The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public heal...The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public health concern.Timely identification and effective antiviral therapy hold the potential to reduce liver-related mortality attributable to chronic infection with hepatitis B virus(HBV)substantially.However,the current global treatment rates for CHB remain conspicuously low,with the excessively stringent treatment criteria advocated by national CHB guidelines being a contributing factor to these low rates.Nevertheless,recent strides in comprehending this malady and the emergence of novel antiviral agents prompt the imperative re-evaluation of treatment standards to extend the sphere of potential beneficiaries.An impending need arises for a novel paradigm for the classification of patients with CHB,the expansion of antiviral treatment eligibility for HBV-infected individuals,and even the streamlining of the diagnostic process for CHB to amplify cost-effectiveness and augment survival prospects.展开更多
BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is unclear.AIM To investigate the survival of patients with AILDOS and asse...BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is unclear.AIM To investigate the survival of patients with AILDOS and assess the accuracy of non-invasive serum models for predicting liver-related death.METHODS Patients with AILDOS were defined as either autoimmune hepatitis and primary biliary cholangitis overlap(AIH-PBC)or autoimmune hepatitis and primary sclerosing cholangitis overlap(AIH-PSC)and were identified from three tertiary centres for this cohort study.Liver-related death or transplantation(liver-related mortality)was determined using a population-based data linkage system.Prognostic scores for liver-related death were compared for accuracy[including liver outcome score(LOS),Hepascore,Mayo Score,model for end-stage liver disease(MELD)score and MELD incorporated with serum sodium(MELD-Na)score].RESULTS Twenty-two AILDOS patients were followed for a median of 3.1 years(range,0.35-7.7).Fourteen were female,the median age was 46.7 years(range,17.8 to 82.1)and median Hepascore was 1(range,0.07-1).At five years post enrolment,57%of patients remained free from liver-related mortality(74%AIH-PBC,27%AIH-PSC).There was no significant difference in survival between AIH-PBC and AIH-PSC.LOS was a significant predictor of liver-related mortality(P<0.05)in patients with AIH-PBC(n=14)but not AIH-PSC(n=8).A LOS cut-point of 6 discriminated liver-related mortality in AIH-PBC patients(P=0.012,log-rank test,100%sensitivity,77.8%specificity)(Harrell's C-statistic 0.867).The MELD score,MELD-Na score and Mayo Score were not predictive of liver-related mortality in any group.CONCLUSION Survival in the rare,AILDOS is unclear.The current study supports the LOS as a predictor of liver-related mortality in AIH-PBC patients.Further trials investigating predictors of survival in AILDOS are required.展开更多
BACKGROUND Whether patients with compensated cirrhosis and low-level viremia(LLV)of hepatitis B should receive antiviral therapy(AVT)is still controversial,and published results are inconsistent.AIM To investigate the...BACKGROUND Whether patients with compensated cirrhosis and low-level viremia(LLV)of hepatitis B should receive antiviral therapy(AVT)is still controversial,and published results are inconsistent.AIM To investigate the link between LLV in compensated cirrhosis and prognosis concerning hepatocellular carcinoma(HCC),decompensation,and liver-related events.METHODS The PubMed,EMBASE,and Cochrane Library databases were searched up to March 5,2023.Outcomes of interest were assessed by pooled hazard ratios(HRs).The study was registered with PROSPERO(CRD42023405345).RESULTS Six cohort studies representing 3155 patients were included.Compared with patients with undetectable HBV DNA,patients with LLV was associated with increased risk of HCC(HR:2.06,95%CI:1.36-3.13;Q-statistic-P=0.07,I^(2)=51%)regardless of receiving AVT or not(AVT group:HR:3.14;95%CI:1.73-5.69;Qstatistic-P=0.60,I2=0%;un-AVT group:HR:1.73,95%CI:1.09-2.76;Q-statistic-P=0.11,I2=50%).The pooled results showed no statistical association between LLV and decompensation of cirrhosis(HR:2.06,95%CI:0.89-4.76;Q-statistic-P=0.04,I2=69%),and liver-related events(HR:1.84,95%CI:0.92-3.67;Q-statistic-P=0.03,I2=72%),respectively.Grading of Recommendations Assessment,Development and Evaluation assessment indicated moderate certainty for HCC,very low certainty for decompensation of cirrhosis and liver-related clinical events.CONCLUSION LLV in compensated cirrhotic patients is associated with increased risk of HCC,higher tendency for hepatic decompensation and liver-related events.Closer screening of HCC should be conducted in this population.展开更多
