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Introduction: Liver cirrhosis is often associated with altered thyroid function, which may reflect the severity of liver dysfunction. Understanding this relationship can help in predicting disease progression and prognosis in cirrhotic patients. The aim of this study was to demonstrate the relationship between thyroid function tests and the severity of liver function in cirrhosis of the liver. Method: A total of 73 patients diagnosed with cirrhosis of liver based on clinical, biochemical, and radiological findings were included. Results: Majority of the patients belonged to the age group of 41-59 years (63%) with male predominance (79.4%). Alcoholism (84.9%) emerged as the leading cause of liver cirrhosis. Fatigue (73.9%), body ache (57.5%), and dysphagia (54.7%) were the most common clinical symptoms linked to thyroid dysfunction. Using the Child-Pugh classification system, 15 patients were categorized as Child A, 37 as Child B, and 21 as Child C. Hypothyroidism (65.7%) was more prevalent than hyperthyroidism among the patients. Significant correlations were found between T3, FT3, and TSH levels and the severity of liver dysfunction, as classified by the Child-Pugh score (p<0.05). Hepatic encephalopathy (42.85%) was the main complication causing mortality, and all fatal cases (7) had abnormal thyroid profiles. Conclusion: In conclusion, altered T3, FT3, and TSH levels were associated with disease progression in cirrhosis and can serve as valuable indicators for prognosis. These findings suggest that thyroid function tests should be considered in evaluating the severity of liver disease progression and outcome of cirrhosis in affected patients. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to evaluate the predictors of deterioration of the Child‐Pugh classification 1 month after transcatheter arterial chemo‐embolization (TACE) in patients with treatment‐naive hepatocellular carcinoma (HCC). Methods: Between 2010 and 2020, consecutive patients who underwent conventional TACE using epirubicin as the initial treatment were enrolled. Patients with Barcelona Clinic Liver Cancer stage‐0, A or B and Child‐Pugh class A were included. The Child‐Pugh score was evaluated before treatment and 1 month after TACE. The following variables were analyzed by univariate and multivariate analyses as predictors of deterioration of the Child‐Pugh class from A to B: age, sex, etiology, serum albumin, bilirubin, prothrombin time (PT), encephalopathy, ascites, largest tumor diameter, tumor number, tumor location, α‐fetoprotein, protein induced by vitamin K absence or antagonist‐II, epirubicin dosage, ethiodized oil dosage, and number of treated liver segments. Results: A total of 152 patients were retrospectively enrolled. The deterioration rate of the Child‐Pugh class from A to B was 8.6%. Multivariable analysis showed that serum albumin ≤ 3.8 g/dL, PT ≤ 80%, and largest tumor diameter ≥ 3.8 cm were predictors of deterioration of the Child‐Pugh class. The deterioration rate to Child‐Pugh class B was 0% in patients with up to one of these factors, 14.3% in those with two factors, and 70% in those with three factors. Conclusions: A combination of serum albumin ≤ 3.8 g/dL, PT ≤ 80%, and largest tumor diameter ≥ 3.8 cm can predict the immediate deterioration of the Child‐Pugh classification from A to B following TACE. [ABSTRACT FROM AUTHOR]

Objective: To determine the predictive ability of "platelet albumin bilirubin (PALBI)" scores in assessing outcomes among acute variceal hemorrhage (AVH) patients. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital. Period: September 2022 to September 2023. Methods: Cirrhotic patients with upper gastrointestinal bleed of either gender of age at least 18 years were included. Patients with malignancies and unwilling to participate were excluded. Patients were enlisted with their written informed consent. Data was analyzed using IBM-SPSS version 26. Results: Total 300 patients were enrolled into the study with mean age of 59.9 ± 10.4 years and majority were males (73.7%). According to endoscopic findings, small, medium and large esophageal varices (EV) were seen in 9%, 28% and 63% patients respectively. Rebleeding was seen in 27.7%. On multivariable model, none of the score including "Child-Turcotte-Pugh (CTP)" score, "Model of End-stage Liver Disease (MELD)" score, "albumin-bilirubin (ALBI)" score and PALBI score were found to be associated with rebleeding. During the study in-hospital mortalities were seen in 10.3% cases. In multivariable regression analysis, when adjusted for confounders, prediction score MELD and PALBI were found to be linked with in-hospital mortality. Conclusion: The present study found that PALBI predicting in-hospital mortality even after adjusting other confounders. However, PALBI was not a promising marker for prediction of re-bleeding. [ABSTRACT FROM AUTHOR]

Fenfluramine (Fintepla®) is approved for the treatment of seizures associated with the rare epileptic encephalopathies Dravet syndrome and Lennox–Gastaut syndrome. Fenfluramine is extensively metabolized; thus, patients with hepatic impairment (HI) might experience changes in exposure to fenfluramine or its metabolites. In this phase 1 study, we investigated the pharmacokinetics (PK) and safety of a single oral dose of 0.35 mg/kg fenfluramine in subjects with mild (n = 8), moderate (n = 8), or severe (n = 7) HI (Child–Pugh A/B/C, respectively) and healthy control subjects (n = 22) matched for sex, age, and BMI. All subjects underwent serial sampling to determine total plasma concentrations of fenfluramine and its active metabolite, norfenfluramine. Hepatic impairment was associated with increases in fenfluramine exposures, mainly area‐under‐the‐curve (AUC). Geometric least squares mean ratios (90% confidence intervals) for fenfluramine AUC0‐∞ in mild, moderate, and severe HI versus healthy controls were 1.98 (1.36–2.90), 2.13 (1.43–3.17), and 2.77 (1.82–4.24), respectively. Changes in exposure to norfenfluramine in mild, moderate, and severe HI were minimal compared with normal hepatic function. Exposures to fenfluramine and norfenfluramine in all HI groups were within the ranges that have been characterized in the overall development program, including ranges examined in exposure–response relationships for efficacy and safety in patients, and determined to have an acceptable safety profile. Mild and moderate HI had a modest effect on fenfluramine exposure that was not clinically meaningful, whereas the higher fenfluramine exposure in severe HI may require dose reduction based on general caution in this population. The modest decrease in norfenfluramine exposure is not considered clinically relevant. [ABSTRACT FROM AUTHOR]

Introduction: Lack of an established methodology for post-progression systemic treatment following atezolizumab plus bevacizumab (Atez/Bev) administration is an important clinical issue. The present study aimed to elucidate the potential of lenvatinib as a second-line treatment option after Atez/Bev failure. Methods: From 2020 to 2022, 101 patients who received lenvatinib as second-line treatment were enrolled (median 72 years, males 77, Child-Pugh A 82, BCLC-A:B:C:D = 1:35:61:4), while 29 treated with another molecular targeting agent (MTA) during the period as second-line treatment were enrolled as controls. The therapeutic efficacy of lenvatinib given as second-line treatment was retrospectively evaluated. Results: Median progression-free survival/median overall survival for all patients was 4.4/15.7 months and for those with Child-Pugh A was 4.7 months/not-reached. When prognosis was compared with patients who received another MTA, there was no significant difference for PFS (3.5 months, p = 0.557) or OS (13.6 months, p = 0.992), and also no significant differences regarding clinical background factors. mRECIST findings showed that objective response and disease control rates in patients treated with lenvatinib were 23.9% and 70.4%, respectively (CR:PR:SD:PD = 3:14:33:21), while those shown by RECIST, ver. 1.1, were 15.4% and 66.2%, respectively (CR:PR:SD:PD = 1:10:36:24). Adverse events (any grade ≥10%) were appetite loss (26.7%) (grade 1:2:3 = 2:15:10), general fatigue (21.8%) (grade 1:2:3 = 3:13:6), protein in urine (16.8%) (grade 1:2:3 = 0:4:13), and hypertension (13.9%) (grade 1:2:3 = 1:8:5). Conclusion: Although lenvatinib treatment might not provide a pseudo-combination immunotherapy effect following Atez/Bev failure, lenvatinib when used as second-line treatment after Atez/Bev failure might be expected to be comparable as compared to its use as first-line treatment. [ABSTRACT FROM AUTHOR]

