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Introduction and Objectives: Alcoholic hepatitis (AH) is an acute liver inflammation associated with excessive alcohol consumption. The pharmacological treatment for AH is corticosteroids. There is a study that has proposed calculating the Lille model on day 4 (Lille-4), which apparently has comparable accuracy to the Lille model calculated on day 7 (Lille-7). However, this finding has not been validated. Therefore our objective is to determine if Lille-4 is equivalent to Lille-7 in predicting 28-day mortality in patients with probable severe alcoholic hepatitis (AH) as defined by the 2016 consortium criteria sponsored by NIAAA. Materials and Patients: Observational, prospective, ambidirectional, analytical cohort study conducted from January 2010 to April 2023. We collected clinical and biochemical variables upon admission, calculated Lille models, assessed response and 28-day mortality. Comparative analyses were performed based on survival versus mortality. Sensitivity, specificity, PPV, NPV, and accuracy of the models were calculated. Results: A total of 327 patients were included, 297 (90.8%) being male. Mean age was 43.4±9.3 years. The 50th percentile for alcohol consumption was 320 g/day (5th-95th percentile: 100.8-662). At day 28, 207 patients (63.3%) died. Upon admission, the patients who died showed a significant difference compared to survivors in: Maddrey (90 [95%CI: 81-99] vs. 70 [95%CI:65-75]; p0.45 had a sensitivity (S) of 78% and specificity (E) of 45% in predicting early mortality. Lille-4 model had an AUROC of 0.68 [0.63-0.74], where a value >0.45 had an S of 81% and E of 54% (Figure 1). Conclusions: Lille-7 is the model with the highest accuracy, according to the obtained AUROC, for predicting early mortality in severe alcoholic hepatitis (AH). Therefore, the determination of total bilirubin should not be done prematurely (before day 7), and steroid therapy should be provided to patients for up to 7 days to classify treatment response.

Introduction and Objectives: MAFLD is a highly prevalent cause of chronic liver disease, present in 70% of overweight people, 70% of diabetics, and 90% of morbidly obese people. It is the hepatic manifestation of the metabolic syndrome, defined by the presence of central obesity, insulin resistance, hyperlipidemia, hyperglycemia, and hypertension. The development of liver fibrosis is secondary to several factors, steatosis being one of them. To evaluate the correlation of steatosis with hepatic fibrosis in patients with metabolic syndrome using transition elastography. Materials and Patients: Patients older than 18 years who met MALFD criteria were included, transition elastography was performed to calculate CAP and kilopascals, steatosis degree and fibrosis degree were calculated according to the myfibroscan application, for statistical analysis Pearson's bivariate correlations were used between CAP and kilopascal values. The association between the degree of steatosis and fibrosis was performed using the chi-square test. Was considered significant at p < 0.05. Results: 94 patients were included, 20 men (21.3%), 74 women (78.7%), mean age 40.5 ± 10.02, CAP 300.6 ± 63.4, kilopascals 6.4 ± 2.7, steatosis grade S0: 8, S1: 8, S2: 20, S3: 58, degree of fibrosis F0: 58, F1: 14, F2:14, F3: 6, F4:2. The correlation between CAP and kilopascals was moderate and significant RHO=0.343 P =0.001. A significant association was found between the degree of steatosis and that of fibrosis chi-square (12) =25.1, p=0.015. The proportions were 50% (S0:F0), 16% (S1:F3), 50% (S2:F3), 100% (S3:F4). Conclusions: The correlation between steatosis and fibrosis is moderate, implying that there are other factors that influence the development of fibrosis and its progression, so metabolic control and other factors in patients with MALFD are highly relevant to prevent fibrosis progression.

