Background & Aims Several clinical risk models have been proposed to stratify hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis C virus (HCV) after sustained virologic response (SVR). However, validation efforts have focused on monocentric or country-specific cohorts, and it is unclear if clinical risk models can be broadly applied to global populations. We characterised regional variation in model performance for HCC risk stratification in post-SVR patients.Methods Four HCC clinical risk models (aMAP score, FIB-4 index, GES score, and Toronto HCC risk index [THRI]) were analysed in six real-world cohorts, which included 8796 post-SVR patients from different geographic regions globally. Model discrimination was assessed using Harrel's c-statistic index. HCC incidence rates were compared across low-, intermediate-, and high-risk groups for each model.Results Distributions of patient characteristics and HCC incidence rates varied across geographic regions. Predictive performances of models were comparable within each cohort despite the model with the highest c-statistics differing by regions. Performance was lower than those from original reports overall; c-statistics of models across most regions remained below 0.70.Conclusions There remains a continued need to improve discrimination and calibration of clinical models to stratify HCC risk in post-SVR patients. Accuracy of models may differ by geographic region, underscoring the importance of external validation to assess transportability of models and suggesting no single model can be universally applied.

Autoimmune hepatitis (AIH) is an immune-mediated inflammatory disorder. It is a highly heterogeneous entity, having a wide range of presentations from asymptomatic chronic hepatitis to cirrhosis and acute liver failure. In consonance with the variabilities in presentation, there are also variations in response to treatment, depending on disease phenotype, presentation, extent of fibrosis, and the presence of comorbidities. In addition, pediatric AIH and AIH postliver transplant have their individual nuances. Addressing such areas to identify strategies for best practices is an unmet goal in this population of "difficult to treat" AIH. While established guidelines exist for AIH overall, specific guidance documents for phenotypes of difficult-to-treat AIH are lacking. The current document provides consensus-based guidance statements on definitions and criteria for determining difficult-to-treat AIH, encompassing the spectrum from acute AIH to AIH with compensated and decompensated cirrhosis, drug-induced autoimmune-like hepatitis, overlap syndromes, AIH in the presence of pregnancy, unique populations of pediatrics and postliver transplant AIH, and the impact of concomitant comorbidities.

This article examines the dynamics of COVID-19 regarding transmission rates and loss of immunity, utilizing a system of ODEs that encompasses the impacts of quarantine and vaccination, including the incidence rate. Our methodology aims to understand the consequences of vaccination and quarantine through the utilization of the fundamental reproduction number (R0). The stability study indicates that if R0 < 1, the disease-free equilibrium points are locally and globally asymptotically stable, whereas the endemic point is stable for R0 > 1. Finally, we use Python software to draw some characteristics of the covid-19 virus and to identify the effective parameters for spreading this disease by sensitivity diagrams and the simulation results agree with our qualitative study.

Background: Alcohol-related liver disease (ALD), encompassing cirrhosis and alcoholic hepatitis, poses a significant global health burden with high morbidity and mortality. Limited data exist on hospitalization trends in Ayodhya, Uttar Pradesh. The objective is to evaluate clinical profiles, complications, and outcomes of patients hospitalized with alcohol-related cirrhosis (ARC) and alcoholic hepatitis (AH) in a tertiary care center. Material and Methods: A retrospective analysis of 150 patients admitted between January–December 2022 was conducted. Data included demographics, clinical parameters, laboratory values, complications, and mortality. Groups (ARC vs. AH) were compared using chi-square and t-tests. Results: Mean age was 48.2 ± 9.8 years; 86.7% were male. AH patients (n=62) had higher bilirubin (12.4 ± 5.2 mg/dL vs. 5.1 ± 2.8 mg/dL; p<0.001) and mortality (25.8% vs. 10.9%; p=0.012) than ARC patients (n=88). Ascites (68.0%) was the most common complication. In-hospital mortality was 16.0%, significantly associated with hepatic encephalopathy (p=0.003) and infection (p=0.008). Conclusion: ALD hospitalizations predominantly affect middle-aged males with high complication rates. AH correlates with severe liver dysfunction and mortality, underscoring the need for early intervention. Keywords: Alcohol-related cirrhosis, alcoholic hepatitis, hospitalization, mortality, complications, retrospective study.

