Decompensated Cirrhosis Patients Research Articles

Distinct immunometabolic signatures in circulating immune cells define disease outcome in acute-on-chronic liver failure.

Acute-on-chronic liver failure (ACLF) is a complication of cirrhosis characterized by multiple organ failure and high short-term mortality. The pathophysiology of ACLF involves elevated systemic inflammation leading to organ failure, along with immune dysfunction that heightens susceptibility to bacterial infections. However, it is unclear how these aspects are associated with recovery and non-recovery in ACLF. Here we mapped the single-cell transcriptome of circulating immune cells from ACLF-, acute decompensated (AD) cirrhosis patients and healthy individuals. We further interrogate how these findings as well as immunometabolic- and functional profiles associate with ACLF recovery (ACLF-R) or non-recovery (ACLF-NR). Our analysis unveiled two distinct states of classical monocytes (cMon). Hereto, ACLF-R cMons were characterized by transcripts associated with immune- and stress tolerance, including anti-inflammatory genes such as RETN and LGALS1. Additional metabolomic- and functional validation experiments implicated an elevated oxidative phosphorylation metabolic program as well as an impaired ACLF-R cMon functionality. Interestingly, we observed a common stress-induced tolerant state, oxidative phosphorylation program and blunted activation among lymphoid populations in ACLF-R patients. Conversely, ACLF-NR cMon featured elevated expression of inflammatory- and stress response genes such as VIM, LGALS2, and TREM1 along with blunted metabolic activity and increased functionality. This study identifies distinct immuno-metabolic cellular states that contribute to disease outcome in ACLF patients. Our findings provide valuable insights into the pathogenesis of ACLF, shedding light on factors driving either recovery or non-recovery phenotypes which may be harnessed as potential therapeutic targets in the future.

Edmonton Symptom Assessment System is a Valid Tool to Measure Symptom Burden Among Decompensated Cirrhosis Patients (GP119)

Edmonton Symptom Assessment System is a Valid Tool to Measure Symptom Burden Among Decompensated Cirrhosis Patients (GP119)

Efficacy of fresh frozen plasma transfusion in decompensated cirrhosis patients with coagulopathy admitted to ICU: a retrospective cohort study from MIMIC-IV database

We aimed to explore the association between FFP transfusion and outcomes of DC patients with significant coagulopathy. A total of 693 DC patients with significant coagulopathy were analyzed with 233 patients per group after propensity score matching (PSM). Patients who received FFP transfusion were matched with those receiving conventional therapy via PSM. Regression analysis showed FFP transfusion had no benefit in 30-day (HR: 1.08, 95% CI 0.83–1.4), 90-day (HR: 1.03, 95% CI 0.80–1.31) and in-hospital(HR: 1.30, 95% CI 0.90–1.89) mortality, associated with increased risk of liver failure (OR: 3.00, 95% CI 1.78–5.07), kidney failure (OR: 1.90, 95% CI 1.13–3.18), coagulation failure (OR: 2.55, 95% CI 1.52–4.27), respiratory failure (OR: 1.76, 95% CI 1.15–2.69), and circulatory failure (OR: 2.15, 95% CI 1.27–3.64), and even associated with prolonged the LOS ICU (β: 2.61, 95% CI 1.59–3.62) and LOS hospital (β: 6.59, 95% CI 2.62–10.57). In sensitivity analysis, multivariate analysis (HR: 1.09, 95%CI 0.86, 1.38), IPTW (HR: 1.11, 95%CI 0.95–1.29) and CAPS (HR: 1.09, 95% CI 0.86–1.38) showed FFP transfusion had no beneficial effect on the 30-day mortality. Smooth curve fitting demonstrated the risk of liver failure, kidney failure and circulatory failure increased by 3%, 2% and 2% respectively, for each 1 ml/kg increase in FFP transfusion. We found there was no significant difference of CLIF-SOFA and MELD score between the two group on day 0, 3, 7, 14. Compared with the conventional group, INR, APTT, and TBIL in the FFP transfusion group significantly increased, while PaO2/FiO2 significantly decreased within 14 days. In conclusion, FFP transfusion had no beneficial effect on the 30-day, 90-day, in-hospital mortality, was associated with prolonged the LOS ICU and LOS hospital, and the increased risk of liver failure, kidney failure, coagulation failure, respiratory failure and circulatory failure events. However, large, multi-center, randomized controlled trials, prospective cohort studies and external validation are still needed to verify the efficacy of FFP transfusion in the future.

Comparison of the single-cell and single-nucleus hepatic myeloid landscape within decompensated cirrhosis patients.