In patients with chronic liver diseases,identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies,assessing therapeutic response,and stratifying long-term prognosis.A...In patients with chronic liver diseases,identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies,assessing therapeutic response,and stratifying long-term prognosis.Although liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases,several non-invasive methods have been developed as alternatives to liver biopsies.Some of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference standard.However,non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint marker.Accordingly,recent studies have focused on assessing the performance of non-invasive methods through longterm,longitudinal,follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and cirrhosis.As a result,current view is that these alternative methods can independently predict future cirrhosis-related complications,such as hepatic decompensation,liver failure,hepatocellular carcinoma,or liver-related death.The clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related events.In this article,we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.展开更多
BACKGROUND Liver fibrosis leads to liver-related events in patients with chronic hepatitis C(CHC)infection.Although non-invasive tests(NITs)are critical to early detection of the development of liver fibrosis,the prog...BACKGROUND Liver fibrosis leads to liver-related events in patients with chronic hepatitis C(CHC)infection.Although non-invasive tests(NITs)are critical to early detection of the development of liver fibrosis,the prognostic role of NITs remains unclear due to the limited types of NITs and liver outcomes explored in previous studies.AIM To determine the prognostic value of NITs for risk stratification in CHC patients.METHODS The protocol was registered in PROSPERO(International Prospective Register of Systematic Reviews;no.CRD42019128176).The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Search was performed using MEDLINE and EMBASE databases under a timeframe from the inception of the databases through February 25,2020.We restricted our search to CHC cohort studies reporting an association between liver fibrosis assessed by NITs and the development of hepatocellular carcinoma,decompensation,or mortality.Pooled hazard ratios(HR)and area under the receiver operating characteristic(AUROC)for each NIT were estimated using a random effects model.Subgroup analyses were performed for NITs assessed at pre-treatment or post-treatment with sustained virologic response(SVR),treatment with either pegylated interferon and ribavirin or direct acting antiviral,Eastern or Western countries,and different cutoff points.RESULTS The present meta-analysis included 29 cohort studies,enrolling 69339 CHC patients.Fibrosis-4(FIB-4)index,aspartate aminotransferase to platelet ratio(APRI)score,and liver stiffness measurement(LSM)were found to have hepatocellular carcinoma predictive potential with pooled adjusted HRs of 2.48[95%confidence interval(CI):1.91-3.23,I2=96%],4.24(95%CI:2.15-8.38,I2=20%)and 7.90(95%CI:3.98-15.68,I2=52%)and AUROCs of 0.81(95%CI:0.73-0.89,I2=77%),0.81(95%CI:0.75-0.87,I2=68%),and 0.79(95%CI:0.63-0.96,I2=90%),respectively.Pooled adjusted HR with a pre-treatment FIB-4 cutoff of 3.25 was 3.22(95%CI:2.32-4.47,I2=80%).Pooled adjusted HRs for post-treatment with SVR FIB-4,APRI,and LSM were 3.01(95%CI:0.32-28.61,I2=89%),9.88(95%CI:2.21-44.17,I2=24%),and 6.33(95%CI:2.57-15.59,I2=17%),respectively.Pooled adjusted HRs for LSM in patients with SVR following direct acting antiviral therapy was 5.55(95%CI:1.47-21.02,I2=36%).Pooled AUROCs for post-treatment with SVR FIB-4 and LSM were 0.75(95%CI:0.55-0.95,I2=88%)and 0.84(95%CI:0.66-1.03,I2=88%),respectively.Additionally,FIB-4 and LSM were associated with overall mortality,with pooled adjusted HRs of 2.07(95%CI:1.49-2.88,I2=27%)and 4.04(95%CI:2.40-6.80,I2=63%),respectively.CONCLUSION FIB-4,APRI,and LSM showed potential for risk stratification in CHC patients.Cutoff levels need further validation.展开更多
Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagn...Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagnostic ability of MAFLD for identifying high-risk individuals.Methods:In this retrospective cohort study,we enrolled 72,392 Chinese participants between 2014 and 2015.Participants were classified as MAFLD,nonalcoholic fatty liver disease(NAFLD),non-MAFLD-NAFLD,and a normal control group.The primary outcomes were liver-related and cardiovascular disease(CVD)events.Person-years of follow-up were calculated from enrolment to the diagnosis of the event,or the last date of data(June,2020).Results:Of the 72,392 participants,31.54%(22,835)and 28.33%(20,507)qualified the criteria for NAFLD or MAFLD,respectively.Compared with NAFLD,MAFLD patients were more likely to be male,overweight,and have higher biochemical indices including liver enzyme levels.Lean MAFLD diagnosed