BACKGROUND:Alcohol-associated hepatitis (AH), characterized by severe inflammation of the liver among patients with heavy alcohol use, has been associated with increased susceptibility to developing infections. This study evaluates the trends, burden, and impact of infections on the clinical course of AH. METHODS:Data from the 2016 to 2022 National Inpatient Sample database were used to identify adult patients with AH. Patients were stratified into 2 groups: those with and without infections. We collected data on patient demographics, liver-related decompensations, comorbidities, and outcomes [in-hospital mortality, sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and thrombotic events]. Multivariate logistic/linear regression analysis was used to assess the impact of infections on these outcomes. RESULTS:Among the 917,345 patients with AH, 186,655 (20.3%) developed infections. The most frequent infections observed included urinary tract infection (9%), pneumonia (6.0%), and skin/soft tissue infections (2.7%). After adjusting for confounding factors, patients with infections had higher odds of in-hospital mortality (aOR: 1.84, 95% CI: 1.75-1.95), sepsis (aOR: 1.87, 95% CI: 1.77-1.97), AKI (aOR: 1.78, 95% CI: 1.73-1.84), shock (aOR: 2.54, 95% CI: 2.43-2.65), ICU admissions (aOR: 2.52, 95% CI: 2.42-2.63), pulmonary embolism (aOR: 2.02, 95% CI: 1.74-2.35), and deep vein thrombosis (aOR: 2.39, 95% CI: 2.13-2.70), (all P<0.001). CONCLUSIONS:The development of systemic infections in patients with AH leads to worse clinical outcomes. Early identification, management, and prevention are necessary to prevent adverse outcomes and improve the overall prognosis among these patients.

Background: Patients with cirrhosis have impaired immunity, predisposing them to severe infections. Streptococcus pneumoniae, a leading cause of community-acquired pneumonia, may worsen outcomes in this vulnerable patient population. This study aims to evaluate the burden and impact of pneumococcal pneumonia among patients with cirrhosis. Methods: The National Inpatient Sample database (2016-2022) was used to identify adult hospitalizations with cirrhosis. Patients were stratified by the presence or absence of pneumococcal pneumonia. Data were obtained on demographics, liver disease etiology and de-compensations, comorbidities, and clinical outcomes. A multivariate logistic/linear regression analysis was used to assess the impact of pneumococcal pneumonia on clinical outcomes. Results: Among 4,716,863 patients with cirrhosis, 90,680 (1.92%) developed pneumococcal pneumonia. Patients with pneumococcal pneumonia had higher odds of in-hospital mortality (adjusted odds ratio (aOR): 2.95, 95% confidence interval (CI): 2.84-3.09), acute kidney injury (aOR: 1.85, 95% CI: 1.79-1.91), shock (aOR: 4.75, 95% CI: 4.58-4.93), intensive care unit admissions (aOR: 7.55, 95% CI: 7.28-7.83), non-home discharges (aOR: 2.29, 95% CI: 2.21-2.38), longer length of stay (adjusted coefficient: 6.61 days, 95% CI: 6.38-6.83), and higher hospitalization charges (adjusted coefficient: $112,230.5, 95% CI: $106,802.3-$117,658.7) (all P < 0.001). Conclusion: We noted an increased in-hospital mortality and higher resource utilization among patients with pneumococcal pneumonia. These findings underscore the importance of targeted preventive strategies, including pneumococcal vaccination and early infection recognition, to reduce morbidity and healthcare burden in this vulnerable population.