Introduction and Objectives: Orlistat is a drug widely used in overweight/obese patients, while the combination with l-carnitine could offer an improvement in its effectiveness. To our knowledge, the effect of this combination on the quality of life of overweight patients has not been determined.To evaluate the effects on the quality of life of patients who took the combination of orlistat and l-carnitine at 4 and 8 weeks of treatment. Materials and Patients: : We evaluated the quality of life (Short Form-36) in 16 patients [41.81±8.26 (37.77-45.86) years, 81% women] undergoing pharmacotherapy of the combination of orlistat and l-carnitine (once a day) at 4 and 8 weeks of treatment. Data express mean±SD and 95%IC or percentages as correspond. We use paired Student t Test, two tails with an alpha=0.05. Results: Patients lowered their weight by about 3%. Patients show improvement in body pain, general health, vitality and in both Mental [45.68±6.51 (42.49-48.86) vs. 49.88±3.21 (48.31-51.46), p=0.02] and Physical [59.4±8.92 (55.03-63.77) vs. 63.36±9.64 (58.63-68.08), p=0.01) summaries. Conclusions: These results suggest a beneficial effect of the combination of Orlistat and l-carnitine on the treatment of overweight. Further studies compared with placebo and standard care are required.

Introduction and Objectives: First-line direct-acting antiviral agents (DAAs) achieved a sustained viral response (SVR) in >95%, failure to follow the scheme is rare and the option of retreatment with sofosbuvir/velpatasvir/voxilaprevir does not exist in our setting, therefore although G/P is considered an alternative, it is the only available option. There are few reports evaluating it; due to this, we describe the frequency and characteristics of patients with failure to first-line DAA schemes and the result of retreatment with G/P during the period from January 2017 to January 2023 in 3 tertiary hospital centers. Materials and Patients: The intentional search for cases with failure to achieve SVR with first-line DAAs was carried out in 2 Mexican reference centers and one Ecuadorian center during the period from January 2017 to January 2023. Characteristics and results of patients treated with the scheme were documented. of G/P. No conflict of interest was reported by the researchers. Results: From a total of 2,397 HCV-infected patients treated with the first-line DAA scheme, without cirrhosis or with compensated cirrhosis, a total of 9 patients presented virological failure, the average age was 52.4 years, five women and four men, of these, six patients had fibrosis grade F4, 3 of them F1, the predominant genotype was 1a, the initial regimens were SOF/VEL or SOF/LED in the majority, only one case used Paritaprevir/Ritonavir/Ombitasvir/Dasabuvir + Ribavirin, all the patients re-treated with G/P had SVR at 12 weeks, no resistance profile was routinely performed, adverse effects were mild, and were reported in 22.2% of the total, none of them abandoned treatment. Conclusions: First-line DAAs are effective; virological failure in our sample is lower (0.37%) than reported in the literature. G/P is an effective and safe scheme for retreatment of patients with failure without cirrhosis or with compensated cirrhosis (100% response in our study), without serious adverse effects, which makes it possible to eliminate and meet the WHO 2030 goals.

Introduction and Objectives: Prevalence of patients with decompensated cirrhosis with requirement of liver transplantation (LT) has increased in our country. A significant percentage of patients with this condition belongs to a geriatric population, which could contraindicate LT, although trends in other countries indicate that the results of LT in geriatric patients are excellent.To assess one-year survival of LT patients over 60 years Materials and Patients: Retrospective, observational, and analytical study of patients over 60 years who underwent LT, evaluating survival, cold ischemia time (CIT), hot ischemia time (HIT), and donor age (DA), compared with a group of patients under 60 years who underwent LT.We evaluated survival over time in months with a follow-up at one year of recipients under 60 years and older than 60 using the Kaplan-Meier curve and the log-rank test, with a significant alpha level

