Statin Therapy and Portal Pressure Reduction in Cirrhosis: A Systematic Review and Meta-Analysis.

Background And Aims: Portal hypertension is the principal driver of cirrhosis decompensation, leading to heightened morbidity and mortality. While non-selective beta-blockers (NSBBs) remain the standard of care, up to 45% of patients fail to achieve sufficient portal pressure reduction. Statins have gained attention as a potential therapeutic agent for portal hypertension.

Patient-Centered Treatment of Cirrhosis.

Patient-centered care for chronic liver disease is an approach that supports patient engagement and proactive interventions aimed at preserving quality of life and function and preventing adverse outcomes. Patient-centered care is fully realized by embracing multidisciplinary care, technological innovation, and fully optimized use of the electronic health record for remote monitoring and patient communication/education. It is best enabled using conducive payment models and may require adjustments to clinical structures.

Incidence and risk factors for skin cancer in liver transplant recipients: A systematic review.

Skin cancer is a frequent complication of liver transplantation; however, contemporary incidence rates and associated risk factors remain poorly defined. We conducted a systematic review to summarize the literature on the incidence and risk factors of skin cancer after liver transplant. In July 2024, we searched MEDLINE, CINAHL, EMBASE, ClinicalTrials.

Cardiovascular risk assessment tools are insufficient for patients with metabolic dysfunction associated steatotic liver disease.

Introduction: Risk for cardiovascular (CV) events is estimated by the Framingham Risk Score (FRS), Pooled Cohort Equation (PCE) and the American Heart Association Predicting Risk of CVD EVENTs (PREVENT) equation. The applicability of these risk tools in patients with MASLD is uncertain. This study sought to determine the accuracy of the FRS, PCE, and PREVENT in a real-world cohort of patients with MASLD.

Timing and Method of Patient-Provider Communication for Abnormal Hepatocellular Carcinoma Screening Results in Cirrhosis.

Purpose: Patients with cirrhosis undergo frequent abdominal imaging including semiannual hepatocellular carcinoma (HCC) screening, with results released immediately via the patient portal. We characterized time from patient review to patient-provider communication (PPC) for patients with abnormal liver imaging results.

Methods: We identified patients with cirrhosis enrolled in the patient portal with a new abnormal liver lesion (LI-RADS, LR) on ambulatory liver ultrasound (US) or multiphasic computed tomography/magnetic resonance imaging.

Timing of Liver Imaging Result Release Is Associated with Patients with Cirrhosis Reviewing Results Prior to Providers.

Background:  Patients with cirrhosis are at high risk for developing hepatocellular carcinoma (HCC), warranting receipt of semiannual surveillance imaging with the potential to identify abnormal liver lesions. Since the implementation of the 21st Century Cures Act's Information Blocking provision, test results are immediately released to patients through the patient portal. There is an increasing trend of patients reviewing their results before their providers.

Sexual health and function in liver disease.

Sex is a central aspect of human life and is significantly impacted by chronic illness. Cirrhosis, due to its unique pathophysiology and the side effects of common therapies, serves as a paradigmatic example, being associated with very high rates of sexual dysfunction in both men and women. Liver transplantation can modify certain hormonal and pathophysiological aspects related to sexual dysfunction, but complete recovery occurs in only a relatively small percentage of patients.

A systematic review of noninvasive laboratory indices and elastography to predict hepatic decompensation.

Background: Hepatic decompensation carries profound implications for patient quality of life and risk of mortality. We lack comparative data on how noninvasive tools perform in risk stratification for those with compensated cirrhosis. We performed a systematic review to assess the performance of laboratory and transient elastography-based models for predicting hepatic decompensation in patients with compensated cirrhosis.

Testosterone Replacement Reduces Morbidity and Mortality for Most Patients With Cirrhosis.

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.

Diagnosis of Acute-on-Chronic Liver Failure in Critically Ill Patients With Cirrhosis Using Administrative Data.

Introduction: We evaluated the positive predictive value (PPV) of International Classification of Diseases, Tenth Revision ( ICD-10 ) codes used to identify organ failures in critically ill patients with cirrhosis.

Methods: A cohort of 315 hospitalized cirrhosis patients was analyzed. PPVs were calculated using chart review as the reference standard.

Food Insecurity Is Increasing and Is More Common Among Persons with Chronic Liver Disease.

Background: Effective interventions for metabolic liver disease include optimized nutritional intake. It is increasingly clear, however, that many patients with metabolic liver disease lack the resources to execute nutritional advice. Data on the trends of food insecurity are needed to prioritize public health strategies to address the burden of liver disease.

LIVE-SMART: A sequential, multiple assignment randomized trial to reduce falls in cirrhosis.

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.

Electronic Interventions to Improve Quality for Inpatient Cirrhosis Care: A Prospective Evaluation.

Introduction: Efforts to improve adherence to quality measures in cirrhosis care are encouraged by American Association for the Study of Liver Diseases (AASLD) to improve clinical outcomes.

Methods: We prospectively evaluated 2 best practice advisory (BPA) interventions to alert clinicians caring for patients with cirrhosis and acute variceal hemorrhage or spontaneous bacterial peritonitis.

Results: Our BPAs increased utilization.

Systems of care that improve outcomes for people with hepatic encephalopathy.

Hepatic encephalopathy (HE) is a critical neuropsychiatric complication of liver cirrhosis with a significant impact on patient quality of life and survival. The global prevalence of cirrhosis and associated HE necessitates a comprehensive understanding of the condition and effective systems of care to optimize outcomes. This review addresses the epidemiology, classification, diagnosis, and management of HE, with an emphasis on systems of care that improve outcomes for people with HE.

The new digital era in decompensated cirrhosis.

There is a growing global burden of liver disease with the current management for complications of liver cirrhosis being reactive as opposed to proactive, affecting outcomes. Management can often be suboptimal in overburdened health-care systems with considerable socioeconomic and geographical disparity existing, which was exacerbated by the COVID-19 pandemic, highlighting the need for sustainable care pathways to be delivered remotely. To this end, digital health care could be the key and, in this Review, we highlight the principal studies that have explored the use of digital technology in the management of cirrhosis complications.