Introduction: Liver transplant (LT) recipients are at high risk of infections due to chronic immunosuppression, complex perioperative factors, and preexisting malnutrition. These infections significantly contribute to increased morbidity, mortality, and health care utilization. This study aimed to evaluate the burden and impact of infections on in-hospital outcomes among LT recipients. Methods: We conducted a retrospective analysis using the National Inpatient Sample (NIS) database from 2016 to 2022 to identify LT recipients. Patients were stratified into 2 groups based on the presence of infections. Demographic characteristics, underlying liver disease, liver-related decompensations, comorbidities, and clinical outcomes were analyzed. Multivariate logistic and linear regression models were used to assess the independent impact of infections on outcomes. Results: Among 247,955 LT recipients, 84,660 (34.1%) developed infections during hospitalization. The most frequently observed infections were pneumonia (12.8%), urinary tract infections (10.7%), and skin and soft tissue infections (5.2%). After adjustment for potential confounders, infections were significantly associated with increased odds of in-hospital mortality (adjusted odds ratio: 2.17; 95% CI: 1.93 to 2.43; P < 0.001), prolonged length of stay (adjusted coefficient: 2.34 d; 95% CI: 2.15 to 2.53; P < 0.001), and higher total hospitalization charges (adjusted coefficient: $25,424.53; 95% CI: $22,068.63 to $28,780.42; P < 0.001). Conclusion: Infections remain a common and clinically significant complication in LT recipients, leading to worse hospital outcomes. These findings highlight the importance of early identification, preventive strategies, and optimized management to improve posttransplant outcomes and reduce health care burden.

Background:Cirrhosis is associated with immune dysfunction, which increases susceptibility to bacterial infections and contributes significantly to patient morbidity and mortality. Understanding the burden and impact of infections in this population is essential for improving outcomes and reducing health care costs.Methods:We analyzed data from the National Inpatient Sample (NIS) database from 2016 to 2022, identifying adult patients hospitalized with cirrhosis. Patients were stratified based on the presence or absence of infections. Collected variables included patient demographics, etiology of cirrhosis, decompensation status, and adverse outcomes. Multivariate logistic and linear regression analyses were used to evaluate the impact of infections on clinical outcomes and health care utilization.Results:Among 5,061,228 patients with cirrhosis, 1.51 million (30%) developed infections. The infected group was predominantly 45 to 65 years old (48.2%), male (54%), and White (68%). Common infections included urinary tract infections (11.5%), pneumonia (9.6%), skin and soft tissue infections (6.2%), spontaneous bacterial peritonitis (3.2%), Clostridioides difficile infection (1.8%), and cholangitis (0.8%). Compared with patients without infections, infected patients had higher rates of in-hospital mortality (9.7% vs. 4.7%), sepsis (31.6% vs. 6.9%), acute kidney injury (39.4% vs. 26.8%), ICU admissions (12.5% vs. 6.1%), deep vein thrombosis (2.1% vs. 1.2%), and pulmonary embolism (1% vs. 0.7%).Conclusions:Infections substantially worsen clinical outcomes and increase health care burden among hospitalized patients with cirrhosis. Early identification, preventive strategies, and prompt management of infections are critical to improving prognosis and reducing associated health care costs.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated alcohol-related liver disease (MetALD) have emerged as increasingly important sources of morbidity among people living with human immunodeficiency virus (HIV). Advances in antiretroviral therapy have substantially improved life expectancy in people living with HIV (PLWH), but have also unmasked a growing burden of metabolic comorbidities which contribute to steatotic liver disease. Recent shifts in nomenclature and the introduction of MetALD emphasize metabolic dysfunction and graded alcohol exposure as central drivers of disease and are particularly relevant to PLWH, a population in whom overlapping metabolic and behavioral risk factors are common. Epidemiologic studies demonstrate that MASLD affects approximately one-third to one-half of PLWH worldwide, often occurring at younger ages and lower body mass index thresholds than in HIV-negative individuals. Emerging data further highlight the synergistic contribution of metabolic dysfunction and alcohol use to accelerated fibrosis progression in PLWH. Pathophysiologic mechanisms linking HIV infection to MASLD and MetALD include chronic immune activation and systemic inflammation, antiretroviral therapy-associated metabolic effects, altered adipose tissue distribution, gut-liver axis dysregulation, and alcohol-metabolic synergy. This review synthesizes contemporary evidence on the definitions, epidemiology, pathogenesis, clinical assessment, and management of MASLD and MetALD in PLWH.

