 12-mo mortality was examined using Pearson Chi-square test. RESULTS The sample population consisted of 120 adults, comprising 84 (70%) male and 57 (50.9%) of alcoholic etiology and presenting as Child-Pugh A, B, or C at admission. The identified cutoff point for NPI was <41, identifying nutritional risk in 82.5% of patients. The NPI presented a statistically significant association with the RFH-NPT, with a substantial agreement coefficient of 0.34. An association between NPI <41 cutoff and mortality were observed, with 82.1% of the sample below cutoff experiencing mortality within 12 mo. CONCLUSIONS The NPI is a valuable nutritional marker for the identification of nutritional risk in ACLD and is a simple and effective assessment tool that can aid in early CLD prognosis assessment. Validation, however, remains necessary in other CLD populations of different etiologies.
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Affiliation(s)
| | | | | | - André Castro Lyra
- Division of Gastroenterology & Hepatology, Department of Medicine, School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Allain Amador Bueno
- College of Health, Life and Environmental Science, University of Worcester, Henwick Grove, Worcester, UK.
| | - Rosangela Passos de Jesus
- Department of Nutrition Sciences, School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
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Markakis GE, Lai JC, Karakousis ND, Papatheodoridis GV, Psaltopoulou T, Merli M, Sergentanis TN, Cholongitas E. Sarcopenia As a Predictor of Survival and Complications of Patients With Cirrhosis After Liver Transplantation: A Systematic Review and Meta-Analysis. Clin Transplant 2025; 39:e70088. [PMID: 39876624 PMCID: PMC11775496 DOI: 10.1111/ctr.70088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 12/23/2024] [Accepted: 01/12/2025] [Indexed: 01/30/2025]
Abstract
INTRODUCTION This systematic review/meta-analysis evaluated the impact of sarcopenia in patients with cirrhosis before liver transplantation (LT) on outcomes after LT. METHODS A systematic search was conducted in six medical databases until February 2022. The primary outcome was overall mortality after LT, while several secondary outcomes including liver graft survival and rejection, the need for transfusions, the length of the intensive care unit (ICU) and hospital stay, and surgical complications were evaluated. Sub-group analyses and meta-regression analyses were also performed. RESULTS Fifty-three studies were evaluated in the systematic review, of which 30, including 5875 patients, were included in the meta-analysis. All studies included were cohort studies of good/high quality on the Newcastle-Ottawa scale (NOS), while in our analysis no publication bias was found, although there was substantial heterogeneity between the studies. Muscle mass was assessed using skeletal muscle index (SMI) in 14 studies, psoas muscle area (PMA) in seven studies, and psoas muscle index (PMI) in four studies. The prevalence of pre-LT sarcopenia ranged from 14.7% to 88.3%. Pre-LT sarcopenia was significantly associated with post-LT mortality (Relative Risk [RR] = 1.84, 95% CI:1.41,2.39), as well as with a high risk of infections post-LT, surgical complications, fresh frozen plasma (FFP) transfusions, and ICU length of stay (LOS). CONCLUSIONS Pre-LT sarcopenia in patients with cirrhosis is a strong risk factor for clinically meaningful adverse outcomes after LT. Assessment may help identify patients at the highest risk for poor outcomes who may benefit from targeted interventions.
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Affiliation(s)
- George E. Markakis
- Department of GastroenterologyMedical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - Jennifer C. Lai
- Department of MedicineDivision of Gastroenterology and HepatologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Nikolaos D. Karakousis
- Department of GastroenterologyMedical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - George V. Papatheodoridis
- Department of GastroenterologyMedical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - Theodora Psaltopoulou
- Department of HygieneEpidemiology and Medical StatisticsMedical SchoolNational University of AthensAthensGreece
| | - Manuela Merli
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | | | - Evangelos Cholongitas
- Department of GastroenterologyMedical SchoolNational and Kapodistrian University of AthensAthensGreece
- First Department of Internal MedicineNational and Kapodistrian University of AthensAthensGreece
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50
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Li L, Wu S, Cao Y, He Y, Wu X, Xi H, Wu L. Visual Analysis of Hot Topics and Trends in Nutrition for Decompensated Cirrhosis Between 1994 and 2024. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2025; 44:115-127. [PMID: 39254761 DOI: 10.1080/27697061.2024.2401608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 09/03/2024] [Accepted: 09/03/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVE An updated summary of the research profile of nutrition for the last 30 years for decompensated cirrhosis is lacking. This study aimed to explore the literature on nutrition for decompensated cirrhosis, draw a visual network map to investigate the research trends, and provide suggestions for future research. The Web of Science database retrieves the literature on nutrition for decompensated cirrhosis between 1994 and 2024. METHODS We used the cooperative, co-occurrence, and co-citation networks in the CiteSpace knowledge graph analysis tool to explore and visualize the relevant countries, institutions, authors, co-cited journals, keywords, and co-cited references. RESULTS We identified 741 articles on nutrition for decompensated cirrhosis. The number of publications and research interests has generally increased. The USA contributed the largest number of publications and had the highest centrality. The University of London ranked first in the number of articles issued, followed by the University of Alberta and Mayo Clinic. TANDON P, a "core strength" researcher, is a central hub in the collaborative network. Of the cited journals, HEPATOLOGY had the highest output (540, 15.3%). CONCLUSIONS Over the past three decades, the focus of research on nutrition in decompensated cirrhosis has shifted from "hepatic encephalopathy, intestinal failure, metabolic syndrome, and alcoholic hepatitis" to "sarcopenia and nutritional assessment." In the future, nutritional interventions for sarcopenia should be based on a multimodal approach to address various causative factors. Its targeted treatment is an emerging area that warrants further in-depth research.
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Affiliation(s)
- Lu Li
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Gastroenterology, the Third People's Hospital of Chengdu, the Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Shiyan Wu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Gastroenterology, the Third People's Hospital of Chengdu, the Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yuping Cao
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Gastroenterology, the Third People's Hospital of Chengdu, the Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yumei He
- North Sichuan Medical College, Nanchong, China
| | - Xiaoping Wu
- Department of Gastroenterology, the Third People's Hospital of Chengdu, the Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Heng Xi
- Department of Pharmacy, the Third People's Hospital of Chengdu, the Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Liping Wu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Gastroenterology, the Third People's Hospital of Chengdu, the Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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