Impact of Frailty on the Prognosis of Patients With Liver Cirrhosis Undergoing Insertion of a TIPS.

Background And Aims: Frailty is associated with a poorer prognosis of patients awaiting liver transplantation. Data on the impact of frailty on prognosis after transjugular intrahepatic portosystemic shunt (TIPS)-insertion in patients with cirrhosis and the influence of TIPS on longitudinal changes in frailty are lacking.

Methods: We retrospectively analysed data of 123 prospectively recruited patients with cirrhosis in Mainz and Hannover prior to elective TIPS insertion and monitored them for death/liver transplantation or post-TIPS overt hepatic encephalopathy (OHE).

Transjugular diagnostic procedures in hepatology: Indications, techniques and interpretation.

Measurement of the hepatic venous pressure gradient (HVPG) and transjugular liver biopsy have emerged as important tools in clinical hepatology. Measurement of HVPG is considered the gold standard for detecting clinically significant portal hypertension, with an HVPG of ≥10 mmHg being the key prognostic threshold in patients with compensated advanced chronic liver disease (cACLD; compensated cirrhosis). A transjugular liver biopsy can be obtained within the same procedure and may be preferred over percutaneous liver biopsy in patients with coagulopathy, ascites and/or significant obesity.

Chronic kidney disease is associated with incident depression requiring treatment: a retrospective cohort study.

Background: Depression is one of the most common psychiatric condition in patients with chronic kidney disease (CKD). It is associated with decreased adherence and quality of life as well as increased risk for dialysis, hospitalization, and mortality. Large population-based analysis evaluating the effect of CKD on the incidence of depression are missing.

Cardiovascular comorbidities predict mortality in acute pancreatitis.

Background: The in-hospital mortality of acute pancreatitis (AP) is determined by severity of AP, but also significantly impacted by patients' comorbidities. Therefore, we aimed to examine the association between comorbid risk-profiles and survival in hospitalized patients admitted with AP.

Methods: We utilized the German nationwide inpatient statistics to identify all AP patient-cases (ICD code K85) admitted to hospitals in Germany between 2005 and 2019.

Albumin infusion in hepatorenal syndrome-acute kidney injury: New evidence challenges recent consensus.

Recent consensus guidelines by the ADQI (Acute Disease Quality Initiative) and the ICA (International Club of Ascites) put forth recommendations for the management of acute kidney injury (AKI) in cirrhosis, including hepatorenal syndrome-AKI. These recommendations included the use of crystalloids over albumin for first-line volume resuscitation and restricting the use of albumin infusion to 24 h. Whilst based on sound scientific rationale, recent evidence challenges these positions.

Minimal Hepatic Encephalopathy in Cirrhotic Patients: A New Simple and Fast Digital Screening Method.

Backround: Minimal hepatic encephalopathy is a common and prognostically severe complication of cirrhosis with a significant impact on the quality of life. Detailed diagnostic work-up of minimal hepatic encephalopathy is time-consuming and difficult to integrate into daily clinical routine.

Objective: We aimed to develop a new, simple, and easy-applicable smartphone-based self-assessment method for screening of minimal hepatic encephalopathy.

QuickStroop for screening for minimal hepatic encephalopathy in patients with cirrhosis.

Background & Aims: QuickStroop, a shortened version of the Stroop EncephalApp, has recently been proposed for screening for minimal hepatic encephalopathy (MHE) in patients with cirrhosis in the USA. At present, there are no data on its clinical utility for MHE screening in patients in Europe, and only limited data are available regarding its comparison to the Animal Naming Test (ANT).

Methods: In total, 242 patients with cirrhosis without signs of hepatic encephalopathy (HE) ≥ grade 1 and no history of overt HE were included as the development cohort.

Effect of albumin treatment duration on response rates and outcomes in patients with cirrhosis and acute kidney injury.

Background & Aims: Guidelines recommended volume expansion with albumin for 48 hours for patients with cirrhosis and acute kidney injury (AKI) to correct hypovolemia and rule out prerenal AKI. A recent update in the ADQI-ICA consensus guidelines suggested shortening this duration to 24 hours, primarily based on expert opinion. This study aimed to evaluate the response rates to albumin treatment after 24 and 48 hours and to compare and assess the prognostic significance of three different definitions of response to albumin therapy.

Early Occurrence of Hepatic Encephalopathy Following Transjugular Intrahepatic Portosystemic Shunt Insertion is Linked to Impaired Survival: A Multicenter Cohort Study.

Background & Aims: Hepatic encephalopathy (HE) is a common complication following transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, the prognostic significance of overt HE post-TIPS remains controversial.

Methods: We screened 2137 patients who underwent TIPS insertion at 8 German tertiary care centers between 2004 and 2021.

MCAM is a prognostic biomarker in patients with liver cirrhosis and HCC.

