Integrative hepatology: Enhancing overall health to manage liver disease.

Despite remarkable advances in diagnostics, pharmacotherapy, and transplantation, conventional hepatology often falls short in addressing the persistent symptoms, impaired quality of life, and broader health needs of people living with chronic liver disease. Integrative Hepatology-rooted in the principles of integrative medicine-offers a holistic, evidence-informed approach that combines conventional hepatology with complementary modalities to address the biological, nutritional, physical, psychosocial, behavioral, and environmental determinants of liver health. This framework emphasizes multimodal, patient-centered care aimed at improving both liver-specific and overall health outcomes.

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.

Clinical Ethics Consultations in Cirrhosis Care.

Background: Ethics consultations may reflect the nature and frequency of conflicts in clinical care. Data regarding consultations for patients with cirrhosis, however, are limited.

Aims: To understand the reasons and context for ethics consultations and identify areas for improvement.

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.