Objective·To investigate the insulin resistance in liver cirrhosis patients.Methods·Patients with liver cirrhosis from Xinhua Hospital,Shanghai Jiao Tong University School of Medicine in 2013‒2017 were retrospectively assessed. Biochemical indexes, including fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c), fasting insulin and homeostatic model assessment-insulin resistance (HOMA-IR), were collected. The complications of liver cirrhosis were recorded, including esophagogastric varices bleeding (EVB), ascites and hepatic encephalopathy (HE). According to HOMA-IR value, the liver cirrhosis patients were divided into non-insulin resistance group (IR≤1.64) and insulin resistance group (IR>1.64). Various indicators were compared between the two groups.Results·A total of 376 patients with liver cirrhosis were included in this study. The proportions of Child-Pugh A, Child-Pugh B and Child-Pugh C were 162 (43.09%), 148 (39.36%), and 66 (17.55%), respectively. The main cause of liver cirrhosis was hepatitis B virus infection 163 (43.35%). Fasting insulin levels were measured in 208 of 376 liver cirrhosis patients. Among them, 117 patients (56.25%) had no insulin resistance and 91 patients (43.75%) had insulin resistance. The body mass index (BMI) of liver cirrhosis patients in the insulin resistance group was significantly higher than that in the non-insulin resistance group (P=0.000), and the prevalence of type 2 diabetes in the former was also higher (P=0.001). The scores of Child-Pugh in patients with liver cirrhosis in the insulin resistance group were lower than those in the non-insulin resistance group, and the difference in Child-Pugh score was statistically significant (6.93±1.99 vs 7.63±2.20, P=0.020). The proportion of Child-Pugh C grade in the insulin resistance group was significantly lower than that in the patients without insulin resistance (P=0.028). The prevalence of ascites in cirrhotic patients with insulin resistance was significantly lower than that in cirrhotic patients without insulin resistance (36.26% vs 66.67%, P=0.000). There was no significant difference in the prevalence of EVB and HE between the two groups (P>0.05).Conclusion·Nearly half of patients with liver cirrhosis are associated with insulin resistance. Compared with no-insulin resistance patients, cirrhotic patients with insulin resistance have a higher BMI, lower percentage of Child-Pugh C, and fewer ascites prevalence.

This study assessed the use of pretreatment albumin–-bilirubin (ALBI) grade as a prognostic factor in patients with hepatocellular carcinoma (HCC) receiving combined transarterial chemoembolization (TACE) and radiotherapy (RT). Patients who underwent RT following TACE between January 2011 and December 2020 were analyzed retrospectively. The survival outcomes of patients in regard to the ALBI grade and Child–Pugh (C–P) classification were evaluated. A total of 73 patients with a median follow-up of 16.3 months were included. Thirty-three (45.2%) and forty patients (54.8%) were categorized into ALBI grades 1 and 2–3, respectively, while sixty-four (87.7%) and nine (12.3%) were C–P classes A and B, respectively (p = 0.003). The median progression-free survival (PFS) and overall survival (OS) for ALBI grade 1 vs. 2–3 were 8.6 months vs. 5.0 months (p = 0.016) and 27.0 months vs. 15.9 months (p = 0.006), respectively. The median PFS and OS for C–P class A vs. B were 6.3 months vs. 6.1 months (p = 0.265) and 24.8 months vs. 19.0 months (p = 0.630), respectively. A multivariate analysis showed that ALBI grades 2–3 were significantly associated with worse PFS (p = 0.035) and OS (p = 0.021). In conclusion, the ALBI grade could be a good prognosticator in HCC patients who were treated with combined TACE-RT. [ABSTRACT FROM AUTHOR]

Abstract Objective Post-hepatectomy liver failure (PHLF) is a severe complication in patients with hepatocellular carcinoma (HCC) who underwent hepatectomy. This study aims to develop a nomogram of PHLF grade B–C in patients with huge HCC (diameter ≥ 10 cm). Methods We retrospectively collected clinical information of 514 and 97 patients who underwent hepatectomy for huge HCC at two medical centers between 2016 and 2021. Univariate and multivariate analysis were carried out to screen the independent risk factors of PHLF grade B–C, which were visualized as a nomogram. Results Three Hundred Forty Three Thousand One Hundred Seventy One and 97 HCC patients were included in the training cohort, internal validation cohort, and external validation cohort, with probabilities of PHLF grade B–C of 15.1%, 12.9%, and 22.7%, respectively. Pre-operative modified albumin-bilirubin (mALBI) grade (p

Tadelle Amanuel, Banjaw Zelalem Department of Biomedical Sciences, Jimma University, Jimma City, EthiopiaCorrespondence: Tadelle Amanuel, Email newaman09@yahoo.com; amanuel.muluneh@ju.edu.etBackground: Liver disease affects the electrophysiology of the heart. ECG abnormalities, especially QT interval prolongation are common in CLD. Heart rate affects QT interval, so QT interval is reported as corrected QT interval (QTc). The mechanism of QTc interval prolongation in patients with CLD is related to dysfunction of the autonomic nervous system.Objective: To assess QT interval prolongation among patients with chronic liver disease.Methods: The semi-structured questionnaire, ECG machine, automatic serum analyzer, and centrifuge were data collection instruments. Serum HDL, total proteins, albumin, bilirubin, electrolytes, triglycerides, total cholesterol, and fasting glucose were measured during data collection. LDL cholesterol was calculated. Prothrombin time was measured and INR was calculated. The severity of liver diseases was determined by the child Pugh classification (CTP score), so patients were classified by CTP score (class A, class B, or class C).Results: Twenty-seven (32.5%) were males and 56 (67.5%) were females. Thirty-nine (47%) patients were in child class B and 44 (53%) patients were in child class C. However, no patients were in child class A. Among all male CLD patients, 14 (35.9%) were in child class B and 13 (29.5%) were in child class C. Among all female patients, 25 (64.1%) were in child class B and 31 (70.5%) were in child class C. 52 (94.5%) of the patients had QT prolongation, 49 (89.1%) of the patients had QTc prolongation. Among QT prolongation, 24 (61.5%) was in Child B, 28 (63.6%) was in Child C, and among QTc prolongation, 6 (15.4%) was in Child B, 43 (97.7%) was in Child C. The independent factors significantly associated with QT interval prolongation in this study were systolic hypotension (p = 0.003) and overweight (p = 0.018).Conclusion: QT and QTc prolongation was observed. The prolongation also was increased especially when the disease is more advanced like in child C.Keywords: CLD, Q-T interval, child-Pugh classification