Background: Despite the rising prevalence of liver cirrhosis and HCC worldwide, reliable prognostic blood biomarkers are lacking. Melanoma cell adhesion molecule (MCAM) is a cell adhesion protein, and its cleavage by metalloproteinases, known to be enriched in fibrotic and malignant diseases, results in the release of a soluble form into the blood. The aim of this study was to characterize MCAM expression in patients with chronic liver disease and to evaluate soluble MCAM (sMCAM) as a prognostic blood biomarker in patients with liver cirrhosis and HCC.

Freiburg index of post-TIPS survival (FIPS) identifies patients at risk of further decompensation and ACLF after TIPS.

Background & Aims: The Freiburg index of post-TIPS survival (FIPS) defines a high-risk group of patients with significantly reduced survival following transjugular intrahepatic portosystemic shunt (TIPS) implantation. However, the clinical hallmarks responsible for these patients' unfavorable outcome remain to be identified. Therefore, the present study aimed to characterize the clinical course after TIPS implantation according to the FIPS.

Impact of type 2 diabetes mellitus on results in the animal naming test in patients with and without liver cirrhosis.

Introduction And Objectives: Diabetes mellitus is a common comorbidity in patients with cirrhosis and is associated with the development of hepatic encephalopathy (HE) and cognitive dysfunction. The simplified Animal Naming Test (S-ANT1) has been established for detecting minimal HE (MHE). It is currently unknown whether S-ANT1 results are affected by diabetes mellitus in patients with and without cirrhosis.

Impairment of health-related quality of life among people with type 2 diabetes and advanced liver fibrosis.

People with type 2 diabetes mellitus (T2DM) show a high prevalence of steatotic liver disease (SLD), and especially metabolic dysfunction-associated steatotic liver disease (MASLD), with liver fibrosis. Their health-related quality of life (HRQL) is affected by multiple in part overlapping factors and aggravated by metabolic and liver-related comorbidities, including liver fibrosis stage. The aim of this study was to investigate the effect size of advanced fibrosis (AF) on the HRQL in people with T2DM.

Evaluation of Sonographic Muscle Measurement Using Established Muscle Markers.

Objectives: Loss of muscle quantity and function is associated with frailty and reduced quality of life. Sonography is a simple option to quantify muscle mass, which could be included into routine diagnostic workup. This study was designed to prospectively evaluate sonographic measurement and to compare it with established measurements of muscle quantity and function.

Proton pump inhibitor use and risk of hepatic encephalopathy: A multicentre study.

Background & Aims: Data on the association between proton pump inhibitor (PPI) use and hepatic encephalopathy (HE) are conflicting, and data from multicentre studies are scarce. The aim of this study was to dissect the potential association between PPI use and minimal (MHE) and overt HE (OHE).

Methods: Data from patients with cirrhosis recruited at seven centres across Europe and the US were analysed.

Proton pump inhibitor use and bone fractures in patients with chronic kidney disease.

Background: Patients with chronic kidney disease (CKD) are at high risk for bone fractures, which are associated with high morbidity and mortality. Proton pump inhibitors (PPI) have been linked to an increased risk for fractures in the general population as well as in patients with need for hemodialysis, but studies in patients with CKD are currently missing.

Methods: We performed a population-based observational case-control study exploring a sample of patients with CKD derived from the IQVIATM Disease Analyzer database.

Food for the Brain: Is Vegan/Vegetarian Diet the Way to Go for Hepatic Encephalopathy?

High-protein diet is the cornerstone of supportive care for patients living with hepatic encephalopathy. Although any protein source is better than protein restriction, there is uncertainty regarding the benefits of specific protein types. Using a randomized trial, Badal et al.

Lower uromodulin serum levels are associated with poorer prognosis in patients with cirrhosis and hepatorenal syndrome type 2.

Hepatorenal syndrome (HRS) is associated with a dismal prognosis in patients with cirrhosis, and therapeutic options are limited. Biomarkers to identify patients with poor response to therapy are urgently needed. This study aimed to evaluate the predictive value of serum levels of uromodulin (sUMOD) in patients with cirrhosis and HRS treated with terlipressin and albumin (T/A).

Short-term reduction of dietary gluten improves metabolic-dysfunction associated steatotic liver disease: A randomised, controlled proof-of-concept study.

Background: The current management of metabolic dysfunction-associated steatotic liver disease (MASLD) relies on lifestyle intervention. Prior studies have shown that nutritional wheat amylase trypsin inhibitors (ATI) activate toll-like receptor 4 on intestinal myeloid cells to enhance intestinal and extra-intestinal inflammation, including the promotion of murine MASLD, insulin resistance and liver fibrosis.

Aims: We aimed to assess the impact of ATI (gluten)-free diet in liver as well as metabolic parameters of biopsy-proven MASLD patients.