with≥2 or≥3 metabolic abnormalities presented similar clinical manifestations.During the median follow-up of 5.22 years,919 incident cases of severe liver disease and 2,073 CVD cases were recorded.Compared with the normal control group,the NAFLD and MAFLD groups had a higher cumulative risk of liver failure and cardiac-cerebral vascular diseases.There were no significant differences in risk between the non-MAFLD-NAFLD and normal group.Diabetes-MAFLD group had the highest incidence of liver-related and cardiac-cerebral vascular diseases,lean MAFLD came second,and obese-MAFLD had the lowest incidence.Conclusions:This real-world study provided evidence for rationally assessing the benefit and practicability of the change in terminology from NAFLD to MAFLD.MAFLD may be better than NAFLD in identifying fatty liver with worse clinical features and risk profile.展开更多
Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This ...Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This retrospective chart review included patients at Stanford University Medical Center with NAFLD confirmed by imaging between March 1995 and December 2021.Lean,overweight,and obese patients had body mass index of<25.0,>25.0 and<29.9,and 230.0 kg/m2 for non-Asian and>23.0 and≥27.5 for overweight and obese Asian patients.Results:A total of 9061 lean(10.2%),overweight(31.7%),and obese(58.1%)patients were included.Lean patients were 5 years older than obese patients(53±17.4 VS.48.7±±15.1 years),more were female(59.6%vs.55.2%),white(49.1%vs.46.5%),had NASH(29.2%VS.22.5%),cirrhosis(25.3%.Vs.19.2%),or nonliver cancer(25.3%Vs.18.3%).Fewer had diabetes(21.7%Vs.35.8%)or metabolic comorbidi-ties(all p<0.0001).Lean NAFLD patients had liver-related mortality similar to other groups but higher overall(p=0.01)and nonliver-related(p=0.02)mortality.After multivariable model adjustment for covariates,differences between lean and obese NAFLD in liver-related,nonliver-related,and over-all mortality(adjusted hazard ratios of 1.34,1.00,and 1.32;p=0.66,0.99,and 0.20,respectively)were not significant.Conclusions:Lean NAFLD had fewer metabolic comorbidi-ties but similar adverse or worse outcomes,suggesting that it is not benign.Healthcare providers should provide the same level of care and intervention as for overweight and obese NAFLD.展开更多
Background and aims:Drug-induced liver injury(DILI)is a leading cause of death from acute liver failure(ALF).Hy's law warns that a hepatocellular pattern of injury accompanied by jaundice and normal alkaline phosp...Background and aims:Drug-induced liver injury(DILI)is a leading cause of death from acute liver failure(ALF).Hy's law warns that a hepatocellular pattern of injury accompanied by jaundice and normal alkaline phosphatase(ALP)levels is associated with a 10%or greater chance of progression to transplant or liver-related death.This meta-analysis of DILI studies evaluates acute and chronic outcomes of DILI according to clinical pattern of injury.Methods:We conducted a systematic search using electronic databases PubMed and EMBASE through to 8 March 2022.Our primary outcome was to compare acute outcomes including ALF,liver-related death,and liver transplant between patients experiencing hepatocellular,cholestatic,and mixed patterns of DILI.Our secondary outcome was to compare the rate of DILI chronicity between patients of these three differing patterns of injury.Pooled odds ratios(ORs)and 95%confidence intervals(CIs)were calculated using a random-effects model.Results:Overall,12 studies comprising 4290 patients were included.Patients with cholestatic DILI demonstrated similar rates of ALF(OR:0.80,95%CI:0.46–1.40,p=0.429)and liver-related death(OR:0.92,95%CI:0.50–1.69,p=0.792)compared to patients with hepatocellular DILI.Patients with cholestatic DILI were significantly more likely to experience chronicity compared to patients with hepatocellular DILI(OR:2.53,95%CI:1.34–4.79,p=0.004).展开更多
文摘The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public health concern.Timely identification and effective antiviral therapy hold the potential to reduce liver-related mortality attributable to chronic infection with hepatitis B virus(HBV)substantially.However,the current global treatment rates for CHB remain conspicuously low,with the excessively stringent treatment criteria advocated by national CHB guidelines being a contributing factor to these low rates.Nevertheless,recent strides in comprehending this malady and the emergence of novel antiviral agents prompt the imperative re-evaluation of treatment standards to extend the sphere of potential beneficiaries.An impending need arises for a novel paradigm for the classification of patients with CHB,the expansion of antiviral treatment eligibility for HBV-infected individuals,and even the streamlining of the diagnostic process for CHB to amplify cost-effectiveness and augment survival prospects.
