Purpose:To identify risk factors for bacterial intra-abdominal infections (IAIs) after orthotopic liver transplantation (OLT) and establish a nomogram prediction model based on preoperative neutrophil-to-lymphocyte ratio (NLR) and preoperative prothrombin time-international normalized ratio (PT-INR)-to-albumin ratio (PTAR). Patients and Methods:We retrospectively analyzed 261 patients who received OLT between January 2020 and April 2024 in Beijing Friendship Hospital. Independent risk factors for bacterial IAIs within 30 days postoperatively were identified by logical regression analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was calculated to evaluate the predictive performance of NLR and PTAR as well as the nomogram model based on them. Hepatic function was evaluated using the Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) score. Results:Fifty patients (19.2%, 50/261) developed postoperative bacterial IAIs. The majority of the 66 isolated strains were gram-negative (63.6%). Most infections (74.0%, 37/50) occurred within two weeks postoperatively. Multivariate logistic regression analysis identified preoperative NLR, preoperative PTAR, acute physiology and chronic health evaluation II (APACHE II) score, and biliary leakage as independent risk factors. A nomogram-based prediction model was constructed utilizing the identified independent risk factors. Internal validation was conducted through the bootstrap method. The Hosmer-Lemeshow test indicated no significant deviation from the goodness-of-fit (χ2 = 7.349, P = 0.499 > 0.05). The calibration curve indicated excellent concordance between predicted and observed outcomes. The nomogram exhibited strong discriminative capability, evidenced by a C-index of 0.900 (95% CI: 0.828-0.972) and an AUC of 0.912 (95% CI: 0.864-0.960) for predicting abdominal infection, with an optimal diagnostic threshold of 0.221 (95% CI: 0.125-0.265). Decision curve analysis revealed a positive net benefit across a wide range of threshold probabilities (0.03-1.0), indicating the model's substantial clinical utility. Conclusion:Both the preoperative NLR and the preoperative PTAR are independent risk factors for IAIs within 30 days after OLT. The nomogram model based on NLR and PTAR can effectively predict the occurrence of IAIs after OLT.

Background and aims: Hepatopulmonary syndrome (HPS) is a risk factor for poor prognosis in patients with cirrhosis. However, Early diagnosis of HPS remains difficult. This study aimed to investigate some clinical indicators of HPS in early liver cirrhosis. Methods: A total of 188 hospitalized patients with cirrhosis who completed transthoracic contrast echocardiography for the detection of pulmonary vasodilation were included in this study. HPS was diagnosed according to the International Liver Transplant Society Practice Guidelines. Clinical characteristics and results of laboratory tests were evaluated. The risk factors were analyzed using multivariable logistic regression analysis. Results: In this retrospective observational single-center study , 11.7% (22/188) of hospitalized patients with cirrhosis had HPS, regardless of etiology. Almost all the identified patients were in the mild stage of the disease. The intrapulmonary vasodilation (IPVD) detection rate was as high as 29.8% (56/188). In patients with HPS, except for saturation of peripheral oxygen (SpO 2 ) ( p =0.001), no significant differences in demographic or clinical features were noted compared with patients without HPS. The area under the receiver operating characteristic curve of SpO 2 for discriminating HPS in patients with cirrhosis was 0.801 (95% confidence interval: 0.705–0.898). The optimal cut-off value was 95.5%. There were no independent risk factors for HPS. Conclusions: Lower levels of SpO 2 (<95.5%)were an important clinical indicator that helped to discriminate HPS in patients with cirrhosis. There were no obvious risk factors associated with HPS in this cohort.

Hepatic encephalopathy (HE) is a frequent and life-threatening neurological complication of acute liver failure (ALF) encountered in the intensive care unit and remains a major determinant of short-term mortality and long-term neurological outcomes. Increasing evidence indicates that HE in ALF is primarily driven by hyperammonemia, with synergistic contributions from systemic inflammation, cerebral hemodynamic dysregulation, metabolic failure, and osmotic imbalance. These interacting mechanisms promote astrocytic swelling, disruption of the blood-brain barrier, cerebral edema, and intracranial hypertension. In patients with ALF, early recognition of cerebral involvement and systematic exclusion of alternative causes of altered mental status are essential. Given the dynamic and heterogeneous neurological manifestations of HE, reliance on isolated clinical, biochemical, or radiological parameters is insufficient. Multimodal neuromonitoring-integrating neurological examination, ammonia kinetics, cerebral hemodynamic assessment, and neuroimaging-allows more accurate assessment of cerebral injury and supports timely, targeted intervention. This review summarizes current evidence on the pathophysiology of HE in ALF with a focus on mechanisms relevant to intensive care practice. We highlight evidence-based strategies for cerebral protection, including early and sustained control of hyperammonemia with continuous renal replacement therapy, optimization of cerebral perfusion and osmotic balance, selective use of plasma exchange, and structured neurocritical care. An integrated management framework is proposed to guide prognostication and inform timely decisions regarding advanced liver support and liver transplantation in the ICU setting.