Introduction and Objectives: Chronic liver disease (CLD) is considered an important health problem worldwide. The production of IL-10 regulated the hepatic inflammation. Whereas TGF-β plays a crucial role during the progression of CLD, promoting the dysregulated production of extracellular matrix in the liver. However, the role of TGF-β1, 2, and 3 and IL-10 in CLD is not completely understood. To evaluate the circulatory values of TGF-β1, 2, and 3 and IL-10 in hepatitis C virus (HCV), Non-alcoholic fatty liver disease (NAFLD) and alcoholic cirrhosis (OHCi) and control subjects (CT). Materials and Patients: A prospective, cross sectional, observational and multicentric study. HCV (n=33), NAFLD (n=33) and OHCi patients (n=22) and CT (n=26) were enrolled. The anthropometric variables, detailed clinical history and biochemical parameters were considered. TGF-β1, 2, and 3 and IL-10 (pg/mL) were evaluated using multiple suspension arrays. Kruskal-Wallis and Mann-Whitney U test were used for the statistical analysis. The study has the approval of the Research and Ethics Commissions with code FM/DI/135/2017 and the Research Ethics Committee of the Hospital General de México Dr. Eduardo Liceaga with code DI/16/107/03/031 as well the consent informed of the patients. Results: The age of CT group was estimated at 33 yrs., while the average of the different hepatopathies was 47 yrs. Male predominance was marked in OHCi and CT, but in NAFLD the distribution of women was similar. Multiple comparison analysis revealed that serum levels of TGF-β1, 2, and 3 did not present statistical differences in each CLD group. Nevertheless, TGF-β2 isoform showed significant difference in NAFLD and OHCi vs. CT (pNAFLD>HCV showing correlation with the increment of the ratio of 4.4, 2.7, and 2.3 folds compared to CT, respectively. Conclusions: Our data showed no differential changes of TGF-β1, 2, and 3 in accordance with CLD. The up regulation of TGF-β2 isoform could be related to different inflammatory responses in NAFLD and OHCi. On the other hand, IL-10 was upregulated in all the chronic conditions reflecting its role as pro-inflammatory mediator.

Introduction and Objectives: Alcoholic liver and non-alcoholic liver disease causes liver disease. Dual damage has been gaining great relevance. Insulin growth factor binding proteins (IGFBPs) regulate the signaling pathways of IGF; IGFBP-3 have emerged as promising biomarkers in HGNA; however, in alcohol intake and dual damage has not been previously reported the levels of IGFBPs. To demonstrate the changes in the serum levels of IGFBP-1, 3 and 7 in alcohol consumption, NAFLD and dual insult Materials and Patients: Prospective, cross-sectional and multicenter study; approved by the research and ethics commission of the UNAM and the General Hospital of Mexico. A clinical history was taken and an informed consent was requested. IGFBP-1, 3 and 7 were evaluated in alcoholism (OH), alcoholic liver disease (cirrhosis (CiOH)), alcoholic hepatitis (AH), NAFLD, dual patients and control group (CT) using multiple suspension arrays. Kruskal-Wallis, Mann-Whitney U test were used for the statistical analysis. Results: The data showed that alcohol dependence increased the serum levels of IGFBP-1, 3 and 7 (ng/mL) vs. CT, and vs. the other hepatopathies as follows OH>AH>CiOH>HGNA>Dual. Whereas in CiOH the levels of IGFBP-1, 3 and 7 were reduced vs. CT, but a slight increment was observed in AH; however, it never reached similar values to CT. On the other hand, in NAFLD the serum concentrations of all the IGFBPs evaluated were downregulated vs. CT. Conclusions: The serum levels of IGFBPs were regulated in a differential manner in accordance with the negative liver stimuli, these changes were more evident in alcoholism The dual stimulus showed the clear synergistic effects of alcohol consumption and diet in IGFBP regulation. IGFBPs could be used as biomarkers or targets in the control of different hepatopathies.

