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Application of Global Leadership Initiative on Malnutrition criteria in patients with liver cirrhosis

Chinese Medical Journal 2024年第1期137卷 97-104页

作者： Minjie Jiang Juan Chen Muchen Wu Jing Wu Xiaotong Xu Juan Li Can Liu Yaping Zhao Xin Hua Qinghua Meng Department of Hepatology Beijing You-An HospitalCapital Medical UniversityBeijing 100069China Beijing Institute of Hepatology Beijing 100069China Department of Medical Oncology Beijing You-An HospitalCapital Medical UniversityBeijing 100069China Department of Nutrition Beijing You-An HospitalCapital Medical UniversityBeijing 100069China

Background:The Global Leadership Initiative on Malnutrition(GLIM)criteria were published to build a global consensus on nutritional diagnosis.Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria.However,there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings.This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition,as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients.Methods:This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1,2018,and February 28,2022,at Beijing You-An Hospital,Capital Medical University.Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography(CT)examination during hospitalization were included in the study.These patients were randomly divided into a modeling group(cohort 1,667 patients)and a validation group(cohort 2,335 patients).In cohort 1,optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index(L3-SMI)were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups.Next,patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002(NRS-2002),and malnutrition was diagnosed by GLIM criteria.Additionally,the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1.Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes.Results:The optimal cut-off values of L3-SMI were 39.50 cm 2/m 2 for male patients and 33.06 cm 2/m 2 for female patients.Based on the cut-off values,31.63%(68/215)of the male patients and 23.3%(28/120)of the female patients had CT-determined sarcopenia in cohort 2.The prevalence of GL

关键词： Malnutrition liver cirrhosis Sarcopenia Clinical outcomes GLIM criteria

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Red cell distribution width/platelet ratio estimates the 3-year risk of decompensation in Metabolic Dysfunction-Associated Steatotic liver Disease-induced cirrhosis

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World Journal of Gastroenterology 2024年第7期30卷 685-704页

作者： Marcello Dallio Mario Romeo Paolo Vaia Salvatore Auletta Simone Mammone Marina Cipullo Luigi Sapio Angela Ragone Marco Niosi Silvio Naviglio Alessandro Federico Department of Precision Medicine Hepatogastroenterology DivisionUniversity of Campania Luigi VanvitelliNaples 80138Italy Department of Precision Medicine Clinical Biochemistry DivisionUniversity of Campania Luigi VanvitelliNaples 80138Italy

BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to decompensated advanced chronic liver disease(dACLD)can occur through two modalities referred to as acute decompensation(AD)and non-AD(NAD),respectively.Clinically Significant Portal Hypertension(CSPH)is considered the strongest predictor of decompensation in these patients.However,due to its invasiveness and costs,CSPH is almost never evaluated in clinical practice.Therefore,recognizing noninvasively predicting tools still have more appeal across healthcare systems.The red cell distribution width to platelet ratio(RPR)has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic liver Disease(MASLD).However,its predictive role for the decompensation has never been explored.AIM In this observational study,we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients.METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up(FUP)semiannually for 3 years.At baseline,biochemical,clinical,and liver Stiffness Measurement(LSM),Child-Pugh(CP),Model for End-Stage liver Disease(MELD),aspartate aminotransferase/platelet count ratio index(APRI),Fibrosis-4(FIB-4),Albumin-Bilirubin(ALBI),ALBI-FIB-4,and RPR were collected.During FUP,DEs(timing and modaities)were recorded.CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines.RESULTS Of 150 MASLD-related cACLD patients,43(28.6%)progressed to dACLD at a median time of 28.9 months(29 NAD and 14 AD).Baseline RPR values were significantly higher in cACLD in comparison to controls,as well as MELD,CP,APRI,FIB-4,ALBI,ALBI-FIB-4,and LSM in dACLD-progressing compared to cACLD individuals[all P0.472 and>0.894 as the best

关键词： liver cirrhosis Red blood cell distribution width Red blood cell distribution width to platelet ratio Translational Medicine Prognostic biomarker

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Development and validation of a nomogram for predicting in-hospital mortality of intensive care unit patients with liver cirrhosis

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World Journal of Hepatology 2024年第4期16卷 625-639页