文摘BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is unclear.AIM To investigate the survival of patients with AILDOS and assess the accuracy of non-invasive serum models for predicting liver-related death.METHODS Patients with AILDOS were defined as either autoimmune hepatitis and primary biliary cholangitis overlap(AIH-PBC)or autoimmune hepatitis and primary sclerosing cholangitis overlap(AIH-PSC)and were identified from three tertiary centres for this cohort study.Liver-related death or transplantation(liver-related mortality)was determined using a population-based data linkage system.Prognostic scores for liver-related death were compared for accuracy[including liver outcome score(LOS),Hepascore,Mayo Score,model for end-stage liver disease(MELD)score and MELD incorporated with serum sodium(MELD-Na)score].RESULTS Twenty-two AILDOS patients were followed for a median of 3.1 years(range,0.35-7.7).Fourteen were female,the median age was 46.7 years(range,17.8 to 82.1)and median Hepascore was 1(range,0.07-1).At five years post enrolment,57%of patients remained free from liver-related mortality(74%AIH-PBC,27%AIH-PSC).There was no significant difference in survival between AIH-PBC and AIH-PSC.LOS was a significant predictor of liver-related mortality(P<0.05)in patients with AIH-PBC(n=14)but not AIH-PSC(n=8).A LOS cut-point of 6 discriminated liver-related mortality in AIH-PBC patients(P=0.012,log-rank test,100%sensitivity,77.8%specificity)(Harrell's C-statistic 0.867).The MELD score,MELD-Na score and Mayo Score were not predictive of liver-related mortality in any group.CONCLUSION Survival in the rare,AILDOS is unclear.The current study supports the LOS as a predictor of liver-related mortality in AIH-PBC patients.Further trials investigating predictors of survival in AILDOS are required.
基金Supported by the National Natural Science Foundation of China,No.82070574。
文摘BACKGROUND Whether patients with compensated cirrhosis and low-level viremia(LLV)of hepatitis B should receive antiviral therapy(AVT)is still controversial,and published results are inconsistent.AIM To investigate the link between LLV in compensated cirrhosis and prognosis concerning hepatocellular carcinoma(HCC),decompensation,and liver-related events.METHODS The PubMed,EMBASE,and Cochrane Library databases were searched up to March 5,2023.Outcomes of interest were assessed by pooled hazard ratios(HRs).The study was registered with PROSPERO(CRD42023405345).RESULTS Six cohort studies representing 3155 patients were included.Compared with patients with undetectable HBV DNA,patients with LLV was associated with increased risk of HCC(HR:2.06,95%CI:1.36-3.13;Q-statistic-P=0.07,I^(2)=51%)regardless of receiving AVT or not(AVT group:HR:3.14;95%CI:1.73-5.69;Qstatistic-P=0.60,I2=0%;un-AVT group:HR:1.73,95%CI:1.09-2.76;Q-statistic-P=0.11,I2=50%).The pooled results showed no statistical association between LLV and decompensation of cirrhosis(HR:2.06,95%CI:0.89-4.76;Q-statistic-P=0.04,I2=69%),and liver-related events(HR:1.84,95%CI:0.92-3.67;Q-statistic-P=0.03,I2=72%),respectively.Grading of Recommendations Assessment,Development and Evaluation assessment indicated moderate certainty for HCC,very low certainty for decompensation of cirrhosis and liver-related clinical events.CONCLUSION LLV in compensated cirrhotic patients is associated with increased risk of HCC,higher tendency for hepatic decompensation and liver-related events.Closer screening of HCC should be conducted in this population.