Introduction and Objectives: Hepatocellular carcinoma (HCC) is the most common malignant tumor in patients with advanced cirrhosis, posing a significant challenge to the healthcare system. Treatment involves a multidisciplinary approach; however, advanced disease limits the available options. Effectiveness and outcomes can differ depending on the stage of the disease, the patient's functional reserve, and other factors. This study aims to describe the clinical characteristics, staging, treatment, and outcomes of patients with HCC at a third-level hospital Materials and Patients: A retrospective, descriptive study of HCC patients. Demographic variables, treatment received according to the Barcelona Clinic Liver Cancer (BCLC) staging system, and treatment response according to the Response Evaluation Criteria in Solid Tumors (RECIST) were evaluated. Descriptive statistics with measures of central tendency and dispersion were performed. Results: The study included 50 patients (20 females, 30 males; mean age 62 ±8). Etiology of cirrhosis: MAFLD (19), alcohol-related (14), Hepatitis C (11), and other causes (6). The average MELD score was 12.5 ±6.22, and the MELD-Na score was 14.7 ±5.44. BCLC staging: A (9), B (28), C (4), D (9). Eligible for treatment (30), categorized as Child-Pugh A(2), B(22), C(6). Radiological treatment (21) included Transarterial Chemoembolization (TACE) in 13 cases, ablation (4), and a combination TACE/Ablation (4). Medical treatment with Lenvatinib (1). Combination of medical and radiological treatments (3). TACE followed by transplantation (4), and transplantation alone (1). Treatment response evaluation: Complete response (4), partial response (9), stable disease (7), and progression (8). The 3-month mortality rate was 8.3%. Conclusions: In our group, most of the patients were males, with a relatively equal distribution between compensated and decompensated cirrhosis. MAFLD was the most prevalent etiology, and a significant portion of cases presented at an intermediate stage (BCLC B), qualifying them as candidates for treatment. The response rates to treatment were 13% for complete response and 30% for partial response. Furthermore, the calculated mortality rate at 3 months was relatively low.

Introduction and Objectives: Chronic liver disease is increasingly prevalent, the causes range from MAFLD, alcohol consumption, HCV, autoimmune disease, and others. They develop complications such as: portal hypertension with esophageal and gastric varices, hepatic encephalopathy, ascites, renal injury, among others, conditioning the final stage of the disease and death; therefore, knowing the factor that has the greatest impact on mortality is relevant. To evaluate which decompensations are associated with higher mortality in patients with cirrhosis of different etiologies. Materials and Patients: Retrospective, analytical, observational study of patients with cirrhosis. To determine the factors associated with 28- and 90-day mortality, proportional hazard curves were performed for COX with encephalopathy, gastrointestinal bleeding, ascites, renal injury, ACLF and infection, with absence of the factor as reference. Considering significant α ≤0.05, SPSS-V 25.0 was used Results: 200 patients, men 53%, women 47%. Etiology: alcohol 86, MAFLD 58, autoimmune 27, dual 16 and HCV 13; 37 died at 28 days and 49 at 90 days. Cumulative mortality rate 28 days 18.4%, 90 days 24.4%, with CHI square test for the model was significant, 109.34 (10), p

Introduction and Objectives: Liver abscess (HA) is currently a rare entity, the prevalence is low, the epidemiological transition from amoebic to pyogenic in recent years may have modified its characteristics and outcome. Therefore, knowing its presentation, evolution, management and outcome is relevant. Describe the characteristics and outcome of patients with liver abscess Materials and Patients: Retrospective and observational study of patients diagnosed with HA, epidemiological variables, presentation, treatment, drainage, and outcome were evaluated. Descriptive statistics were performed with measures of central tendency and dispersion Results: Records of patients with HA were reviewed, in a period from 2018 to 2023. A total of 103 patients with HA were included, age 48.3 ± 15.7, 70% men and 30% women, 84.5% pyogenic and 14.5% amoebic with 0.9% of deaths. 25.2% of the patients were diabetic. 42.7% were single liver abscesses, the most frequent location was segment VII in 50.4%. Regarding antibiotic treatment, 80.4% were treated with metronidazole and ceftriaxone, followed by carbapenems in 14.5%. Of the total number of patients, 73.7% required percutaneous drainage, 60.1% underwent culture, of the identified agents E. Coli was the most frequent in 9.7%. Only one patient died due to septic shock. Conclusions: The most frequent etiology of HA is now pyogenic, much higher than amebic, mortality is low, the outcome is healing without sequelae with the use of antimicrobials and percutaneous drainage.