作者： Xiao-Wei Tang Wen-Sen Ren Shu Huang Kang Zou Huan Xu Xiao-Min Shi Wei Zhang Lei Shi Mu-Han Lü Department of Gastroenterology The Affiliated Hospital of Southwest Medical UniversityLuzhou 646099Sichuan ProvinceChina Nuclear Medicine and Molecular Imaging Key Laboratory The Affiliated Hospital of Southwest Medical UniversityLuzhou 646099Sichuan ProvinceChina Department of Gastroenterology Lianshui People’Hospital of Kangda College Affiliated to Nanjing Medical UniversityHuaian 223499Jiangsu ProvinceChina

BACKGROUND liver cirrhosis patients admitted to intensive care unit(ICU)have a high mortality rate.AIM To establish and validate a nomogram for predicting in-hospital mortality of ICU patients with liver cirrhosis.METHODS We extracted demographic,etiological,vital sign,laboratory test,comorbidity,complication,treatment,and severity score data of liver cirrhosis patients from the Medical Information Mart for Intensive Care IV(MIMIC-IV)and electronic ICU(eICU)collaborative research database(eICU-CRD).Predictor selection and model building were based on the MIMIC-IV dataset.The variables selected through least absolute shrinkage and selection operator analysis were further screened through multivariate regression analysis to obtain final predictors.The final predictors were included in the multivariate logistic regression model,which was used to construct a nomogram.Finally,we conducted external validation using the eICU-CRD.The area under the receiver operating characteristic curve(AUC),decision curve,and calibration curve were used to assess the efficacy of the models.RESULTS Risk factors,including the mean respiratory rate,mean systolic blood pressure,mean heart rate,white blood cells,international normalized ratio,total bilirubin,age,invasive ventilation,vasopressor use,maximum stage of acute kidney injury,and sequential organ failure assessment score,were included in the multivariate logistic regression.The model achieved AUCs of 0.864 and 0.808 in the MIMIC-IV and eICU-CRD databases,respectively.The calibration curve also confirmed the predictive ability of the model,while the decision curve confirmed its clinical value.CONCLUSION The nomogram has high accuracy in predicting in-hospital mortality.Improving the included predictors may help improve the prognosis of patients.

关键词： liver cirrhosis Intensive care unit Nomogram Predicting model Mortality

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Clinical study on the relationship between liver cirrhosis,ascites,and hyponatremia

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 751-758页

作者： Xuan-Ji Li Hui-Hui Meng Department of Gastroenterology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022Hubei ProvinceChina Department of Hepatology Hubei Provincial Hospital of Traditional Chinese MedicineWuhan 430065Hubei ProvinceChina

BACKGROUND cirrhosis is a common liver disease,and ascites is one of the common clinical conditions.However,the clinical manifestations of ascites combined with hyponatremia as a high-risk condition and its relationship to patient prognosis have not been fully studied.AIM To explore the clinical manifestations,prognostic factors,and relationships of ascites with hyponatremia in patients with cirrhosis to provide better diagnostic and treatment strategies.METHODS In this study,we retrospectively analyzed the clinical data of 150 patients diagnosed with cirrhosis and ascites between 2017 and 2022.Patients were divided into two groups:ascites combined with hyponatremia group and ascites group.We compared the general characteristics,degree of hyponatremia,complications,treatment,and prognosis between the two groups.RESULTS In the study results,patients in the ascites combined with hyponatremia group showed an older average age(58.2±8.9 years),64.4%were male,and had a significantly longer hospitalization time(12.7±5.3 d).Hyponatremia was more severe in this group,with a mean serum sodium concentration of 128.5±4.3 mmol/L,which was significantly different from the ascites group of 137.6±2.1 mmol/L.Patients with ascites and hyponatremia were more likely to develop hepatic encephalopathy(56.2%vs 39.0%),renal impairment(45.2%vs 28.6%)and infection(37.0%vs 23.4%).Regarding treatment,this group more frequently used diuretics(80.8%vs 62.3%)and salt supplements(60.3%vs 38.9%).Multiple logistic regression analysis identified older age[Odds ratio(OR)=1.06,P=0.025]and male gender(OR=1.72,P=0.020)as risk factors for hyponatremia combined with ascites.Overall,patients with ascites and hyponatremia present a clear high-risk status,accompanied by severe complications and poor prognosis.CONCLUSION In patients with cirrhosis,ascites with hyponatremia is a high-risk condition that is often associated with severe complications.