A complete understanding of disease pathophysiology in advanced liver disease is hampered by the challenges posed by clinical specimen collection. Notably, in these patients, a transjugular liver biopsy (TJB) is the only safe way to obtain liver tissue. However, it remains unclear whether successful sequencing of this extremely small and fragile tissue can be achieved for downstream characterization of the hepatic landscape. Here we leveraged in-house available single-cell RNA-sequencing (scRNA-seq) and single-nucleus (snRNA-seq) technologies and accompanying tissue processing protocols and performed an in-patient comparison on TJB's from decompensated cirrhosis patients (n = 3). We confirmed a high concordance between nuclear and whole cell transcriptomes and captured 31,410 single nuclei and 6,152 single cells, respectively. The two platforms revealed similar diversity since all 8 major cell types could be identified, albeit with different cellular proportions thereof. Most importantly, hepatocytes were most abundant in snRNA-seq, while lymphocyte frequencies were elevated in scRNA-seq. We next focused our attention on hepatic myeloid cells due to their key role in injury and repair during chronic liver disease. Comparison of their transcriptional signatures indicated that these were largely overlapping between the two platforms. However, the scRNA-seq platform failed to recover sufficient Kupffer cell numbers, and other monocytes/macrophages featured elevated expression of stress-related parameters. Our results indicate that single-nucleus transcriptome sequencing provides an effective means to overcome complications associated with clinical specimen collection and could sufficiently profile all major hepatic cell types including all myeloid cell subsets.

Exploring the Prevalence, Predictors, and Impact of Bacterial Infections to Guide Empiric Antimicrobial Decisions in Cirrhosis (EPIC-AD)

BackgroundThis study delved into cirrhosis-related infections to unveil their epidemiology, risk factors, and implications for antimicrobial decisions. MethodsWe analyzed acutely decompensated cirrhosis patients (n=971) from North India between 2013-2023 at a tertiary center. Microbiological and clinical features based on infection sites (EASL criteria) and patient outcomes were assessed. ResultsMedian age was 45 years; 87% were males with 47% having alcoholic hepatitis. Of these, 675 (69.5%) had infections; 305 (45%) were culture-confirmed. Notably, 71% of confirmed cases were MDRO-related, chiefly carbapenem-resistant (48%). MDRO prevalence was highest in pulmonary (80.5%) and skin-soft-tissue infections (76.5%). Site-specific distribution and antimicrobials were suggested.Predictive models identified prior hospitalization [OR:2.23 (CI:1.58-3.14)], norfloxacin prophylaxis [OR:2.26 (CI:1.44-3.55)], prior broad-spectrum antibiotic exposure [OR:1.61 (CI:1.12-2.30)], presence of SIRS [OR:1.75 (CI: 1.23-2.47)], procalcitonin [OR:4.64 (CI:3.36-6.40)], and HE grade [OR:1.41 (CI:1.04-1.90)], with an AUC of 0.891 for infection prediction. For MDRO infection prediction, second infection [OR: 7.19 (CI: 4.11-12.56)], norfloxacin prophylaxis [OR: 2.76 (CI: 1.84-4.13)], CLIF-C OF [OR: 1.10 (CI: 1.01-1.20)], prior broad-spectrum antibiotic exposure [OR: 1.66 (CI: 1.07-2.55)], rifaximin [OR: 040 (0.22-0.74)] multisite [OR: 3.67 (CI: 1.07-12.56)], and polymicrobial infection [OR: 4.55 (CI: 1.45-14.17)] yielded an AUC of 0.779 and 93% specificity. Norfloxacin prophylaxis, multisite infection, mechanical ventilation, prior broad-spectrum antibiotic exposure, and infection as acute precipitant predicted carbapenem-resistant infection (AUC: 0.821).Infections (culture-proven or probable), MDROs, carbapenem/pan-drug resistance, and second infections independently linked with mortality (p<0.001), adjusted for age, leucocytosis, and organ failures. A model incorporating age [HR:1.02 (CI: 1.01-1.03), infection [HR:1.52 (CI: 1.05-2.20)], prior hospitalization [HR:5.33 (CI: 3.75-7.57)], norfloxacin [HR:1.29 (CI: 1.01-1.65)], multisite infection [HR:1.47 (CI:1.06-2.04)], and CLIF-C OF [HR:1.17 (CI: 1.11-1.23)] predicted mortality with C-statistics of 0.782 (p<0.05). ConclusionHigh MDRO burden, especially carbapenem-resistant, necessitates urgent control measures in cirrhosis. Site-specific epidemiology and risk models can guide empirical antimicrobial choices in cirrhosis management. Lay summaryOur study delved into infections among hospitalized cirrhosis patients, investigating their occurrence, distribution, risks, and consequences. Notably, infections affected almost 70% of patients, with nearly half of them being confirmed through culture. Most concerning was the identification of multidrug-resistant organisms (MDROs) in 71% of culture-proven cases, particularly carbapenem-resistant bacteria (48%). Pulmonary and skin-soft-tissue infections were the hardest hit. We developed predictive models to foresee infections and particularly drug-resistant and carbapenem-resistant bacterial infections and their mortality. Thus, highlighting the urgent need for measures to counter the substantial impact of MDRO infections in cirrhosis patients. Our findings underscore the importance of targeted antimicrobial therapy guided by site-specific epidemiological insights.