Introduction and Objectives: Spontaneous bacterial peritonitis (SBP) is a severe complication that can occur in patients with cirrhosis and is associated with high mortality rates. Evaluating SBP as a risk factor in the outcome of patients with cirrhosis is important because it helps understand the impact of this complication on the overall prognosis of these patients. Therefore, the objective of this study is to identify risk factors, treatment outcomes, and mortality rates associated with SBP in this population. Materials and Patients: A retrospective and analytical study was conducted on patients with cirrhosis who developed SBP. The cause of cirrhosis and Child-Pugh score were evaluated. They were classified into early responders (ER) (more than 25% decrease in polymorphonuclear cells on the second day of effective antibiotic treatment), development of renal injury, acute-on-chronic liver failure (ACLF), and 28-day mortality. Statistical analysis included evaluating the mortality rate using the Kaplan-Meier curve, log-rank test, considering significance at p ≤ 0.05. Renal injury, ACLF, and non-early responders were independently compared. Results: A total of 79 patients were included in the study, 40 males (50.63%) and 39 females (49.36%). Alcohol-related in 49.36% of cases. Child-Pugh C was found in 67 cases (84.81%). Antibiotics were cephalosporins in 66 cases (84.81%) and carbapenems in 13 cases (16.45%). There were 6 deaths among early responders and 29 among non-early responders, with a mean survival of 25.76 days for early responders versus 9.78 days for non-early responders, p < 0.001 (Figure 1). Regarding Acute-on-Chronic Liver Failure (ACLF), there were 2 deaths in patients without ACLF and 33 deaths in patients with ACLF. The mean survival for patients without ACLF was 26.93 days, compared to 14.6 days for those with ACLF, p < 0.001. Patients without renal injury had 3 deaths, while those with renal injury had 32 deaths. The mean survival for patients without renal injury was 25.65 days, compared to 16.17 days for those with renal injury, p < 0.001 (Figure 2) Conclusions: SBP in patients with cirrhosis is associated with a high mortality rate. However, several factors such as treatment response, the presence of ACLF, and renal injury have a significant impact on patient survival.

Introduction and Objectives: Cirrhosis is a prevalent disease worldwide, with complications such as acute kidney injury (AKI) that increase the risk of fatal outcomes. A high BUN/creatinine ratio (IBC) has been associated with mortality in other diseases Therefore, evaluating this index in patients with cirrhosis could predict mortality. To determine whether a high BUN/creatinine ratio is associated with mortality in patients with cirrhosis and AKI. Materials and Patients: Retrospective analysis was conducted on a cohort of cirrhotic patients with and without AKI, calculating the IBC and assessing its association with mortality. Results: A total of 201 patients with cirrhosis were included, of whom 106 were male (52.73%), with a mean age of 55±10.4 years. The distribution of Child Pugh scores was as follows: A (25, 12.43%), B (70, 34.82%), and C (106, 52.73%); the mean MELD-Na score was 21.8±9.45. The cumulative mortality rate at 28 days was 37 (18.4%) and at 90 days was 39 (24.4%). The model was not significant at 28 days but was significant at 90 days with a X2 value of 48.18 (2) and p20 mg/dl vs. 20 mg/dl) could predict mortality in patients with cirrhosis, as the odds ratios at 28 and 90 days were significant.