Achieving a “functional” cure for chronic hepatitis B (HBV) is primary goal for novel antiviral treatments. We sought to evaluate efficacy and safety of these novel treatments and identified emerging barriers to achieving a functional cure. We systematically reviewed clinical trials from 2018 to 2023, identifying 244 trials from clinicaltrials.gov records on HBV. The primary outcome was functional cure rate at the end of follow-up (EOF). Secondary outcomes included changes in HBsAg levels, HBsAg loss rates, HBV DNA rebound, and adverse events. Meta-analysis was performed. Our meta-analysis of 19 studies involving 1789 non-cirrhotic HBV patients found a minimal functional cure rate (0.0

The cut-offs of viscoelastic hemostatic assays used for guiding blood products transfusion in patients with cirrhosis undergoing invasive procedures are arbitrary. The aim of this study was to evaluate the efficacy and safety of two different ROTEM thresholds [“relaxed” ROTEM thresholds vs. “conventional” thresholds used in liver transplantation] for prophylactic blood product transfusion for invasive procedures in advanced cirrhosis patients with impaired traditional coagulation. Patients with advanced cirrhosis scheduled to undergo invasive procedures with high inherent procedure bleeding risk or low inherent procedure bleeding risk along with the presence of any adverse patient specific factors, and abnormalities on conventional coagulation tests requiring correction (any of the following: platelet count < 30 × 109/L, INR > 2.0, and plasma fibrinogen < 100 mg/dL), were randomized to receive correction based on standard ROTEM criteria (n = 519, MELD = 26.5 ± 7.4, CTP score = 12.4 ± 2.3, intrinsic low-risk procedure with any high-risk patient factors = 72.2

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.

Background: Studies show that the Neutrophil Percentage-to-Albumin Ratio (NPAR) predicts mortality in a number of illnesses. On the other hand, there is currently limited clinical support for using NPAR in liver cirrhosis patients. Investigating the associated of NPAR and hospital mortality outcome patients with liver cirrhosis is the goal of this study. Methods: All cirrhosis patients who were admitted to the hospital were included in this retrospective cohort analysis. The percentage of neutrophils and albumin levels on the first day of hospitalization were compared to determine the NPAR. Data were analyzed using the Mann-Whitney test, operating curve (ROC) analysis, and Kaplan-Meier survival curves. P-value 0.05 was considered statistically significant. Results: This study included 98 patients with liver cirrhosis. It was found that NPAR had a high incidence of patient mortality compared to surviving patients who were hospitalised (35.13 vs. 25.33, p 0.001). The median overall survival for all subjects was 10 days, indicating that 50% of the subjects had died within 10 days. According to ROC analysis, NPAR has an ideal cutoff value of 29.63 and can be utilized as a predictor of in-hospital mortality (sensitivity 74.1%, specificity 72.7%, AUC 0.8, p 0.001). Survival analysis stratified by NPAR showed that patients with NPAR ≥ 29.63 had a lower median survival compared to those with NPAR 29.6. Conclusion: In patients with liver cirrhosis, the Neutrophil Percentage-to-Albumin Ratio (NPAR) is a metric that can be used to assess in-hospital mortality outcomes

Background: Hepatitis C virus (HCV) remains a significant public health issue in India due to lack of awareness. This research assessed the knowledge, attitudes and practices of university students regarding HCV. Methods: A cross-sectional study design was conducted among 390 students. Random sampling technique was used to select the participants. Data was collected by using a questionnaire included four sections which are demographic, knowledge, attitude and practices and were analyzed using descriptive statistics and chi-square tests Results: Although majority of the students (65.6%) had heard of HCV and 60.8% correctly identified it as a viral liver infection, many misconceptions persisted including the belief that a vaccine is available (55.7%). Risky behaviors such as receiving injections from unregistered practitioners (8.7%) and sharing personal items (39.5% not always avoiding) were reported. A significant association was found between education level and comfort in interacting with HCV-positive individuals (p=0.006). Conclusions: These findings highlight the urgent need for targeted educational interventions to improve awareness and reduce stigma regarding HCV disease.