关键词： liver cirrhosis Ascites Hyponatremia Risk Complications

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Contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis patients

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World Journal of Hepatology 2024年第2期16卷 126-134页

作者： Dmitry Victorovich Garbuzenko Department of Faculty Surgery South Ural State Medical UniversityChelyabinsk 454092Russia

This editorial describes the contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis(LC)patients according to the current guidelines.Gastroesophageal variceal bleeding is the most dangerous complication of portal hypertension in LC patients.Risk stratification and determination of an individual approach to the choice of therapeutic measures aimed at their prevention and management has emerged as one of the top concerns in modern hepatology.According to the current guidelines,in the absence of clinically significant portal hypertension,etiological and nonetiological therapies of LC is advisable for the primary preventing gastroesophageal variceal bleeding,whereas its presence serves as an indication for the administration of non-selectiveβ-blockers,among which carvedilol is the drug of choice.Non-selectiveβ-blockers,as well as endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt can be used to prevent recurrence of gastroesophageal variceal bleeding.Pharmacotherapy with vasoactive drugs(terlipressin,somatostatin,octreotide),endoscopic variceal ligation,endovascular techniques and transjugular intrahepatic portosystemic shunt are recommended for the treatment of acute gastroesophageal variceal bleeding.Objective and accurate risk stratification of gastroesophageal variceal bleeding will allow developing individual strategies for their prevention and management,avoiding the first and further decompensation in LC,which will improve the prognosis and survival of patients suffering from it.

关键词： liver cirrhosis Portal hypertension Gastroesophageal variceal bleeding Prevention Management

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Pulmonary Bacterial Infection and liver cirrhosis: Current Status and Treatment

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Infectious Microbes & Diseases 2024年第1期6卷 5-10页

作者： Yingying Zhao Song Yang Huichun Xing Center of liver Diseases Division 3 Beijing Ditan HospitalCapital Medical UniversityBeijingChina

liver cirrhosis has a higher incidence rate and mortality when complicated with bacterial infections.Concomitant bacterial infections,especially bacterial pneumonia,increase the susceptibility of cirrhotic patients to decompensation,with a higher likelihood of mortality.Bacterial pneu-monia is often overlooked in patients with liver cirrhosis,although it can impact the clinical progress and outcomes.Untimely diagnosis and inappropriate antibiotic treatments are associated with poor prognosis and increased mortality.Current understanding of mechanisms and appropriate antibiotic treatments for cirrhosis-related bacterial pneumonia remain inadequate.Herein,we reviewed the epidemiology,clinical characteristics and treatment of pulmonary bacterial infections in cirrhotic patients to provide suggestions for clinical practice.

关键词： bacterial pneumonia liver cirrhosis epidemiology characteristics treatment

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From liver to hormones:The endocrine consequences of cirrhosis

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World Journal of Gastroenterology 2024年第9期30卷 1073-1095页

作者： Juan Eduardo Quiroz-Aldave Elman Rolando Gamarra-Osorio María del Carmen Durand-Vásquez Luciana del Pilar Rafael-Robles Jhean Gabriel Gonzáles-Yovera María Alejandra Quispe-Flores Luis Alberto Concepción-Urteaga Alejandro Román-González José Paz-Ibarra Marcio José Concepción-Zavaleta Non-communicable Diseases Endocrinology Research LineHospital de Apoyo ChepénChepén 13871Peru Department of Endocrinology Hospital Víctor Lazarte EchegarayTrujillo 13006Peru Department of Endocrinology Clínica Javier PradoLima 15046Peru Department of Gastroenterology Hospital Nacional Guillermo Almenara IrigoyénLima 15018Peru Department of Endocrinology Hospital de Emergencias GrauLima 15001Peru Internal Medicine Hospital Regional Docente de TrujilloTrujillo 13011Peru Department of Endocrinology Hospital Universitario de San Vicente FundaciónMedellin 050010Colombia Internal Medicine Universidad de AntioquiaMedellín 050010Colombia School of Medicine Universidad Nacional Mayor de San MarcosLima 15081Peru Department of Endocrinology Hospital Nacional Edgardo Rebagliati MartinsLima 15072Peru Carrera de Medicina Humana Universidad Científica del SurLima 15067Peru