基金Supported by The Liver Cirrhosis Clinical Research Center,a grant from the Korea Healthcare Technology RandD Project,Ministry of Health and Welfare,South Korea,No.HI10C2020the Bilateral International Collaborative RandD Program from the Ministry of Knowledge Economy,South Korea
文摘In patients with chronic liver diseases,identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies,assessing therapeutic response,and stratifying long-term prognosis.Although liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases,several non-invasive methods have been developed as alternatives to liver biopsies.Some of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference standard.However,non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint marker.Accordingly,recent studies have focused on assessing the performance of non-invasive methods through longterm,longitudinal,follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and cirrhosis.As a result,current view is that these alternative methods can independently predict future cirrhosis-related complications,such as hepatic decompensation,liver failure,hepatocellular carcinoma,or liver-related death.The clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related events.In this article,we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.
基金Supported by Research Grant for New Scholar Ratchadaphiseksomphot Endowment Fund Chulalongkorn University,No.RGN_2559_055_10_30.
文摘BACKGROUND Liver fibrosis leads to liver-related events in patients with chronic hepatitis C(CHC)infection.Although non-invasive tests(NITs)are critical to early detection of the development of liver fibrosis,the prognostic role of NITs remains unclear due to the limited types of NITs and liver outcomes explored in previous studies.AIM To determine the prognostic value of NITs for risk stratification in CHC patients.METHODS The protocol was registered in PROSPERO(International Prospective Register of Systematic Reviews;no.CRD42019128176).The systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Search was performed using MEDLINE and EMBASE databases under a timeframe from the inception of the databases through February 25,2020.We restricted our search to CHC cohort studies reporting an association between liver fibrosis assessed by NITs and the development of hepatocellular carcinoma,decompensation,or mortality.Pooled hazard ratios(HR)and area under the receiver operating characteristic(AUROC)for each NIT were estimated using a random effects model.Subgroup analyses were performed for NITs assessed at pre-treatment or post-treatment with sustained virologic response(SVR),treatment with either pegylated interferon and ribavirin or direct acting antiviral,Eastern or Western countries,and different cutoff points.RESULTS The present meta-analysis included 29 cohort studies,enrolling 69339 CHC patients.Fibrosis-4(FIB-4)index,aspartate aminotransferase to platelet ratio(APRI)score,and liver stiffness measurement(LSM)were found to have hepatocellular carcinoma predictive potential with pooled adjusted HRs of 2.48[95%confidence interval(CI):1.91-3.23,I2=96%],4.24(95%CI:2.15-8.38,I2=20%)and 7.90(95%CI:3.98-15.68,I2=52%)and AUROCs of 0.81(95%CI:0.73-0.89,I2=77%),0.81(95%CI:0.75-0.87,I2=68%),and 0.79(95%CI:0.63-0.96,I2=90%),respectively.Pooled adjusted HR with a pre-treatment FIB-4 cutoff of 3.25 was 3.22(95%CI:2.32-4.47,I2=80%).Pooled adjusted HRs for post-treatment with SVR FIB-4,APRI,and LSM were 3.01(95%CI:0.32-28.61,I2=89%),9.88(95%CI:2.21-44.17,I2=24%),and 6.33(95%CI:2.57-15.59,I2=17%),respectively.Pooled adjusted HRs for LSM in patients with SVR following direct acting antiviral therapy was 5.55(95%CI:1.47-21.02,I2=36%).Pooled AUROCs for post-treatment with SVR FIB-4 and LSM were 0.75(95%CI:0.55-0.95,I2=88%)and 0.84(95%CI:0.66-1.03,I2=88%),respectively.Additionally,FIB-4 and LSM were associated with overall mortality,with pooled adjusted HRs of 2.07(95%CI:1.49-2.88,I2=27%)and 4.04(95%CI:2.40-6.80,I2=63%),respectively.CONCLUSION FIB-4,APRI,and LSM showed potential for risk stratification in CHC patients.Cutoff levels need further validation.