Background: Hepatic decompensation and mortality are common after COVID-19 infection in patients with cirrhosis. According to Child-Pugh class, mortality rose in a linear pattern. Objective: The aim of the current study is to predict outcome of COVID-19 infection in cirrhotic patients. Patient and methods: A total of 104 patients with COVID-19 infection with history of cirrhosis admitted to Zagazig University Hospital and El-Ahrar Teaching Hospital participated in our case control study. Patients were divided into 2 groups: The case group included 52 COVID-19 cirrhotic patients, and the control group included 52 patients with cirrhosis but with no evidence of COVID-19 infection. All subjects were subjected to full history taking, clinical examination, laboratory investigations, and radiological findings. Results: The inflammatory markers (D-dimer, CRP, ESR first hour, ESR second hour and WBC) and Ferritin were statistically significant higher in the case group compared with the control group. There were high significant correlations between severity COVID-19 and Child Pugh classification. There were high significant correlations between laboratory parameters and severity of COVID-19. Mortality rate was significantly higher in the case group compared with the control group (13.4% vs. 25%, respectively). Length of hospital stay, Child Turcot Pugh, fresh frozen plasma transfusion to correct coagulopathy, ascites and hepatic encephalopathy could predict hospital mortality among COVID-19 patients. Conclusion: The in-hospital mortality rate for patients hospitalized with COVID-19 in the context of cirrhosis is higher than the in-hospital mortality rate for patients hospitalized for cirrhosis alone. It is essential to acknowledge that hospitalized patients with cirrhosis are at an elevated risk of mortality regardless of the presence of COVID-19. [ABSTRACT FROM AUTHOR]

Background Esophageal varices (EVs) develop as a complication of chronic liver disease and, when left unaddressed, can lead to variceal hemorrhage manifesting as severe hematemesis and occasionally, melena. Due to its frequent negative associations, early diagnosis and the implementation of non-selective beta blocker primary prophylaxis are imperative. Although upper gastrointestinal endoscopy has historically been used to image and identify EVs, patients frequently find this intrusive treatment to be uncomfortable and burdensome. It can also be expensive and challenging for patients who live in remote places and healthcare deserts, where access to healthcare is limited. Therefore, it is crucial to identify non-invasive markers for the prediction of variceal bleeding and EVs in individuals with chronic liver disease. Methodology A cross-sectional observational study was done at Osmania General Hospital, a tertiary healthcare center in Hyderabad, India. The study sample consisted of patients with chronic liver disease who underwent upper gastrointestinal endoscopy during the study period in keeping with the inclusion and exclusion criteria. In a sample of 103 patients, the mean age was 10.72±45.55 years, with 22 females (21.4%) and 81 males (78.6%). The majority (85, 82.5%) had alcoholic chronic liver disease, while 14 (13.6%) had other etiologies, and four (3.9%) had infectious causes. Data were collected to calculate the Child-Pugh score, AST to platelet ratio index (APRI), model for end-stage liver disease (MELD) score, and fibrosis-4 (FIB-4) index. The patients were observed and followed up for a duration of three months. The data were evaluated using chi-squared tests and independent t-tests, chosen according to their relevance, to assess the utility of these scores as non-endoscopic predictors of EVs and esophageal variceal bleeding (EVB). Results The results indicated that only the FIB-4 index was found to be a significant predictor of Grade 2 or higher grades of EV according to the Pacquet classification. The FIB-4 index was significantly higher in the Grade 2 or higher EV group (p = 0.029) with t(101) = 1.98. Conclusion Thus, the study demonstrates that ≥ Grade 2 EV on upper gastrointestinal endoscopy can be predicted using the FIB-4 index. Even though our study shows that the FIB-4 index is a useful noninvasive predictor of EV, large-scale studies with bigger sample sizes and longer follow-up times are necessary to ensure accurate clinical application., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Institutional Ethics Committee, Osmania Medical College issued approval (TEC/OMC/2024/M.No.(8)/Acad-14). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tarannum et al.)

Background/Aim: Lenvatinib and sorafenib are currently available to treat patients with advanced hepatocellular carcinoma (HCC). However, since the clinical trials evaluating the efficacy of lenvatinib and sorafenib included only patients with Child–Pugh class A, little is known about the effectiveness of the treatments in patients with hepatic decompensation. We compared the effectiveness of lenvatinib and sorafenib in decompensated patients with unresectable HCC. Methods: Consecutive patients who were classified as Child–Pugh class B or C and received lenvatinib or sorafenib as first-line systemic therapy for unresectable HCC between November 2018 and April 2020 at a tertiary referral center were included in this retrospective study. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS), time-to-progression, best overall tumor response, and safety profiles. Results: Among 94 patients, 34 received lenvatinib and 60 received sorafenib. The median OS was 4.1 months (95% confidence interval [CI], 2.9–5.2): 4.2 months (95% CI, 2.9–5.3) for lenvatinib and 4.1 months (95% CI, 2.7–6.4) for sorafenib. The treatment regimen was not associated with significant improvement in OS after adjusting for covariables (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.54–1.54; P = 0.74). The treatment regimen was not an independent predictor of PFS (lenvatinib vs. sorafenib; aHR, 0.77; 95% CI, 0.48–1.24; P = 0.28). HRs were maintained even after balancing with the inverse probability treatment weighting method. Objective response rates were 11.8% and 6.7% in patients receiving lenvatinib and sorafenib, respectively (P = 0.45). Ten patients in both groups (five in the lenvatinib group and five in the sorafenib group) underwent dose modification due to adverse events, and significant difference was not observed between the treatment groups (P = 0.49). Conclusion: The effectiveness of lenvatinib and sorafenib was comparable for the treatment of unresectable HCC in decompensated patients. [ABSTRACT FROM AUTHOR]

Background: The combination of atezolizumab and bevacizumab (Atezo-Bev) has become the standard first-line therapy for patients with advanced hepatocellular carcinoma (HCC), but the prognosis and treatment pattern after its treatment failure are unclear. Methods: We reviewed the medical records of patients who failed first-line Atezo-Bev treatment for advanced HCC from January 2018 to May 2021 in four Taiwan medical centers. Post-first-line survival (PFLS) was defined as the date from the failure of Atezo-Bev treatment to the date of death or last follow-up. Results: A total of 41 patients were included in the study. All patients had Child–Pugh A liver reserve before the initiation of Atezo-Bev treatment, but the liver reserve of 6 (15%) and 7 (17%) patients deteriorated to Child–Pugh B and C, respectively, after treatment failure. The median PFLS was 5.9 months. PFLS significantly differed among patients with various liver reserves after the failure of Atezo-Bev treatment (median 9.6 vs 3.8 vs 1.2 months, for Child–Pugh A, B, and C; p < 0.001). In total, 30 (73%) patients received second-line systemic therapy, and they exhibited significantly longer PFLS (median 8.0 vs 1.8 months, p = 0.033) than patients who did not. Deteriorated liver function and not receiving second-line therapy remained associated with inferior PFLS in multivariate analysis. The most common second-line therapies were sorafenib (n = 19, 63%) and lenvatinib (n = 9, 30%), with no significant differences in efficacies. Conclusion: Receiving second-line therapy and good liver reserve were associated with favorable PFLS after the failure of first-line Atezo-Bev treatment. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a usual problem in liver cirrhosis patients, progressing with advancement of disease. Protein-calorie malnutrition is related with illness and death, and the value of nutritional status assessment tools for malnutrition is debated. We conducted this study to monitor undernutrition assessment among cirrhotics using subjective global assessment (SGA) and standard anthropometric parameters and to observe the association of different clinical characteristics with SGA score and Child-Pugh classification. Methods: Patients enrolled wereend-stage liver disease (ESLD) patientsand obtained informed consent. The nutritional screening was performed using the SGAand standard anthropometry along with mid-upper arm circumference (MUAC), mid-arm muscle circumference (MAMC), triceps skin fold thickness (TST), and hand grip strength (HGS). Results: 141 ESLD patients awaiting liver transplant (LT) were enrolled in the study and among them, 113 (80.1%) were males and 28 (19.9%) females. Patient's average age at presentation was 49.5 years. Alcoholism was the major etiological factor (51.1%) and its median duration was 10 years. The liver disease severity as per Child-Pugh classification was as follows: the majority, 66 (46.8%), were in Child-Pugh category B, and 27 (19.1%) were in Child-Pugh category C. The comparison of nutritional parameters with the Child-Pugh classification showed a statistical significance (P<0.05) with BMI (body mass index) and MAMC between the Child-Pugh categories. The comparison of SGA nutrition scores shows that it does not significantly differ on average between gender, Child-Pugh classification, aetiologies, co-morbidity, oedema, and ascites status. The nutritional score was further categorized as normal, moderately malnourished, and severely malnourished based on the SGA score, and it shows that the nutritional level is significantly correlated with Child-Pugh classification and co-morbidity. The level of liver function parameters was not correlated with the level of different nutritional parameters. Conclusion: SGA and HGS can be used as an easy and economical tool for evaluating the level of nutrition among cirrhotics and can be consistently used in liver clinics for malnutrition screening, and one can plan for nutrition education and counselling. Nutritional level monitoring is challenging in patients with ESLD due to fluid retention, and SGA will be a better nutritional screening tool for nutritional assessment. [ABSTRACT FROM AUTHOR]