Hepatocrinology explores the intricate relationship between liver function and the endocrine system.Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption.Despite its importance,assessing endocrine issues in cirrhotic patients is frequently neglected.This article provides a comprehensive review of the epidemiology,pathophysiology,diagnosis,and treatment of endocrine disturbances in liver cirrhosis.The review was conducted using the PubMed/Medline,EMBASE,and Scielo databases,encompassing 172 articles.liver cirrhosis is associated with endocrine disturbances,including diabetes,hypoglycemia,sarcopenia,thyroid dysfunction,hypogonadotropic hypogonadism,bone disease,adrenal insufficiency,growth hormone dysfunction,and secondary hyperaldosteronism.The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system,respectively.Sarcopenia can be assessed through imaging and functional tests,while other endocrine disorders are evaluated using hormonal assays and imaging studies.Treatment options include metformin,glucagon-like peptide-1 analogs,sodium-glucose co-transporter-2 inhibitors,and insulin,which are effective and safe for diabetes control.Established standards are followed for managing hypoglycemia,and hormone replacement therapy is often necessary for other endocrine dysfunctions.liver transplantation can address some of these problems.

关键词： Diabetes mellitus Hypoglycemia Thyroid diseases Hypogonadism Metabolic bone diseases liver cirrhosis

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Changes in the etiology of liver cirrhosis and the corresponding management strategies

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World Journal of Hepatology 2024年第2期16卷 146-151页

作者： Jin-Jin Dai Yue-Ying Liu Zhen-Hua Zhang Department of Infectious Diseases Suzhou Hospital of Anhui Medical UniversitySuzhou 234000Anhui ProvinceChina Department of Infectious Diseases The Second Affiliated Hospital of Anhui Medical UniversityHefei 230601Anhui ProvinceChina

We read with interest the article by Xing Wang,which was published in the recent issue of the World Journal of Hepatology 2023;15:1294-1306.This article focuses particularly on the prevalence and trends in the etiology of liver cirrhosis(LC),prognosis for patients suffering from cirrhosis-related complications and hepatocellular carcinoma(HCC),and management strategies.The etiology of cirrhosis varies according to geographical,economic,and population factors.Viral hepatitis is the dominant cause in China.Vaccination and effective treatment have reduced the number of people with viral hepatitis,but the overall number is still large.Patients with viral hepatitis who progress over time to LC and HCC remain an important population to manage.The increased incidence of metabolic syndrome and alcohol consumption is likely to lead to a potential exponential increase in metabolic dysfunction-associated steatotic liver disease(MASLD)-associated LC and alcoholic liver disease in the future.Investigating the evolution of the etiology of LC is important for guiding the direction of future research and policy development.These changing trends indicate a need for greater emphasis on tackling obesity and diabetes,and implementing more effective measures to regulate alcohol consumption in order to reduce the occurrence of MASLD.In an effort to help cope with these changing trends,the authors further proposed countermeasures for healthcare authorities doctors,and patients.

关键词： liver cirrhosis Etiology Viral hepatitis Alcoholic liver disease Hepatocellular carcinoma Metabolic dysfunction-associated steatotic liver disease

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Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study

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Chinese Medical Journal 2022年第19期135卷 2319-2325页

作者： Jielin Li Jiexuan Hu Peng Li Yongdong Wu Yongjun Wang Ming Ji Haiyang Hua Wenbin Ran Yanglin Pan Shutian Zhang Department of Gastroenterology Bejing Friendship HospitalCapital Medical UniversityNational Clinical Research Center for Digestive DiseaseBejing 100050China Department of Oncology Beijing Friendship HospitalCapital Medical UniversityBejing 100050China Department of Gastroenterology Cheng De Central HospitalChengdeHebei 06700China xjing Hospital of Digestive Diseases Air Force Medical University of People's Liberation ArmyXranShaanxi 710032China Department of Gastroenterology The Third People's Hospital of ChengduChengduSichuan 610031China.