Background: Early intra-abdominal infections (EIAIs) are among the most frequent and life-threatening complications following liver transplantation (LT). Early identification of high-risk patients remains challenging, and no standardized risk stratification tool is currently available. Objective: To develop and externally validate interpretable machine learning (ML) models for preoperative and postoperative prediction of EIAIs after LT. Design: A multicenter retrospective cohort study. Methods: A total of 363 adult LT recipients were included (Center 1: n = 285; Center 2: n = 78). EIAIs were defined as intra-abdominal infections occurring within 30 days after LT. From 120 candidate variables, predictors were selected using random forest, LASSO regression, and univariate logistic regression. Seven ML algorithms were evaluated, and stacking ensemble models were selected as the final preoperative (pre-liver transplantation early intra-abdominal infection forecast tool (LIFT)) and postoperative (post-LIFT) models. Internal testing and external validation were performed. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: The stacking models demonstrated superior performance. For pre-LIFT, the areas under receiver operator characteristic curve (ROC) curves (AUCs) were 0.995 ± 0.004 (training), 0.818 ± 0.056 (testing), and 0.796 ± 0.024 (external validation). For post-LIFT, AUCs were 0.996 ± 0.003, 0.847 ± 0.055, and 0.858 ± 0.026, respectively. Both models significantly outperformed model for end-stage liver disease and Child-Turcotte-Pugh scores (all p < 0.05). SHAP analysis revealed that baseline liver dysfunction, inflammatory markers, and immune status were key determinants in the pre-LIFT model, whereas perioperative factors such as intraoperative blood loss, ICU stay, and drainage duration predominated in the post-LIFT model. Conclusion: We developed and externally validated interpretable ML-based models (LIFT) for predicting EIAIs after LT. These models enable individualized risk stratification at both preoperative and postoperative stages and may support personalized infection surveillance and management strategies. Prospective validation is warranted.

To evaluate the clinical outcomes of liver transplantation (LT) in patients with Caroli syndrome. We retrospectively analyzed clinical data from 20 patients diagnosed with Caroli syndrome who underwent LT at Beijing Friendship Hospital, Capital Medical University, between April 2014 and May 2024. Data included baseline characteristics, surgical parameters, complications, and survival. Follow-up concluded in February 2025. These 20 cases accounted for 1.23

Purpose:To examine the clinical utility of metagenomic next-generation sequencing (mNGS) in individuals with early pulmonary infection following liver transplantation. Patients and Methods:mNGS and traditional detection results were retrospectively collected from 99 patients with pulmonary infection within one week following liver transplantation. These patients were admitted to the Department of Critical Liver Diseases at Beijing Friendship Hospital from February 2022 to February 2024, along with their general clinical data. Results:mNGS exhibited a significantly higher detection rate than traditional methods (92.93% vs 54.55%, P < 0.05) and was more effective in identifying mixed infections (67.68% vs 14.81%, P < 0.05). mNGS identified 303 pathogens in 92 patients, with Enterococcus faecium, Pneumocystis jirovecii, and human herpesvirus types 5 and 7 being the most prevalent bacteria, fungi, and viruses. A total of 26 positive cases were identified through traditional culture methods (sputum and bronchoalveolar lavage fluid), with 18 cases consistent with mNGS detection results, representing 69.23% consistency. Among the three drug-resistant bacteria that showed positivity in mNGS and traditional culture, the presence of drug-resistance genes-mecA in Staphylococcus aureus; KPC-2, KPC-9, KPC-18, KPC-26, OXA27, OXA423 in Klebsiella pneumoniae; and OXA488 and NDM6 in Pseudomonas aeruginosa-reliably predicted drug-resistance phenotype. The treatment regimen for 76 of the 92 patients with positive mNGS relied on these results; 74 exhibited significant symptom improvement, yielding a 97.37% recovery rate. The overall prognosis was favorable. Conclusion:mNGS offers rapid detection, a high positivity rate, insensitivity to antibiotics, and a superior ability to detect mixed infections in patients with early post-transplant pulmonary infections. Additionally, mNGS shows good consistency with traditional culture and can predict drug-resistant phenotypes to guide targeted antibiotic therapy for early-stage post-transplant pulmonary infection after liver transplantation. Patients whose antibiotic therapy is based on mNGS results have experienced decreased mortality rates and overall improved prognosis.