Objective: Post-hepatectomy liver failure (PHLF) is a severe complication in patients with hepatocellular carcinoma (HCC) who underwent hepatectomy. This study aims to develop a nomogram of PHLF grade B–C in patients with huge HCC (diameter ≥ 10 cm). Methods: We retrospectively collected clinical information of 514 and 97 patients who underwent hepatectomy for huge HCC at two medical centers between 2016 and 2021. Univariate and multivariate analysis were carried out to screen the independent risk factors of PHLF grade B–C, which were visualized as a nomogram. Results: Three Hundred Forty Three Thousand One Hundred Seventy One and 97 HCC patients were included in the training cohort, internal validation cohort, and external validation cohort, with probabilities of PHLF grade B–C of 15.1%, 12.9%, and 22.7%, respectively. Pre-operative modified albumin-bilirubin (mALBI) grade (p < 0.001), Child–Pugh classification (p = 0.044), international normalized ratio (INR) (p = 0.005), cirrhosis (p = 0.019), and intraoperative blood loss (p = 0.004) were found to be independently associated with PHLF grade B–C in the training cohort. All the five independent factors were considered in the establishment of the nomogram model. In the internal validation cohort and external validation cohort, the area under receiver operating characteristic curve for the nomogram in PHLF grade B–C prediction reached 0.823 and 0.740, respectively. Divided into different risk groups according to the optimal cut-off value, patients in the high-risk group reported significantly higher frequency of PHLF grade B–C than those in the low-risk group, both in the training cohort and the validation cohort (p < 0.001). Conclusions: The proposed noninvasive nomogram based on mALBI-Child–Pugh and three other indicators achieved optimal prediction performance of PHLF grade B–C in patients with huge HCC. [ABSTRACT FROM AUTHOR]

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Background: Background liver function in patients with hepatocellular carcinoma (HCC) has improved remarkably with advances in various treatments. Recently, the Child-Pugh classification (CPC) system has been recognized as limited in its ability to assess patients with good hepatic reserve. We compared the albumin-bilirubin (ALBI) grade, which is suitable for a more detailed evaluation of patients with good liver function, with CPC over a 30-year period. Methods: A total of 2,347 patients were analyzed. Patients were stratified by year of diagnosis into 6 groups: Group A (1990–1994, n = 376), Group B (1995–1999, n = 434), Group C (2000–2004, n = 438), Group D (2005–2009, n = 444), Group E (2010–2014, n = 392), and Group F (2015–2018, n = 263). We compared ALBI grade and CPC across the groups. Results: The prevalence of patients with CPC A at diagnosis increased throughout the study period, reaching nearly 80% in Groups E and F (p < 0.001). By contrast, the percentage of patients with ALBI grade 1 disease remained approximately 50% in Groups E and F (p < 0.001). Modified ALBI (mALBI) grade 2a corresponds to patients with CPC A who have poor hepatic function. There were significant survival differences between patients with mALBI grade 1 versus 2a, 1 versus 2b, and 2a versus 2b disease, respectively (p < 0.0001), in patients with CPC A. Conclusions: CPC is not suitable for assessing patients with recently diagnosed HCC and good remnant hepatic function. In such patients with HCC, the prognosis can be stratified by ALBI grade rather than CPC.

Abstract Background The decision of transarterial chemoembolization (TACE) initiation and/or repetition remains challenging in patients with unresectable hepatocellular carcinoma (HCC). The aim was to develop a prognostic scoring system to guide TACE initiation/repetition. Methods A total of 597 consecutive patients who underwent TACE as their initial treatment for unresectable HCC were included. We derived a prediction model using independent risk factors for overall survival (OS), which was externally validated in an independent cohort (n = 739). Results Independent risk factors of OS included Albumin-bilirubin (ALBI) grade, maximal tumor size, alpha-fetoprotein, and tumor response to initial TACE, which were used to develop a scoring system (“ASAR”). C-index values for OS were 0.733 (95% confidence interval [CI] = 0.570–0.871) in the derivation, 0.700 (95% CI = 0.445–0.905) in the internal validation, and 0.680 (95% CI = 0.652–0.707) in the external validation, respectively. Patients with ASAR

Abstract Background The QT interval prolongation was associated with fatal arrhythmias and cardiac death. However, there were not adequate data to clarify the situation of QT interval prolongation in primary biliary cholangitis (PBC) patients. The aim of this study was to clarify the rate and the associated risk factors of corrected QT (QTc) interval prolongation in PBC patients. Methods From January 2016 to December 2020, PBC patients were retrospectively enrolled. The rate of QTc interval prolongation was surveyed and the associated risk factors were clarified by univariate and multivariate analyses. Results Among the 189 PBC patients, 24.3% (46/189) had the QTc interval prolongation. The univariate analysis showed that age, Child‐Pugh classification, creatinine, international normalized ratio (INR), and platelet (PLT) were associated with QTc interval prolongation in the PBC patients. The multivariate analysis further showed only age (p = .028) and Child‐Pugh classification (p = .035) were the associated risk factors. It had the highest risk of QTc interval prolongation (as high as 64.3%) in the patients who were more than 62.5 years old and with Child‐Pugh C. Conclusion The QTc interval prolongation was frequent in PBC patients, especially in the patients with decompensated cirrhosis. The rate of QTc interval prolongation was as high as 64.3% in the PBC patients who were more than 62.5 years old and classified as Child‐Pugh C.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. At present, hepatectomy is one of the most frequent therapeutic options, whereas the high postoperative recurrence rate severely affects the long-term survival of HCC patients. Therefore, it is urgent to choose appropriate therapeutic regime to treat the recurrence of HCC to improve the long-term survival of HCC patients. Surgical treatment is an efficacious treatment for recurrent HCC, including re-hepatectomy, salvage liver transplantation and radiofrequency ablation. Currently, individualized treatment is recommended for postoperative recurrence of HCC. The selection of treatment should be conducted based on the tumor conditions after the first hepatectomy, the characteristics of recurrent tumors, baseline data of patients and recurrence time, etc., aiming to formulate appropriate treatment regimes for patients. In this article, these surgical regimes were reviewed and compared to explore appropriate surgical schemes for postoperative recurrence of HCC, aiming to provide reference for prolonging the survival of HCC patients. [ABSTRACT FROM AUTHOR]

