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Summary: Background and Aims: Zinc and selenium are essential trace elements involved in important (patho)physiological processes. The prevalence and prognostic implications of zinc and selenium deficiency in patients with advanced chronic liver disease (ACLD) remain unknown. Methods: We determined serum zinc and selenium concentrations in 309 patients with ACLD undergoing hepatic venous pressure gradient (HVPG) measurement between 2019 and 2022. We evaluated the prevalence of zinc/selenium deficiency and assessed its association with severity of ACLD and liver‐related events (LRE, i.e. first/further hepatic decompensation/liver‐related death). Results: Among 309 ACLD patients (median: age: 57 [IQR: 50–64], MELD: 11 [IQR: 9–16], HVPG: 17 [IQR: 11–20]), 73% (227) and 63% (195) were deficient in zinc and selenium, respectively. Decompensated (dACLD) patients showed significantly lower serum zinc (median: 48 [IQR: 38–59] vs. compensated, cACLD: 65 [IQR: 54–78], p < 0.001) and selenium levels (median: 4.9 [IQR 4.0–6.2] vs. cACLD: 6.1 [IQR 5.1–7.3], p < 0.001). Significant correlations of zinc/selenium levels were found with MELD (zinc: ρ = −0.498, p < 0.001; selenium: ρ = −0.295, p < 0.001), HVPG (zinc: ρ = −0.400, p < 0.001; selenium: ρ = −0.157, p = 0.006) and liver disease‐driving mechanisms (IL6, bile‐acid homeostasis). On multivariable analysis, low zinc/selenium levels, age and MELD remained independently associated with LRE. Conclusion: Zinc and selenium deficiencies are common in ACLD patients especially with higher MELD and HVPG. Low zinc and selenium levels independently predicted hepatic decompensation and liver‐related death. The effect of zinc/selenium supplementation in ACLD should be investigated in future trials. [ABSTRACT FROM AUTHOR]

Summary: Background: Obesity impacts the diagnostic accuracy of shear wave elastography (SWE). A deep abdominal ultrasound transducer (DAX) capable of point (pSWE) and two‐dimensional (2D)‐SWE has recently been introduced to address this issue. Methods: We performed a prospective study in a cohort of mostly patients with obesity undergoing liver biopsy with a high prevalence of metabolic dysfunction‐associate steatotic liver disease (MASLD). Liver stiffness measurement (LSM) was measured using vibration‐controlled transient elastography (VCTE), as well as pSWE and 2D SWE on the standard (5C1) and the DAX transducers. Results: We included 129 patients with paired LSM and liver biopsy: median age 44.0 years, 82 (63.6%) women, median BMI: 43.2 kg/m2. Histologic fibrosis stages: F0: N = 55 (42.6%), F1: N = 14 (10.9%), F2: N = 50 (38.8%), F3: N = 2 (1.6%), F4: N = 8 (6.2%). VCTE‐LSM failed (N = 13) or were unreliable (IQR/median ≤30% in ≥7.1 kPa, N = 14) in 20.9% of patients. The Pearson correlation of reliable VCTE‐LSM with both pSWE and 2D SWE was strong (all >0.78). The diagnostic accuracy for all LSM techniques was poor for significant fibrosis (≥F2, AUC: 0.54–0.63); however, it was good to excellent for advanced fibrosis (≥F3, AUC: 0.87–0.99) and cirrhosis (F4, AUC: 0.86–1.00). In intention‐to‐diagnose analysis, pSWE on DAX was significantly superior to VCTE‐LSM. Conclusions: pSWE‐ and 2D‐SWE enable the non‐invasive identification of advanced fibrosis and cirrhosis in patients with obese MASLD. The use of the DAX transducer for acoustic radiation force imaging (ARFI)‐LSM avoids technical failures in an obese population and subsequently offers advantages over VCTE‐LSM for the evaluation of fibrosis in an obese MASLD population at risk for fibrosis. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Dominik et al papers. To view these articles, visit https://doi.org/10.1111/apt.18179 and https://doi.org/10.1111/apt.18293. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Dominik et al papers. To view these articles, visit https://doi.org/10.1111/apt.17945 and https://doi.org/10.1111/apt.18066 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Vuijk et al papers. To view these articles, visit https://doi.org/10.1111/apt.18019 and https://doi.org/10.1111/apt.18036 [ABSTRACT FROM AUTHOR]

Summary Background and Aims Methods Results Conclusion We aimed to characterise insulin‐like growth factor‐1 (IGF‐1) signalling in patients with advanced chronic liver disease (ACLD).Consecutive patients undergoing hepatic venous pressure gradient [HVPG] measurement were prospectively included. Clinical stages were defined as follows: probable ACLD (pACLD): liver stiffness ≥10 kPa and HVPG ≤5 mmHg, S0: mild PH (HVPG 6–9 mmHg), S1: clinically significant PH (CSPH), S2: CSPH with varices, S3: past variceal bleeding, S4: past/current non‐bleeding hepatic decompensation and S5: further decompensation.In total, 269 patients were included; 105 were compensated (pACLD: n = 18; S0: n = 30; S1: n = 20; S2: n = 37), and 164 were decompensated (S3: n = 11; S4: n = 89; S5: n = 64). Median levels of IGF‐1 decreased with progressive cirrhosis (from pACLD: 88.5 ng/mL to S5: 51.0 ng/mL; p < 0.001). Patients with CSPH had significantly lower IGF‐1 levels (63.5 ng/mL vs. 81.0 ng/mL; p = 0.001). IGF‐1 showed an independent negative association with body mass index (BMI; aB: −1.56; p < 0.001), enhanced liver fibrosis (ELF) test (aB: −8.43; p < 0.001), MELD (aB: −1.13; p = 0.042) and age (per 10 years; aB: −6.87; p < 0.001). IGF‐1 exhibited an excellent AUROC (0.856) for the prediction of liver‐related death at 6 months of follow‐up. Lower IGF‐1 (per 10 ng/mL) was linked to higher risk of (further) decompensation (0.90; 95% CI: 0.83–0.98; p = 0.016), acute‐on‐chronic liver failure (ACLF; asHR: 0.80; 95% CI: 0.68–0.93; p = 0.004) and liver‐related death (asHR: 0.76; 95% CI: 0.63–0.91; p = 0.004).Decreased levels of IGF‐1 reflect impaired hepatic function and fibrogenesis in patients with cirrhosis, which seems particularly relevant in obesity since low IGF‐1 was independently linked to high BMI. Lower IGF‐1 in cirrhosis predicts decompensation, ACLF and liver‐related death. [ABSTRACT FROM AUTHOR]

The letter discusses the prognostic role of insulin-like growth factor-1 (IGF-1) in chronic liver disease, specifically in predicting liver-related outcomes such as decompensation, acute-on-chronic liver failure, and liver-related death. The study found that lower levels of IGF-1 were independently predictive of adverse outcomes in patients with advanced chronic liver disease. Further research is needed to fully understand the prognostic significance of plasma IGF-1 levels in patients with chronic liver disease. [Extracted from the article]