BackgroundHepatopulmonary syndrome (HPS) is a pulmonary vascular complication of chronic liver disease, which develops insidiously as a result of chronic liver disease. The prognosis for untreated patients with HPS is extremely poor, and liver transplantation (LT) serves as the only effective means for treating this condition. Here, we performed a retrospective analysis to evaluate the efficacy of LT on the survival and long-term prognosis of patients with HPS.MethodsClinical data, including survival and postoperative efficacy, from patients with HPS from records as obtained over the period from January 1 to December 31, 2022. All records were from a waiting list for LT at the Beijing Friendship Hospital Affiliated with Capital Medical University.ResultsAmong the 274 patients on the LT waiting list, 37 were diagnosed with HPS (13.50%) and were enrolled. Survival rates of patients with HPS receiving an LT were greater, whereas a statistically significant difference was obtained between patients with LT vs non-LT with moderate to severe HPS (P = .003). The overall time until death without LT was 4-72 days after their initial HPS diagnosis. Patients with HPS receiving an LT showed a significant improvement in the state of oxygenation after surgery (P = .001).ConclusionComprehensive preoperative screening of patients on the waiting list for LT is critical to identify those patients with HPS who would maximally benefit from LT. Survival rates of patients with moderate to severe HPS are significantly increased after LT, a procedure that should be performed as soon as possible in these patients with HPS.

胆道狭窄是肝移植的常见并发症.胆道狭窄和相关的胆管炎可导致各种不良后果.移植后胆道狭窄的治疗往往需要连续的治疗干预,包括扩张狭窄的胆道和置入支架.内窥镜逆行胰胆管造影和各种放射学指导下的胆道介入手术已被用于处理移植后的狭窄.最近美国胃肠道内镜协会发布的临床实践指南,为管理肝移植受者的胆道狭窄提供了循证的方法.

亚太肝病学会近期在Hepatol Int上在线发表了肝脏疾病腹水管理指南.这份指南为肝脏疾病患者腹水的管理提供了数据为支撑的临床路径,广泛回顾了肝硬化和慢加急性肝衰竭患者的腹水、低钠血症、肝性胸水和肝肾综合征的鉴别诊断、诊断评估和管理.

Background & AimsHepatocellular Carcinoma (HCC)is a leading cause of cancer mortality worldwide. This study was aimed at exploring the prognosis predictive ability of lipid metabolism related genes (LMRGs) in HCC and constructing a reliable risk model for clinical management.MethodsBioinformatics analysis of transcription data obtained from Therapeutically Applicable Research to Generate Effective Treatments (TARGET) and the International Cancer Genome Consortium (ICGC) database was utilized in this study. COX regression and consensus clustering were performed to identify two molecular subgroups based on LMRGs. Immune infiltrating analysis, KEGG, GSVA, and GO pathway analysis was applied to clarify the underlying mechanisms of LMRGs participated in the prognosis of HCC. We then performed LASSO-COX regression analysis to build the risk model and validate the model in an external HCC cohort from the ICGC database.ResultsWe identified two molecular subgroups with distinct overall survival based on the different expression profiles of LMRGs. The increased immune score and expression of immune checkpoints, altered immune cell subtypes, and dysregulated metabolic pathways were involved in the worse overall survival of the molecular subgroup with higher expression of the majority of LMRGs. The risk model based on four LMRGs including SRD5A3, PPARGC1A, HSD17B12, AKR1B15 and the integrated nomogram established with the four LMRGs and TNM stage performed reliable predictive ability of HCC prognosis both in the train set and validation set.ConclusionLMRG dysregulation is correlated with the immune microenvironment and various metabolic pathways in HCC. The risk model developed based on the expression of LMRGs could act as a potent predictor of HCC prognosis.