Background: The QT interval prolongation was associated with fatal arrhythmias and cardiac death. However, there were not adequate data to clarify the situation of QT interval prolongation in primary biliary cholangitis (PBC) patients. The aim of this study was to clarify the rate and the associated risk factors of corrected QT (QTc) interval prolongation in PBC patients. Methods: From January 2016 to December 2020, PBC patients were retrospectively enrolled. The rate of QTc interval prolongation was surveyed and the associated risk factors were clarified by univariate and multivariate analyses. Results: Among the 189 PBC patients, 24.3% (46/189) had the QTc interval prolongation. The univariate analysis showed that age, Child‐Pugh classification, creatinine, international normalized ratio (INR), and platelet (PLT) were associated with QTc interval prolongation in the PBC patients. The multivariate analysis further showed only age (p =.028) and Child‐Pugh classification (p =.035) were the associated risk factors. It had the highest risk of QTc interval prolongation (as high as 64.3%) in the patients who were more than 62.5 years old and with Child‐Pugh C. Conclusion: The QTc interval prolongation was frequent in PBC patients, especially in the patients with decompensated cirrhosis. The rate of QTc interval prolongation was as high as 64.3% in the PBC patients who were more than 62.5 years old and classified as Child‐Pugh C. [ABSTRACT FROM AUTHOR]

Liver cirrhosis is a global health problem that can be associated with several neurological manifestations. We aimed to assessment of the relation between the severity of the liver cirrhosis and the neurological symptoms, nerve conduction studies (NCS), as well as detecting subclinical neuropathic affection using motor unit number estimation (MUNE) technique. This cross‐sectional study was conducted on 56 cirrhotic patients and 61 age‐ and sex‐matched healthy controls. Neurological manifestations, Child‐Pugh classification, Model for End‐Stage Liver Disease score, NCS and MUNE using a modified spike‐triggered averaging technique were studied. Forty‐five (80.3%) of the cirrhotic patients had neurological manifestations. Muscle cramps were the most frequently reported manifestation, followed by fatigue and then numbness. NCS abnormality was significantly related to the presence of neurological symptoms (p < 0.001) and not only to peripheral numbness. Only fatigue was significantly related to the lower MUNE values (p < 0.017). Child‐Pugh classification progression was significantly related to the presence of fatigue and abnormal NCS results (p < 0.001); no similar relation was detected between the Child‐Pugh classification and the MUNE value (p = 0.103). Higher MELD scores were significantly related to NCS abnormalities (p = 0.014) and negatively correlated, although not significantly, with the MUNE values (r = −0.246 and p = 0.067). The progression of liver cirrhosis was related to the presence of neurological manifestations and nerve conduction abnormalities. Nerve conduction abnormalities may be present even in the absence of clinical numbness. A decline in motor unit number could explain the pathophysiology of fatigue in cirrhotic patients. [ABSTRACT FROM AUTHOR]

Aim: Prognosis of liver cirrhosis patients is poor when ascites is present and liver function is impaired, but such up‐to‐date information from a large‐scale, real‐world setting is limited in Japan. We aimed to investigate the hospital mortality of Japanese liver cirrhosis inpatients. Methods: This retrospective cohort study included data on liver cirrhosis inpatients between January 2011 and September 2018 extracted from an administrative claims database. The outcome was in‐hospital mortality. The 1‐ and 3‐year cumulative survival rates were examined for liver cirrhosis etiology, Child–Pugh classification, or ascites presence/absence using Kaplan–Meier analysis. The survival up to 1 year for tolvaptan prescription/nonprescription was examined. Results: We analyzed the data of 57 769 inpatients. Survival rates did not substantially differ among etiologies, with a better prognosis for alcohol etiology and poorer prognosis for hepatitis C virus. According to the Child–Pugh classification, the 1‐ and 3‐year survival rates were 90.2% and 75.3% for grade A, 73.5% and 53.9% for grade B, and 41.9% and 28.9% for grade C, respectively. Patients without ascites had a higher survival rate (83.2% and 67.0% at 1 and 3 years, respectively) than those with ascites (51.9% and 36.3%, respectively). Based on examining matched patients with ascites using a propensity score, prognosis was poor in general but was better at 6 months (58.1%) or similar at 1 year (47.1%) in patients prescribed tolvaptan compared to those not prescribed tolvaptan (54.8% and 47.5%, respectively). Conclusions: Poorer prognosis was suggested in inpatients with cirrhosis who had a worse Child–Pugh grade and ascites. [ABSTRACT FROM AUTHOR]

Cobimetinib is a kinase inhibitor indicated for use in combination with vemurafenib for treatment of unresectable/metastatic melanoma with specific BRAF mutations. Cobimetinib is extensively metabolized in liver; thus, patients with hepatic impairment (HI) might have increased cobimetinib exposure. In this study, we investigated the impact of HI on the pharmacokinetics (PK) and safety of cobimetinib. Subjects with normal hepatic function and mild to severe HI were enrolled. All subjects received a single oral dose of 10 mg cobimetinib, and serial blood samples were collected at specified times. Cobimetinib PK in subjects with mild and moderate HI was similar to that in those with normal liver function. However, subjects with severe HI, on average, showed ∼30% lower total AUC0‐∞ and ∼2‐fold higher unbound AUC0‐∞ compared with those with normal hepatic function. These exposure differences can be explained by lower albumin levels observed in subjects with severe HI, the strong correlation between albumin level and the unbound fraction and the general PK variability of cobimetinib. In addition, previous studies with cobimetinib showed a lack of an exposure‐response relationship for efficacy and safety. Therefore, collectively, our results suggest that the starting dose for patients with hepatic impairment can be the same as that for those with normal hepatic function. [ABSTRACT FROM AUTHOR]

Background and Aim: Since the advent of direct‐acting antiviral (DAA) therapy, the total eradication of hepatitis C virus has been achievable with the recovery of hepatic reserve after achievement of sustained virologic response (SVR). Hence, here, we examined the factors affecting the recovery of hepatic reserve. Methods: We followed up 403 patients (male: 164, female: 239; genotype 1: 299, genotype 2: 104; median age: 69 years) for at least 3 years after they achieved SVR to DAA therapy. Of these patients, 75 (18.6%) had a history of hepatocellular carcinoma (HCC). Biochemical tests were periodically performed, and the hepatic reserve was evaluated based on the albumin–bilirubin grade. We examined background factors such as age, biochemical test results, HCC occurrence and portosystemic shunt by computed tomography. Results: At the start of treatment, the albumin–bilirubin grades were grades 1, 2, and 3 in 241, 157, and 5 patients, respectively, and 3 years later, 117 of 162 (72%) patients with grade 2 or 3 improved to grade 1. Multivariate analysis identified the HCC occurrence after achievement of SVR (hazard ratio [HR]: 3.08, P < 0.0138), male sex (HR: 3.45, P = 0.0143), hemoglobin level of <11.5 g/dL (HR: 4.19, P = 0.0157), the presence of a portosystemic shunt (HR: 3.07, P = 0.0349), and alanine aminotransferase levels <45 U/L (HR: 2.67, P = 0.0425) as factors inhibiting improvement to grade 1. However, old age was not an inhibitory factor. Conclusion: Our results demonstrate that hepatic reserve could be improved even in elderly patients over a long course of time. [ABSTRACT FROM AUTHOR]

The authors provide the results of colloid hepatic scintigraphy and whole body studies, by determining the hepatic and splenic uptake of the radiotracer in 105 patients with hepatic cirrhosis (HC) of different etiology. The results obtained in the groups of patients with varying HC according to the Child-Pugh classification and in the group of 11 healthy volunteers were compared. The results were analyzed in 17 patients prior to and following liver transplantation. In the Child-Pugh B-C groups, the liver showed a tendency to be reduced along with progressive splenic enlargement and radiocolloid redistribution towards the spleen and bone marrow with the most significant differences in the relative splenic and bone marrow uptake of the radiotracer (p < 0.005) and its hepatic capture in percentage of the whole body (p < 0.001). One-six months after surgery, there was a significant improvement of all parameters with obvious regression of the signs of portal hypertension in the patients who had undergone liver transplantation. Colloid hepatic scintigraphy has been shown to be a highly informative technique in assessing liver function in patients with HC; it also permits evaluation of the regression of symptoms of portal hypertension and the functional state of a liver graft in the postoperative period.