Abstract Background: This umbrella review synthesizes evidence from meta-analyses and reviews comparing transarterial chemoembolization (TACE) combined with sorafenib versus monotherapy for unresectable hepatocellular carcinoma. Methods: Following PRIOR guidelines, PubMed, Google Scholar, Web of Science, and Embase were searched from inception to December 2024. Outcomes included overall survival (OS), time to progression (TTP), disease control rate (DCR), and objective response rate (ORR). Corrected covered area (CCA) assessed overlap, and methodological quality was evaluated using AMSTAR-2. Results: Of 13,821 records, 9 meta-analyses were included, with substantial overlap (CCA: 49%). Eight reviews assessed OS; five reported a significant survival benefit (hazard ratio [HR] 0.62–0.74, p < 0.001), while two found no significant effect (HR 0.75–0.97, p > 0.05). Eight evaluated TTP; six showed a significant reduction in risk (HR 0.61–0.75, p < 0.05), while two reported non-significant findings (HR 0.74–0.77, p > 0.05). Four assessed DCR; two reported a significant benefit (odds ratio [OR] 0.52–4.72, p < 0.01), one showed a non-significant trend (OR: 1.57, p = 0.06), and one found no significant effect (relative risk [RR] 1.04, p = 0.57). Six assessed ORR; three reported a significant increase in response (OR 2.19–3.59, p < 0.01), one showed a significant reduction (OR 0.85, p < 0.001), one found no significant effect (RR 1.20, p = 0.26), and one reported a significant protective effect (OR 0.39, p = 0.008). Conclusions: TACE plus sorafenib improves TTP, ORR, and OS in unresectable HCC and highlights the need for personalized treatment and further research.

Metabolic dysfunction-associated steatotic liver disease (MASLD), the updated terminology for fatty liver disease linked to metabolic dysfunction, is highly prevalent among individuals with type 2 diabetes mellitus (T2DM). MASLD affects a majority of patients with T2DM and markedly increases the risk of fibrosis, cirrhosis, hepatocellular carcinoma, and cardiovascular mortality. The pathogenesis in diabetic populations reflects a convergence of insulin resistance, dyslipidemia, mitochondrial dysfunction, chronic inflammation, and genetic predisposition. Advances in non-invasive diagnostics, including elastography and serum biomarkers, enable earlier identification and staging of disease, though limitations remain in diabetic cohorts. Lifestyle modification is the cornerstone of therapy, yet emerging pharmacotherapies are reshaping the therapeutic landscape. Antidiabetic agents such as glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, and pioglitazone show hepatic benefits beyond glycemic control, while novel agents and combination regimens are under active evaluation. This narrative review synthesizes current evidence on epidemiology, mechanisms, diagnostics, and therapeutics of MASLD in T2DM, and highlights future directions in precision medicine. Integration of multidisciplinary care is essential to address this converging epidemic.

Background and Objective:Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease, affecting approximately 30 percent of the population worldwide. Despite this high prevalence, the disease remains underdiagnosed, partially due to the low sensitivity of non-invasive tests (NITs) and reliance on invasive liver biopsies. This review aims to summarize the current literature regarding the role of artificial intelligence (AI) in optimizing the diagnosis and management of MASLD. Methods:We conducted a review of literature using the PubMed/MEDLINE database for English-language articles published from January 2005 through December 2025. The search focused on AI applications in MASLD, including machine learning (ML), deep learning (DL), and natural language processing (NLP). Key Content and Findings:AI tools can improve the diagnosis of MASLD from already existing data-laboratory results, radiology reports, magnetic resonance imaging (MRI) scans, and histopathology slides-by utilizing methods such as NLP. Beyond diagnosis, AI can predict critical outcomes, such as hepatic decompensation and mortality. Additionally, it plays an important role in digital therapeutics and mobile health interventions that can subsequently improve the clinical trajectory. Conclusions:AI holds the potential to transform MASLD care by improving diagnostic accuracy and personalizing management. However, widespread implementation will require addressing challenges related to data safety, standardization and validation in the general population.

Primary Biliary Cholangitis (PBC) is a cholestatic autoimmune liver disease of small bile ducts. Ursodeoxycholic acid (UDCA) was approved as a first line therapeutic option for PBC in 1997. It was later noted that 40