Introduction and Objectives: : Patients with hepatic cirrhosis (HC) are at risk of developing acute kidney injury (AKI) due to multiple factors. The main types of AKI are hypovolemia, acute tubular necrosis (ATN), and urinary obstruction. Common causes of HC include MAFLD, alcohol consumption, viral and autoimmune diseases, which may have a different role in the risk for AKI and mortality. This study aims to assess the etiology of cirrhosis in the development of acute kidney injury (AKI) and mortality. Materials and Patients: Retrospective, analytical, observational study of patients with CH, analyzing etiology, type of AKI, and mortality. Statistical analysis: Using the Log-Rank test, the Kaplan-Meier curve was performed considering death at 28 and 90 days to assess the mortality rate associated with etiology. The Chi-square test with Bonferroni correction was conducted to evaluate the association between etiology and type of AKI; a significance level of ≤ 0.05 was considered. Results: A total of 201 patients with CH were included, 106 of them being male (52.73%), with an average age of 55 ± 10.4 years. Child-Pugh classification distribution was as follows: A: 25 (12.43%), B: 70 (34.82%), and C: 106 (52.73%). The average MELD-Na score was 21.8 ± 9.45 points. The cumulative mortality rate at 28 days was 18.4% (37); the comparison by etiology showed statistical significance with a Chi-square test of 13.23 (4), p=0.01. The mean survival for MAFLD was 27.7, alcohol-related was 23.8, autoimmune was 24.1, viral was 25.92, and dual etiology was 22.56, with an overall survival of 24.88. The comparison at 90 days was significant, with a Chi-square test of 10.46 (4), p=0.033, and a cumulative mortality rate of 24.4% (49). The mean survival for MAFLD was 86.82, alcohol-related was 70.02, autoimmune was 67.03, viral was 80.07, dual etiology was 66.56, and the overall survival was 74.84. Association tests between etiology and type of renal injury showed statistical significance, with a Chi-square test of 29.65 (8), p=

Introduction and Objectives: : The development of acute kidney injury (AKI) in cirrhotic patients is of multifactorial origin, including urinary tract infection, diuretics, portal hypertension, shock, etc. Another important factor is cholemic nephrosis, it is considered when total bilirubin exceeds 20 mg/dl, this implies that bile pigments damage the distal tubule with deterioration of renal function, increasing morbidity and mortality. This study aimed to evaluate the levels of hyperbilrubinemia in the development of AKI and its association with biomarkers of renal failure. Materials and Patients: : Retrospective and analytical study of a cohort of cirrhotic patients, to evaluate the development of AKI associated with bilirubin levels. Statistical analysis: A binary logistic regression model was performed considering bilirubin (greater than 20), NGAL (greater than 150) and cystatin (greater than 0.95) as associated factors. The significance of the model was considered with an alpha level less than 0.05. Results: 109 patients were included, 45 women 64 men, age 54.67 ± 11.6, Child Pugh A: 2, B: 29, C: 78. The binary logistic model was significant W(1)=11.089, p=0.001. The OR for bilirubin was 4.37 (1.168-16.35, 95% CI P=.027), for NGAL OR 2.7 (1.08-6.71, 95% CI; p=.032), cystatin 0.64 (0.35-11.66, CI 95%; p=0.764) not significant. Conclusions: Hyperbilirubinemia increases the risk of developing AKI by up to 4 times. The useful biomarker for AKI was NGAL.

Introduction and Objectives: Hepatic encephalopathy (HE) is a common and serious complication of cirrhosis, associated with high morbidity and mortality. Ammonia and inflammation are the main triggers of HE. The use of L-ornithine-L-aspartate (LOLA) provides precursor substances for glutamine synthesis in perivenous cells, accelerating ammonia detoxification.This study aims to evaluate the efficacy and safety of intravenous L-ornithine-L-aspartate (LOLA) in patients with grade III-IV hepatic encephalopathy (HE). Materials and Patients: Retrospective and analytical study of patients with grade III-IV hepatic encephalopathy (HE).All patients received intravenous LOLA 50 g for up to 48 hours, excluding those with renal failure. Descriptive statistics with measures of central tendency and dispersion were performed. Improvement was considered when HE regressed by at least one grade, and adverse events were evaluated. Results: A total of 32 patients were included, with a mean age of 55 years ± 9.6. There were 13 females (40.6%) and 19 males (59.4%). Eight patients (25%) were classified as Child-Pugh B, while 24 patients (75%) were classified as Child-Pugh C. The mean MELD score was 19.03 ± 6.08, and the mean MELD NA score was 7.19 ± 7.19. The most common etiology was alcohol-related (43.8%), followed by MAFLD (29.1%) and viral (9.5%). All patients had grade III hepatic encephalopathy. The precipitating factors were sepsis (53%), hemorrhage (25%), constipation (12.5%), diuretics (6.3%), and electrolyte imbalance (3.1%). A total of 24 patients (75%) responded to the treatment, while 8 patients (25%) did not. Nineteen patients were found to have some degree of acute-on-chronic liver failure (ACLF). No adverse events were reported. Conclusions: The use of intravenous LOLA for the treatment of grade III-IV hepatic encephalopathy iseffective and safe. These results support the use of LOLA as a therapeutic option in the management of hepatic encephalopathy in this patient population.