Background:Endoscopic retrograde cholangiopancreatography(ERCP)is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases.However,patients with cirrhosis,particularly those with decompensated cirrhosis,are believed to be at increased risk for complications associated with ERCP.There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis.This study aimed to investigate the outcomes of ERCP for cirrhosis patients,especially adverse events,and evaluated its safety and efficacy.Methods:We performed a multicenter,retrospective study of all patients at Beijing Friendship Hospital affiliated to Capital Medical University,Xijing Hospital affiliated to Air Force Military Medical University,Beijing Youan Hospital affiliated to Capital Medical University,and the Fifth Medical Center of the People’s Liberation Army General Hospital from June 2003 to August 2019.The adverse events of inpatient ERCP for patients with(n=182)and without liver cirrhosis(controls;n=385)were compared.Results:A total of 567 patients underwent ERCP between January 2003 and December 2019 were enrolled in this study.Compared to patients without cirrhosis,patients with cirrhosis were at higher risk for postoperative complications(odds ratio[OR],4.172;95%confidence interval[CI],1.232–7.031;Pcirrhosis in this study included choledocholithiasis(101 cases;55.5%),benign bile duct strictures(46 cases;25.3%),and malignant bile duct strictures(28 cases;15.4%).Among them,23 patients(12.6%)underwent balloon dilation and 79 patients(43.4%)underwent sphincterotomy.Of the patients with cirrhosis,delayed bleeding occurred in ten patients(5.5%),postoperative pancreatitis occurred in 80 patients(44.0%),and postoperative cholangitis occurred in 25 patients(13.7%).An additional multivariate analysis showed that the total bilirubin(TBI

关键词： Risk factors Endoscopic retrograde cholangiopancreatography liver cirrhosis

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Branched-chain amino acids supplementation has beneficial effects on the progression of liver cirrhosis:A meta-analysis

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World Journal of Clinical Cases 2022年第30期10卷 10984-10996页

作者： Jia-Yu Du Liu Shu Yu-Tian Zhou Li Zhang School of Clinical Medicine Chengdu Medical CollegeChengdu 610000Sichuan ProvinceChina Department of Neuroscience College of Veterinary Medicine and Life SciencesCity University of Hong KongHong KongChina Department of Geriatrics Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610000Sichuan ProvinceChina Department of Geriatrics Sichuan Academy of Medical Sciences&Sichuan Provincial People’s HospitalChengdu 610072Sichuan ProvinceChina

BACKGROUND liver cirrhosis(LC)is currently the 11^(th) most common cause of death and 15^(th) cause of morbidity globally.The treatment of LC is mainly aimed at etiological intervention,lifestyle intervention,prevention and treatment of complications and nutritional treatment.Nutritional treatment of LC mainly includes increasing dietary intake,food intake time and branched-chain amino acids(BCAAs).Despite the recommendation of BCAAs in some guidelines,adverse effects have been reported in studies so the efficacy and safety of BCAAs remain controversial.Currently,BCAAs have been widely used in chronic liver disease,while the summary of the effect of BCAAs on long-term prognosis is rare.AIM To determine the effects of BCAAs in patients with LC.METHODS The PubMed,Cochrane Library,Embase and Web of Science databases were searched.The retrieval deadline was 1 October 2021 and there were no language restrictions set in the retrieval.The study was performed in strict accordance with the inclusion and exclusion criteria.Nine studies were finally included.The primary outcome was complications of LC.The secondary outcomes were nutritional status and liver function.This meta-analysis used the Review Manager,version 5 statistical package(Cochrane Collaboration,Oxford,England)for analysis.RESULTS The analysis included nine studies that consisted of 1080 patients(554 in the BCAA groups and526 in the control groups).The nine studies were randomized control trials(RCTs).The quality of the studies was assessed using the risk of bias method recommended by the Cochrane Collaboration.BCAAs reduced the rate of complications in LC patients[Risk ratio:0.70,95%confidence interval(CI):0.56-0.88,P=0.002]and improved patients’albumin levels[std mean difference SMD:0.26,95%CI:0.12-0.40,P=0.0002].Meanwhile,BCAAs significantly ameliorated the levels of alanine transaminase(SMD:-2.03,95%CI:-2.52 to-1.53,P<0.00001)and aspartate aminotransferase(SMD:-1.8,95%CI:-2.14 to-1.46,P<0.00001).Meanwhile,glucose in the LC was significantly increased in B

关键词： liver cirrhosis Branched-chain amino acids Complications Nutrition liver function Glucose

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