Objective:To explore the clinical efficacy and safety of Nirmatrelvir/Ritonavir in retreatment for patients with recurrence of coronavirus disease 2019 (COVID-19).Methods:The COVID-19 patients hospitalized in Beijing Ditan Hospital, Capital Medical University and received Nirmatrelvir/Ritonavir therapy from April 17 to June 17 2022 were investigated and the clinical data were analyzed.Results:The retreatment with Nirmatrelvir/Ritonavir for the patients with recurrence of COVID-19 remained effective. The median value of time from the start of retreatment to negative conversion of nucleic acid was 8 (7-10) days. None of the patients showed adverse drug reaction.Conclusions:No drug-related adverse reaction was observed within the treatment course of Nirmatrelvir/Ritonavir and the therapy may be beneficial to shorten hospitalization and quarantine.

Objective:To investigate the clinical efficacy of high-flow nasal cannula (HFNC) oxygen therapy as the respiratory support for severe coronavirus disease 2019 (COVID-19) patients, and to analyze the risk factors of HFNC oxygen therapy failure in the treatment of severe COVID-19.Methods:A retrospective analysis was performed on the clinical data of patients who received HFNC oxygen therapy and met the criteria for severe COVID-19 in the Department of Intensive Care Medicine, Beijing Ditan Hospital, Capital Medical University from January 2020 to June 2020. Patients were divided into HFNC success group and HFNC failure group according to applying non-invasive/invasive positive pressure ventilation or not in the following treatment. T test or chi-square test were used to compare the differences between the two groups in basic data, APACHEII score, laboratory data, basic oxygenation index, time from onset to HFNC usage, baseline ROX index, and respiratory rate, oxygenation index and ROX index at 2, 4 and 12 hours after HFNC treatment. The risk factors of HFNC treatment failure were then analyzed.Results:A total of 40 patients were enrolled in the clinical study. Twenty-one patients (52.5%) successed in HFNC treatment and 19 patients (47.5%) failed. There were no significant differences between the success group and failure group in basic data, laboratory data, basal oxygenation index, time from onset to HFNC use, baseline ROX index, respiratory rate and oxygenation index at 2 h, 4 h and 12 h after HFNC treatment ( P>0.05). There were significant differences between the two groups in APACHEII score and ROX index at 2h, 4h and 12h after HFNC treatment ( P<0.05). Logistic regression analysis showed that APACHEII score and ROX index were independent risk factors for HFNC treatment failure. Conclusions:HFNC can be used as the respiratory support for severe COVID-19, and ROX index monitoring was a key factor in evaluating the success of HFNC treatment.

Objective To evaluate the value of Swansea diagnostic criteria in the diagnosis of patients with acute fatty liver of pregnancy (AFLP) in China. Methods The clinical data of patients discharged with AFLP in Beijing Ditan Hospital, Capital Medical University from January 1996 to March 2017 were retrospectively analyzed by using Swansea diagnostic criteria. The accuracy of Swansea diagnostic criteria for AFLP diagnosis, the major complications of maternal and fetus and the incidence of blood purification therapy at different score thresholds were evaluated. Results From January 1996 to March 2017, a total of 70 patients were diagnosed with AFLP. There were 65 cases (92.8%) whose Swansea diagnostic criteria score greater ≥6, the distribution was 3~13 and the average value was 8.6 ± 2.2. The major abnormal issues were elevated transaminase (69/70, 98.6%), elevated jaundice (67/70, 95.7%), elevated white blood cells (61/70, 87.1%), coagulation dysfunction (50/70, 71.4%), renal insufficiency (50/70, 71.4%), ascites or bright liver showed by ultrasonography (50/70, 71.4%) and renal insufficiency (50/70, 71.4%). The study found that with the score increased, the incidence of serious complications such as postpartum hemorrhage, liver failure, acute kidney injury, pulmonary infection and the need for blood purification support were gradually increased except premature delivery. Conclusion Swansea diagnostic criteria can diagnose AFLP accurately, the score can reflect the severity of the disease and the intensity of treatment intervention.

中性粒细胞胞外诱捕网(NETs)是人体正常的先天性防御系统的一部分,是中性粒细胞释放的一种可以直接捕获微生物网状纤维结构.但NETs的组分可以直接或间接导致组织损伤和诱发机体自身免疫反应,进而造成机体损伤,尤其是急性肾损伤(AKI).NETs相关的肾脏疾病的组织损伤介质主要包括DNA、组蛋白、中性粒细胞弹性蛋白酶、自身抗体和补体等,与缺血再灌注、溶血性尿毒症综合征、抗中性粒细胞胞质抗体相关血管炎、系统性红斑狼疮、血栓性微血管病等疾病合并AKI有关.针对每种疾病类型制订个性化治疗干预措施对AKI的控制可能有一定的帮助.