Introduction and Objectives: Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis, minimal hepatic encephalopathy (MHE) is the initial stage and is characterized by the fact that it has no clinical data, its diagnosis is made with neuropsychological tests, the MHE produces a deterioration in the quality of life of patients and an increased risk of accidents. Hence, it is relevant to diagnose. Performing neuropsychological tests requires prolonged time, so validating an MHE count test that is easy, reproducible, and in less time is recommended. The simplified-animal naming test (S-ANT) test is performed by asking the patient to nominate 20 animals in one minute. In the reference cutoff for the non-Mexican population, a score lower than 15 suggests MHE.We aimed to assess the validity of the S-ANT scale as a screening test in patients with cirrhosis without overt HE. Materials and Patients: We present a prospective, descriptive, and analytical study of patients with cirrhosis of different etiology without overt HE who underwent S-ANT, PHES, and Flicker tests. We determine the area under the receiver operator characteristic (AUROC) curve to validate the S-ANT test. MHE was detected if the PHES and Flicker tests were abnormal.We compared the S-ANT scores of both groups with and without MHE with the student's t-test for independent groups. Sensitivity (S) and specificity (SE) were calculated with the AUROC cutoff point for MHE. Results: Detection of MHE was in 12/83 patients (14.5%); 43 (51.83%) women, mean age 52.7 ± 7.5 years, median schooling 8.3 years (range 0-17), the etiology of cirrhosis was: 39 (47.0%) alcohol, 9 (28.9%) primary biliary cirrhosis, 17 (20.5%) metabolic fatty liver, 18 (21.7%) hepatitis C virus According to Child-Pugh: 57 (68.7%) A, 25 (30.1%) B, and 1 (1.2%) C. The mean S-ANT for non-MHE was 19.35±5.4, and for MHE, 14.7±5.6, p=0.024 AUROC was significant .760 (.577- .942, 95%CI); p=0.037 with S=83% and SE=77% cutoff= 17.5 words, which is higher than for other populations. Conclusions: In the Mexican population, S-ANT reliably discriminates against patients with cirrhosis without overt HE with cognitive impairment, confirmed by PHES and Flicker test

Introduction and Objectives: Patients with decompensated cirrhosis are at risk of variceal hemorrhage, which increases the risk of mortality. Validated scales exist to assess this risk, but there is currently no scale that evaluates the risk of variceal hemorrhage and death simultaneously. The MELDNa AGIB (acute gastrointestinal bleeding) scale incorporates sodium (Na) levels, albumin levels, the corrected QT interval (QTc), and a history of hemorrhage to calculate mortality at 6 weeks. While it has been evaluated in other centers, further studies are needed to validate its utility. To evaluate the MELDNa-AGIB scale for predicting the risk of mortality in decompensated cirrhotic patients. Materials and Patients: This was a retrospective, analytical, observational study conducted on a cohort of patients with decompensated cirrhosis and variceal hemorrhage. The MELDNAAGIB scale was calculated for each patient and compared with other scoring systems, including MELD, MELD NA, MELD LACTATE, and MELD 3.0, to assess its effectiveness. Statistical analysis involved the construction of ROC curves to determine the prognostic value of each scoring system in predicting mortality among patients with variceal bleeding. A significance level of p456ms) as calculated using the Fridericia formula, and 67.2% had a history of previous variceal hemorrhage. The MELDNa-AGIB scale demonstrated an area under the receiver operating characteristic (AUROC) curve of 0.849 (95% confidence interval: 0.681-0.950, p=0.004), with a sensitivity of 87.5% and specificity of 83% when a cutoff point of 17 was applied for MELDNa-AGIB. The AUROC for predicting mortality was significantly lower for MELD/Lactate. Conclusions: Although the study group was small, the MELDNaAGIB scale showed significant performance in predicting 6-week mortality in patients who developed variceal hemorrhage.