Guidance from the U.S. Food and Drug Administration (FDA) and the European Medicines Agency recommends using Child‐Pugh classification for pharmacokinetic evaluation in noncancer subjects with hepatic impairment (HI). Therefore, dosing recommendations for oncology compounds for patients with HI are commonly based on Child‐Pugh classification. In oncology clinical practice, National Cancer Institute classification (NCIc), is commonly used for evaluating hepatic function and dosing decisions for oncology patients. This work evaluated the discordance between the 2 systems and the impact on dosing recommendations. The classification system in HI studies was reviewed for FDA‐approved oncology compounds. Discordance between Child‐Pugh and NCIc was evaluated for sunitinib, dacomitinib, palbociclib, bosutinib, and axitinib. Pharmacokinetic (PK) analyses were conducted based on Child‐Pugh classification and NCIc. Review of 117 approved oncology compounds showed prevalent use of Child‐Pugh classification for dedicated HI studies in noncancer subjects. NCIc is commonly used in cancer patient studies. NCIc tended to classify subjects as less impaired versus Child‐Pugh (64.9%, 73.7%, and 61.5% of subjects with mild, moderate, and severe HI, respectively, via Child‐Pugh were classified as at least 1 category less impaired via NCIc). PK analyses by NCIc were consistent with Child‐Pugh for sunitinib, dacomitinib, and palbociclib. For bosutinib, NCIc showed less impact of HI than Child‐Pugh; an opposite trend was observed for axitinib. The impact of this considerable discordance between the 2 systems on dosing decisions bears consideration. When Child‐Pugh is used for HI study enrollment, exploratory PK analyses based on NCIc should be conducted. Prescribers should attempt to use the same classification system in the product label for dosing decisions. [ABSTRACT FROM AUTHOR]

Background: Background liver function in patients with hepatocellular carcinoma (HCC) has improved remarkably with advances in various treatments. Recently, the Child-Pugh classification (CPC) system has been recognized as limited in its ability to assess patients with good hepatic reserve. We compared the albumin-bilirubin (ALBI) grade, which is suitable for a more detailed evaluation of patients with good liver function, with CPC over a 30-year period. Methods: A total of 2,347 patients were analyzed. Patients were stratified by year of diagnosis into 6 groups: Group A (1990–1994, n = 376), Group B (1995–1999, n = 434), Group C (2000–2004, n = 438), Group D (2005–2009, n = 444), Group E (2010–2014, n = 392), and Group F (2015–2018, n = 263). We compared ALBI grade and CPC across the groups. Results: The prevalence of patients with CPC A at diagnosis increased throughout the study period, reaching nearly 80% in Groups E and F (p < 0.001). By contrast, the percentage of patients with ALBI grade 1 disease remained approximately 50% in Groups E and F (p < 0.001). Modified ALBI (mALBI) grade 2a corresponds to patients with CPC A who have poor hepatic function. There were significant survival differences between patients with mALBI grade 1 versus 2a, 1 versus 2b, and 2a versus 2b disease, respectively (p < 0.0001), in patients with CPC A. Conclusions: CPC is not suitable for assessing patients with recently diagnosed HCC and good remnant hepatic function. In such patients with HCC, the prognosis can be stratified by ALBI grade rather than CPC. [ABSTRACT FROM AUTHOR]

Background: The decision of transarterial chemoembolization (TACE) initiation and/or repetition remains challenging in patients with unresectable hepatocellular carcinoma (HCC). The aim was to develop a prognostic scoring system to guide TACE initiation/repetition.Methods: A total of 597 consecutive patients who underwent TACE as their initial treatment for unresectable HCC were included. We derived a prediction model using independent risk factors for overall survival (OS), which was externally validated in an independent cohort (n = 739).Results: Independent risk factors of OS included Albumin-bilirubin (ALBI) grade, maximal tumor size, alpha-fetoprotein, and tumor response to initial TACE, which were used to develop a scoring system ("ASAR"). C-index values for OS were 0.733 (95% confidence interval [CI] = 0.570-0.871) in the derivation, 0.700 (95% CI = 0.445-0.905) in the internal validation, and 0.680 (95% CI = 0.652-0.707) in the external validation, respectively. Patients with ASAR< 4 showed significantly longer OS than patients with ASAR≥4 in all three datasets (all P < 0.001). Among Child-Pugh class B patients, a modified model without TACE response, i.e., "ASA(R)", discriminated OS with a c-index of 0.788 (95% CI, 0.703-0.876) in the derivation, and 0.745 (95% CI, 0.646-0.862) in the internal validation, and 0.670 (95% CI, 0.605-0.725) in the external validation, respectively. Child-Pugh B patients with ASA(R) < 4 showed significantly longer OS than patients with ASA(R) ≥ 4 in all three datasets (all P < 0.001).Conclusions: ASAR provides refined prognostication for repetition of TACE in patients with unresectable HCC. For Child-Pugh class B patients, a modified model with baseline factors might guide TACE initiation. [ABSTRACT FROM AUTHOR]

Acetaminophen has been increasingly used for the treatment of cancer-related pain in Japan since the revision of the package insert on January 21, 2011. However, high-dose acetaminophen may cause liver injury. The objectives of this study were to investigate the prevalence of liver injury in patients receiving acetaminophen and to identify the risk factors. The subjects were patients who were treated with acetaminophen ≥1500 mg/d for ≥4 weeks at Ehime University Hospital between April 2011 and December 2014. Drug-induced liver injury was evaluated by alanine aminotransferase and alkaline phosphatase levels, Naranjo score, and Child-Pugh classification. A total of 287 of 562 patients were treated for 4 weeks with acetaminophen ≥1500 mg/d. Twenty of 102 patients analyzed had drug-induced liver injury. Multivariate analysis was performed with variables from the results of univariate analysis (sex, age ≥70 years, abnormal alanine aminotransferase and alkaline phosphatase levels, and serious liver disease), and age ≥70 years and serious liver disease were significant risk factors. The findings from the present observational, single-center study suggest that serious liver disease before administration is an independent risk factor for acetaminophen-induced liver injury. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus (HCV) infection is a severe public health problem with a worldwide predominance of 3%. An estimated 5–20% of infected patients develop cirrhosis annually, and 1–4% of them develop hepatocellular carcinoma. In Egypt, the prevalence of HCV antibody and HCV RNA are 10.0 and 7.0%, respectively, in the 15–59 years age group. In children of 1–14 years old, the prevalence of HCV antibody and HCV RNA are 0.4 and 0.2%, respectively. HCV infection is a cause of chronic kidney disease (CKD) and results in a significant problem in hemodialysis (HD) patients. Toll-like receptors (TLRs) might have an essential role in the pathogenesis of renal diseases. They include TLR1, TLR2, TLR3, TLR4, TLR5, TLR6, TLR7, TLR8, TLR9, TLR10, TLR11, TLR12, and TLR13, though the latter two are not found in humans. Recently, it is shown that the mouse and human kidney tubular epithelial cells appear to express TLR3 constitutively and upregulate its expression upon challenge with its legend. For this reason, it appears conceivable that this receptor might play an essential role in this organ in health and disease. Aim The present study was carried out to determine the value of TLR3 in CKD patients with HCV infection. Also, we aimed to study the levels of TLR3 for Child–Pugh different classes to determine its impact on the prognosis of liver disease in those patients. Patients and methods All participants were selected from the National Institute of Urology and Nephrology. Their ages ranged between 40 and 62 years. Our study included 130 individuals of which 105 patients were selected from a dialysis unit with the end-stage renal disease on regular HD three times/week for at least 1 year and 25 healthy participants as a control group. They were divided into three groups. The control group (GI) consisted of 25 clinically healthy participants matched for age and sex; GII constituted 45 HCV negative patients; and GIII had 60 HCV positive patients. GIII was subclassified into GIIIA, GIIIB, and GIIIC, each of which consisted of 20 patients according to the Child–Pugh scoring. All patients and control samples were subjected to the following tests: Antibody screening for HCV using the ELISA technique and quantitative HCV RNA by PCR. Detection of TLR3 was done using the ELISA technique. Other parameters such as Complete Blood Picture (CBC), Prothrombin Time (PT) (INR), urea, creatinine, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), total bilirubin, alkaline phosphatase, albumin, cholesterol, and triglycerides levels were also estimated. Results The percentage of HCV-positive cases among a studied group of patients on HD was 57.2%, and the percentage of negative cases was 42.8%. There was no significant difference between GI, GII, and GIII as regards age and duration of dialysis. There was a highly significant difference between GIII as regards TLR3, INR, urea, total bilirubin, albumin, and triglycerides compared with GI and GII. There was a highly significant positive correlation of TRL3 with creatinine and PCR RNA and a significant negative correlation with albumin and cholesterol. We also found that there was a highly significant difference between GIIIC as regards INR, total bilirubin, and albumin compared with GIIIA and GIIIB. TLR3 showed no significant difference between GIIIA, GIIIB, and GIIIC. Conclusion TLR3 may have a role in the pathogenesis of HCV infection-related CKD and can be used as a new marker for the development of HCV related end-stage renal disease.