Introduction:Fenofibrate forms the standard of care for managing hypertriglyceridemia. Many of these patients have associated metabolic dysfunction-associated steatotic liver disease (MASLD). No systematic review and meta-analysis (SRM) has analysed the impact of fenofibrate in MASLD. Hence, we undertook this SRM. Methods:Electronic databases were searched for randomised controlled trials (RCTs) involving MASLD patients receiving fenofibrate as an intervention and placebo/active comparator as control. The primary outcome was changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Secondary outcomes were alterations in liver fat (ultrasonography or magnetic resonance imaging), lipid parameters, and adverse events. Results:From initially screened 395 articles, data from 5 RCTs were analysed. Fenofibrate had comparable changes in ALT (mean difference [MD]-0.32 IU/L [95% confidence interval [CI]: -6.70-7.33]; P = 0.931; I 2 = 60%) and AST (MD-0.17 IU/L [95% CI: -3.83-3.48]; P = 0.932; I 2 = 31%) as compared to active controls (atorvastatin, omega-3 fatty acids [O3FA] and pioglitazone). Fenofibrate users had a greater increase in liver-fat content as compared to active controls (pioglitazone and O3FA) (MD 5.37 [95% CI: 0.30-10.44]; P = 0.041; I 2 = 85%). O3FA and pioglitazone use is associated with reduction in liver fat, which explains the apparent increase in liver fat with fenofibrate in our analysis. Fenofibrate was associated with a significantly greater decrease in triglycerides compared to active controls (MD-0.22 mmol/l [95% CI: -0.31--0.12]; P < 0.001; I 2 = 0%). Fenofibrate was associated with comparable change in total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, weight, and waist circumference compared to active controls. Conclusion:This SRM provides us with reassuring safety data on use of fenofibrate in MASLD. Fenofibrate is largely MASLD neutral and continues to have good triglyceride lowering properties in MASLD.

Background: The association between cardiovascular disease and advanced liver disease is incompletely understood. To explore this interaction, we compared management, clinical outcomes, readmission rates, and resource utilization in ST-elevation myocardial infarction (STEMI) patients with and without liver disease. Methods: The Nationwide Readmissions Database (2016-2020) was queried to identify hospitalizations for STEMI. Cohorts were stratified by presence of liver disease. Liver disease was defined as documented diagnosis of liver cirrhosis or liver failure. Multivariable regression model and propensity score matching was used to compare the risk of outcomes. Results: Among 1,029,608 hospitalizations for STEMI; 45,478 (4.4 %) patients had a history of significant liver disease. Patient with liver disease had higher baseline prevalence of diabetes, chronic kidney disease, anemia, and heart failure. After propensity matching (N = 24,067 in each group), patients with liver disease had higher in-hospital mortality (48.8 % vs 17.3 %, aOR: 6.80 [CI: 6.55-7.06], p G 0.001) and adverse events, including cerebrovascular accidents (6.8% vs 4.4%, aOR:1.74 [CI: 1.62-1.86], p G 0.001), cardiac arrest (24.4% vs 10.3 %, aOR:3.34 [CI: 3.21-3.48], p G 0.001), cardiogenic shock (55.9 % vs 21.1 %, aOR: 6.4 [CI: 6.18-6.64], p G 0.001), mechanical circulatory support requirement (36.2 % vs 14.4%, aOR: 4.2 [CI: 4.01-4.34], p G 0.001), and major adverse cardiovascular and cerebrovascular events (61.1 % vs 25.3 %, aOR:6.5 [CI: 6.28-6.75], p G 0.001). From 2016 to 2020, in-hospital mortality for STEMI did not change significantly for patients with liver disease (47.4 % to 48.6 %p-trend: 0.826), however percutaneous coronary intervention (PCI) use increased from 43.6 % to 52.2 % (p-trend G0.001).