Introduction and Objectives: Alcoholic Hepatitis (AH) causes acute inflammation of the liver. The prognosis depends on the recovery of the liver from rapid improvement to multi-organ failure and death. There are scales that establish the prognosis and respond to steroid in AH, based on biochemical markers, none uses lactate levels. The lactate level in a patient with hepatitis may be increased. To determine if the MELD-Lactate scale is better than MELD for predicting with greater accuracy the severity and early mortality in patients with Alcoholic Hepatitis. Materials and Patients: Retrospective, retrollective and analytical study, from 2019 to 2022. The variables were obtained with laboratories upon admission, including lactate levels. The area under the curve for sensitivity and specificity was calculated for predictive scales and MELD-lactate to determine mortality at 28 and 90 days. Results: Include 70 patients, 59 men (84.2%) and 11 women (15.7%), age 43.2 ±9.8 years. The mortality at 28 days was 19 patients (27.1%) and at 90 days it was 18 patients (25.7%), a total of 37 (52%). The area under the curve for MELD-Lactate was in general mortality 0.823; 0.705-0.941 (sensibility 81.8% specificity 72.4%), at 28 days 0.874; 0.780-0.968 (sensibility 88.9%; specificity 71.3%) and 90 days there was no significance, compared with MELD which was general mortality 0.741; 0.603-0.878 (sensibility 81.8% specificity 66.1%), at 28 days MELD 0.766; 0.615-.916 (sensibility 88.9% specificity 63.3%) and at 90 days there was no significance, with the rest of the scales (MELD 3.0, ABIC, Maddrey, MELD- Na and Glasgow, it was less than that of MELD-Lactate. (Figure 1,2). Conclusions: Patients with severe AH have higher mortality, either early or late. In our study we showed that the MELD-lactate scale may be a better prognostic scale for early mortality in patients with alcohol hepatitis, since it showed a better performance than all the other scales used, although these results must be confirmed in other hospital centers, we can recommend their use.

Introduction and Objectives: Autoimmune liver disease is classified into 3 well-defined entities: autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis, there is a group of patients who show characteristics of more than one entity and is called overlap syndrome (OS), according to the Paris criteria they are classified, the prevalence of overlap in our country is low. We describe the clinical and biochemical characteristics of patients with OS treated at the liver clinic at the Hospital General de México. Materials and Patients: It is a retrospective and descriptive study, records of the autoimmune liver disease consultation were reviewed, searching for patients with OS using the Paris criteria in the period 2014-2023, descriptive statistics were performed with measures of central tendency and dispersion using SPSS 25.0. Results: 22 patients were included, all of them with liver biopsy, 95% women aged 47 ± 12.6 years, the most common phenotype was PBC/HAI (59%). The time to diagnosis from initial manifestations ranged from 1 to 6 years, the most frequent tests were ANA (81%), AMA (63%), ASMA (18%) and LKM1 (18%), Immunoglobulin G levels on average 2048 ±643.8. The most frequent comorbidities were systemic sclerosis, arterial hypertension and hypothyroidism, the predominant symptoms were fatigue and pruritus reported in 36%; 90% were cirrhotic, Child Pugh A 70%, B 25% and C 5%. The most frequent decompensation was variceal hemorrhage (22.7%), 4.7% reported portal thrombosis, and 2 patients were transplanted. Conclusions: Overlap syndromes are rare, we found the majority of patients are women with advancend stage of liver disease, the most frequent overlapping is PBC/HAI with a high proportion of positive serology tests and concordant biopsy, two patients underwent liver transplantation. It is important to always look for this rare syndrome.