基金This work was supported by the National Natural Science Foundation of China(grant numbers:81903382)Natural Science Foundation of Jiangsu Province(grant numbers:BK20190652)+1 种基金Science and Technology Young Scientific and Technological Talents Project of Jiangsu Province(grants 2021-50)China Postdoctoral Science Foundation(grant numbers:General Program,2019M651900)。
文摘Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagnostic ability of MAFLD for identifying high-risk individuals.Methods:In this retrospective cohort study,we enrolled 72,392 Chinese participants between 2014 and 2015.Participants were classified as MAFLD,nonalcoholic fatty liver disease(NAFLD),non-MAFLD-NAFLD,and a normal control group.The primary outcomes were liver-related and cardiovascular disease(CVD)events.Person-years of follow-up were calculated from enrolment to the diagnosis of the event,or the last date of data(June,2020).Results:Of the 72,392 participants,31.54%(22,835)and 28.33%(20,507)qualified the criteria for NAFLD or MAFLD,respectively.Compared with NAFLD,MAFLD patients were more likely to be male,overweight,and have higher biochemical indices including liver enzyme levels.Lean MAFLD diagnosed with≥2 or≥3 metabolic abnormalities presented similar clinical manifestations.During the median follow-up of 5.22 years,919 incident cases of severe liver disease and 2,073 CVD cases were recorded.Compared with the normal control group,the NAFLD and MAFLD groups had a higher cumulative risk of liver failure and cardiac-cerebral vascular diseases.There were no significant differences in risk between the non-MAFLD-NAFLD and normal group.Diabetes-MAFLD group had the highest incidence of liver-related and cardiac-cerebral vascular diseases,lean MAFLD came second,and obese-MAFLD had the lowest incidence.Conclusions:This real-world study provided evidence for rationally assessing the benefit and practicability of the change in terminology from NAFLD to MAFLD.MAFLD may be better than NAFLD in identifying fatty liver with worse clinical features and risk profile.
文摘Background and Aims:Nonalcoholic fatty liver disease(NAFLD)is commonly associated with obesity but can de-velop in normal-weight people(lean NAFLD).We compared outcomes in lean,overweight,and obese NAFLD.Methods:This retrospective chart review included patients at Stanford University Medical Center with NAFLD confirmed by imaging between March 1995 and December 2021.Lean,overweight,and obese patients had body mass index of<25.0,>25.0 and<29.9,and 230.0 kg/m2 for non-Asian and>23.0 and≥27.5 for overweight and obese Asian patients.Results:A total of 9061 lean(10.2%),overweight(31.7%),and obese(58.1%)patients were included.Lean patients were 5 years older than obese patients(53±17.4 VS.48.7±±15.1 years),more were female(59.6%vs.55.2%),white(49.1%vs.46.5%),had NASH(29.2%VS.22.5%),cirrhosis(25.3%.Vs.19.2%),or nonliver cancer(25.3%Vs.18.3%).Fewer had diabetes(21.7%Vs.35.8%)or metabolic comorbidi-ties(all p<0.0001).Lean NAFLD patients had liver-related mortality similar to other groups but higher overall(p=0.01)and nonliver-related(p=0.02)mortality.After multivariable model adjustment for covariates,differences between lean and obese NAFLD in liver-related,nonliver-related,and over-all mortality(adjusted hazard ratios of 1.34,1.00,and 1.32;p=0.66,0.99,and 0.20,respectively)were not significant.Conclusions:Lean NAFLD had fewer metabolic comorbidi-ties but similar adverse or worse outcomes,suggesting that it is not benign.Healthcare providers should provide the same level of care and intervention as for overweight and obese NAFLD.
文摘Background and aims:Drug-induced liver injury(DILI)is a leading cause of death from acute liver failure(ALF).Hy's law warns that a hepatocellular pattern of injury accompanied by jaundice and normal alkaline phosphatase(ALP)levels is associated with a 10%or greater chance of progression to transplant or liver-related death.This meta-analysis of DILI studies evaluates acute and chronic outcomes of DILI according to clinical pattern of injury.Methods:We conducted a systematic search using electronic databases PubMed and EMBASE through to 8 March 2022.Our primary outcome was to compare acute outcomes including ALF,liver-related death,and liver transplant between patients experiencing hepatocellular,cholestatic,and mixed patterns of DILI.Our secondary outcome was to compare the rate of DILI chronicity between patients of these three differing patterns of injury.Pooled odds ratios(ORs)and 95%confidence intervals(CIs)were calculated using a random-effects model.Results:Overall,12 studies comprising 4290 patients were included.Patients with cholestatic DILI demonstrated similar rates of ALF(OR:0.80,95%CI:0.46–1.40,p=0.429)and liver-related death(OR:0.92,95%CI:0.50–1.69,p=0.792)compared to patients with hepatocellular DILI.Patients with cholestatic DILI were significantly more likely to experience chronicity compared to patients with hepatocellular DILI(OR:2.53,95%CI:1.34–4.79,p=0.004).