In the study, we aimed to determine whether regular outpatient controls in patients with alcoholic liver cirrhosis have an impact on their survival and hospitalisation rates.

Because voriconazole metabolism is highly influenced by liver function, the dose regimen of voriconazole should be carefully assessed in patients with liver cirrhosis. We aimed to identify significant factors associated with plasma concentrations. Blood samples were collected from patients with liver cirrhosis who received voriconazole, and voriconazole concentrations were determined. One-compartment model with first-order absorption and elimination appropriately characterized the in vivo process of voriconazole. The typical population value of voriconazole clearance (CL) was 1.45 L/h and the volume of distribution (V) was 132.12 L. The covariate analysis identified that CYP2C19 gene phenotype and Child-Pugh classification were strongly associated with CL and body weight had a significant influence on V. The results of the Monte Carlo simulation suggested that CYP2C19 gene phenotype was a critical factor for determining voriconazole dosage in patients with liver cirrhosis. The extensive metabolizer patients with Aspergillus fumigatus infections could be treated effectively with a recommended dose of 75 mg twice daily in mild to moderate liver cirrhosis and 100 mg once daily in moderate severe liver cirrhosis. However, the recommended dosage for Candida albicans infections patients was not achieved in present study. [ABSTRACT FROM AUTHOR]

Background Long non-coding RNAs (lncRNAs) have been applied as biomarkers in many diseases. However, scarce biomarkers are available in single lncRNA differential expression associated with different clinical stages of liver cirrhosis (LC). The aim of the study is to identify some lncRNAs that can serve as non-invasive sensitive biomarkers for early diagnosis and grade of LC. Methods Blood lncRNA expression was evaluated in three independent cohorts with 305 participants including healthy controls, hepatitis B virus (HBV) carriers, and patients with chronic hepatitis B (CHB) or LC. First, candidate lncRNAs were screened by CapitalBiotech microarray to diagnose cirrhosis. Quantitative reverse-transcriptase polymerase chain reaction was then used to investigate the expression of selected lncRNAs in the whole group of cirrhosis and different Child–Pugh classes. Ultimately, the diagnostic accuracy of the promising biomarker was examined and validated via Mann–Whitney test and receiver-operating characteristics analysis. Results Lnc-TCL6 was identified as a sensitive biomarker for early diagnosis of LC (Child–Pugh A) compared with healthy controls (area under the ROC curve [AUC] = 0.636), HBV carriers (AUC = 0.671), and CHB patients (AUC = 0.672). Furthermore, lnc-TCL6 showed a favourable capacity in discriminating among different Child–Pugh classes (AUC: 0.711–0.837). Compared with healthy controls, HBV carriers, and CHB patients, the expression of lnc-TCL6 was obviously up-regulated in Child–Pugh A patients and, conversely, significantly down-regulated in Child–Pugh C patients. Conclusions Lnc-TCL6 is a novel potential biomarker for early diagnosis of LC and is a possible predictor of disease progression. [ABSTRACT FROM AUTHOR]

Background and Aim: Albumin–bilirubin (ALBI) grade was developed as a new method to assess hepatic function. Sorafenib has been confirmed to be effective in improving survival in patients with advanced hepatocellular carcinoma (HCC). In this study, we investigated the impact of ALBI grade versus Child–Pugh classification on survival in HCC patients who received sorafenib. Methods: A total of 567 patients with advanced HCC who received sorafenib were included. We analyzed survival based on Child–Pugh classification or score and ALBI grade or score. We also compared the ability of ALBI and Child–Pugh scores to predict survival using time‐dependent receiver operating characteristic analysis. Results: Cumulative survival rates at 90, 180, 360, and 720 days were 84.1%, 66.6%, 47.0%, and 23.3%, respectively. Median survival was 316 days (95% confidence interval, 279–377). Both Child–Pugh classification and ALBI grade were independently associated with overall survival in multivariate analyses. In addition, overall survival differed significantly between patients with ALBI grades 1 and 2 (hazard ratio, 1.44; 95% confidence interval, 1.09–1.92, P = 0.011) among patients with a Child–Pugh score of 5. Time‐dependent receiver operating characteristic analysis showed that ALBI score predicted overall survival better than Child–Pugh score. Conclusions: Albumin–bilirubin grade is a better predictor of survival in patients with advanced HCC who received sorafenib therapy than Child–Pugh classification. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of the different Child-Pugh classification on the recurrence and survival of hepatocellular carcinoma (HCC) recipients after liver transplantation. Methods Clinical data of 125 HCC recipients undergoing liver transplantation were retrospectively analyzed. The 3-year disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival curve. The independent risk factors probably affecting the recurrence and survival of HCC recipients after liver transplantation were identified by using Cox's proportional hazards regression model. Results The median follow-up time was 25.6 months. The 3-year DFS and OS rates were 68.4% and 65.7% for all patients. The 3-year DFS and OS rates in 113 patients with Child-Pugh class A/B HCC were 68.6% and 66.2%, whereas 66.7% and 65.6% for 12 patients with Child-Pugh class C HCC with no statistical significance (all P>0.05). Cox's proportional hazards regression model demonstrated that vascular invasion (P=0.001) and the number of tumors>3 (P=0.025) were the independent risk factors for the postoperative recurrence of HCC in recipients undergoing liver transplantation. Alpha fetoprotein (AFP)>400μg/L (P=0.035), vascular invasion (P=0.031) and number of tumors>3 (P=0.008) were the independent risk factors affecting the survival of HCC patients. Conclusions The postoperative prognosis does not significantly differ between Child-Pugh class C and A/B HCC patients after liver transplantation. AFP, vascular invasion and number of tumors are the risk factors affecting the clinical prognosis of HCC patients after liver transplantation. Liver transplantation is an efficacious treatment for HCC patients with Child-Pugh class C. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between electrocardiographic( ECG) abnormalities and Child-Pugh classification in patients with liver cirrhosis. Methods Thirty patients with hepatitis and cirrhosis admitted to our hospital were enrolled as case group. Among them,12 were Child-Pugh grade A,11 were Child-Pugh grade B and 7 were Child-Pugh grade C. Meanwhile,30 healthy subjects were enrolled as control group. ECG and the Child-Pugh grade were assessed in all participants. Results ECG abnormalities were closely related to ChildPugh classification in patients with cirrhosis. The incidence of ECG abnormalities in the case group was significantly higher than that in the control group( P < 0. 05). Conclusion There is a closely relationship between abnormal ECG and Child-Pugh classification in patients with liver cirrhosis. The measurement of ECG may be a useful marker to evaluate the Child-Pugh grade of liver cirrhosis. [ABSTRACT FROM AUTHOR]

Objectives: To explore the association between liver stiffness and the Child‐Pugh classification of liver function by shear wave elastography (SWE). Methods: A total of 116 patients with liver cirrhosis were divided into 3 groups according to the Child‐Pugh classification prospectively. Conventional ultrasound imaging and SWE were performed for all patients. The associations of liver stiffness measured by SWE with ultrasound measurements, serum biochemical indicators, and the Child‐Pugh classification were analyzed. Receiver operating characteristic curves were analyzed and compared to determine the ability of liver stiffness to diagnose cirrhosis. Results: Liver stiffness measured by SWE increased with an increasing Child‐Pugh classification, internal diameter of the hepatic portal and splenic veins, spleen thickness, spleen length, total bilirubin level, and prothrombin time, which were positively correlated with the Child‐Pugh classification (all P < .05). The albumin level and liver stiffness showed higher areas under the curve in comparison with other parameters for evaluating the Child‐Pugh classification. Albumin and cholinesterase levels were negatively correlated with the Child‐Pugh classification (P < .05). All of these indicators were significantly different between each pair of groups (all P < .05), except for the internal diameter of the hepatic portal vein, prothrombin time, and total bilirubin, and cholinesterase levels between groups B and C (P > 0.05) and the thickness and length of spleen and internal diameter of the splenic vein between groups A and B (P > 0.05). There were no differences among the groups for alanine aminotransferase, aspartate aminotransferase, and globulin levels. Conclusions: Liver stiffness measured by SWE was correlated with the Child‐Pugh classification, and it may be able to help evaluate liver function in patients with cirrhosis. [ABSTRACT FROM AUTHOR]

To investigate the evaluation of the flow status of liver cirrhosis with 16 slice spiral CT perfusion imaging and its correlation with the degree of cirrhosis. Methods: 126 patients with liver cirrhosis who were treated in our hospital from January 2014 to January 2016 as cirrhosis group, the patients were divided into group A (Child A, n=35), group B (Child B, n=50), group C (Child C, n=43) according to Child-Pugh. Another 100 healthy people who received physical examination in our hospital were selected as the control group. 16 slice spiral CT was used to perform dynamic contrast-enhanced CT scan on the liver, spleen, aorta and portal vein of the subjects, the CT perfusion parameters were compared. Pearson correlation analysis was used to analyze the relationship between CT perfusion parameters and severity of liver cirrhosis. Results: The hepatic artery perfusion volume (HAP), hepatic artery perfusion in­dex (HPI), hepatic blood flow (TBV) and mean transit time (MTT) were significantly higher in the cirrhosis group than those in the con­trol group, portal vein perfusion (PVP) and total hepatic perfusion (TLP) were significantly lower than those in the control group (P<0. 05). The HAP and HPI in group A were significantly higher than those in group C, PVP and TLP were significantly lower than those in group C, the differences were statistically significant (P<0.05). There was no significant difference in TBV and MTT between the two groups (P>0.05). and group A compared with group B, group B compared with group C, there was no statistical difference in CT perfu­sion parameters (P>0.05). The severity of liver cirrhosis was positively correlated with HAP and HPI (P<0.05), but negatively correlated with PVP and TLP (P<0.05). Conclusion: 16 slice spiral CT perfusion imaging has certain value in evaluating the blood flow status of cir­rhosis, and the level of CT perfusion parameters is closely related to the severity of cirrhosis. [ABSTRACT FROM AUTHOR]

Liver cirrhosis (LC) is the end stage of chronic liver disease characterized by the appearance of extensive fibrosis and regeneration nodes associated with hepatocyte necrosis in liver but also by the reshuffling of hepatic architecture. The triad consisting of hepatic parenchymal necrosis, regeneration and scarring is always present regardless of the type of clinical manifestation. The Child-Pugh-Turcotte classification dates back more than 30 years and has been widely used in diagnosing and assessing the severity of liver cirrhosis. This is preferred due to a low degree of complexity and a good predictive value. Prolongation of the QT interval on the electrocardiogram is common, with a prevalence exceeding 60% in patients with advanced stage of cirrhosis. In these cases, beta blockers and antiarrhythmics should be avoided or used with caution and with close QT interval monitoring. Changes in heart rate and Q-T interval are new entities in cirrhosis complications. A prolonged Q-T interval in chronic liver disease could lead to ventricular arrhythmias and sudden death. There is no report on heart rate and Q-T interval disorders in our area. [ABSTRACT FROM AUTHOR]

Objective To investigate the relative influence factors and clinical significance of serum CA- 125 in patients with liver cirrhosis in decompensated stage. Methods A total of 292 patients with decompensated cirrhosis in our department from January 2017 to June 2017 were enrolled. Conditions of serum CA-125 level,Child-Pugh classification, etiology, severity of ascites, spontaneous bacterial peritonitis (SBP) were collected and statistics analysis such as multiple linear regression and HOC curve were performed to evaluate the influence factors and prediction values of serum CA- 125. Results SBP [non-standardized coefficient (B) =89.966, 95%CI 26.21 to 145.72, P=0.005] and severity of ascites (B=161.850, 95%CI 121.351 to 202.350, P=0.001) were independent influence factors in CA- 125, but there was no significant correlation were found between CA-125 and etiology, transaminase level, companion of hepatic carcinoma, hepatic encephalopathy and Child-Pugh classification. When serum CA-125 level reached 180.50 U/mL,the sensitivity and specificity of prediction of SBP will be 70.5% and 75.4% respectively; when CA-125 reaches the level of 135.00 U/mL, sensitivity of predicting moderate-severe ascites will be 88.3%,and specificity can be 84.2%. Conclusion Changes of serum CA-125 can be found in patients with liver cirrhosis in decompensated stage. SBP and ascites are two main influence factors in CA-125 elevation. Prediction of SBP and moderate-severe ascites can be precisely forecasted when serum CA-125 is higher than 180.50 U/mL and 135.00 U/mL. [ABSTRACT FROM AUTHOR]

Background In the study, we aimed to determine whether regular outpatient controls in patients with alcoholic liver cirrhosis have an impact on their survival and hospitalisation rates. Patients and methods We included patients with liver cirrhosis and regular outpatient controls as a prospective study group and patients with liver cirrhosis who were admitted to hospital only in cases of complications as a retrospective control group. The study was conducted between 2006 and 2011. Results We included 98 patients in the study group and 101 patients in the control group. There were more outpatient controls in the study group than in the control group (5.54 examinations vs. 2.27 examinations, p = 0.000). Patients in the study group had 25 fewer hospitalisations (10.2%; p = 0.612). The median survival rate was 4.6 years in the study group and 2.9 years in the control group (p = 0.021). Patients with Child A classification had an average survival of one year longer in the study group (p = 0.035). No significant difference was found for Child B patients. Patients with Child C classification had longer survival by 1.6 years in the study group (p = 0.006). Alcohol consumption was lower in the study group than in the control group (p = 0.018). Conclusions We confirmed that patients with regular outpatient controls had lower alcohol consumption, a lower hospitalisation rate and significantly prolonged survival time. We confirmed the necessity for the establishment of regular outpatient controls in patients with alcoholic liver cirrhosis. [ABSTRACT FROM AUTHOR]