Statin use in cirrhosis and its association with incidence of portal vein thrombosis.

Statin use has shown a reduction in hepatic decompensation and portal hypertension. Its association with portal vein thrombosis (PVT) incidence is unknown. We aim to compare the incidence of PVT in patients with and without statin use. We excluded patients with a history of hepatocellular cancer, liver transplants, Budd-Chiari syndrome, and intra-abdominal malignancies. Patients with cirrhosis were followed from their first hepatologist clinical encounter (January 1, 2016, to January 31, 2021) for 180days to determine PVT incidence. We tested the association of statin use with PVT using 1:1 propensity score (PS) matching and Cox proportional hazard regression. We analyzed 2785 patients with cirrhosis (mean age:61.0±12.3years, 44.3% female, 63.8% White, mean MELD-Na score:11.7±6.1, and statin use:23.1%). A total of 89 patients developed PVT during the follow-up, which was lower in patients with statin use as compared to no statin use (1.3% vs 3.8%, P=0.001, unadjusted HR:0.28, 95% CI: 0.13-0.62, P=0.001). After matching for demographics, comorbidities, and hepatic decompensation events, patients with statin use had a lower risk of developing PVT in 180-day follow-up as compared to those without statin use (HR:0.24, 95% CI: 0.10-0.55, P=0.001). Subgroup analysis showed that statin use was associated with lower PVT incidence in non-NASH (HR: 0.20, 95% CI: 0.07-0.54, P=0.002) and decompensated cirrhosis (HR: 0.12, 95% CI:0.03-0.53, P=0.005) than no statin use. PVT incidence was lower in decompensated cirrhosis patients with statin use than in those with no statin use. However, this finding needs to be further tested in randomized control trials.

Pre-hospital symptom clusters and symptom network analysis in decompensated cirrhotic patients: A cross-sectional study.

To generate pre-hospital symptom networks, explore core, bridge and sentinel symptoms, identify pre-hospital symptom clusters and analyse relationship between influencing factors and symptom clusters in decompensated cirrhosis patients. A cross-sectional study design using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Demographical, physiological, psychological and sociological characteristics and the pre-hospital symptoms of 292 decompensated cirrhotic patients were collected from October 2021 to March 2023 in China. Frequencies, percentages, means, standard deviations, independent samples t-tests, one-way analysis of variance, exploratory factor analysis, multiple stepwise regression analysis and network analysis were used for data analysis. 'I don't look like myself' and itching were core and bridge symptoms, while bloating and lack of energy were sentinel symptoms in decompensated cirrhotic patients. Monthly family income, anxiety, depression, social support and disease duration influenced the neuropsychological symptom cluster, with worrying as the strongest predictor symptom. Influential factors for cirrhosis-specific symptom cluster included Child-Pugh class, monthly family income, disease duration, anxiety and depression, with itching being the strongest predictor symptom. Monthly family income, disease duration and depression were influential factors for gastrointestinal symptom cluster, with loss of appetite as the strongest predictor symptom. Neuropsychological, cirrhosis-specific and gastrointestinal symptom clusters were formed in decompensated cirrhotic patients. Through network analysis, direct connections between symptoms, symptom clusters and their influencing factors were revealed, thereby offering clinicians a foundation for effectively managing patients' pre-hospital symptoms. Decompensated cirrhosis patients commonly have multiple symptoms, while the management of pre-hospital symptoms is often suboptimal. This study identified neuropsychological, cirrhosis-specific, gastrointestinal symptom clusters and recognized core, bridge and sentinel symptoms in these patients. It also revealed the most prominent symptoms within each cluster. This provides insight into the hierarchy of symptoms, improving symptom management in decompensated cirrhosis. There was no patient or public involvement.

2-year survival estimation for decompensated cirrhosis patients of prognostic scoring systems.

Prognostic models proposed for cirrhotic patients' survival have not been satisfactorily investigated in the Vietnam population, especially in the medium-term period. In this prospective study, we enrolled a total of 904 patients admitted to Hepato-Gastroenterology Center, Bach Mai Hospital from December 2019 to November 2021 and calculated their CP, MELD, MELD-Na score, IMELD, Refit MELD, and Refit MELD-Na after 2-year follow-up to compare their survival prognosis. The mean age of the patients was 53.8 ±10.8 years, and males constituted 91%. Compared with the surviving group, deceased patients had statistically significant lower albumin, higher INR, serum bilirubin, and creatinine levels with higher means of all prognostic scores. RefitMELD score had the highest AUC (0.768), followed by MELD (0.766), and the lowest belonged to RefitMELDNa (0.669). In conclusion, deceased patients had significantly higher values of Child-Pugh score and all MELD-based scores than survival. RefitMELD is the most reliable scoring system to predict 2-year mortality in patients with decompensated liver cirrhosis.

Shear wave elastography-based deep learning model for prognosis of patients with acutely decompensated cirrhosis.

This study aimed to develop and validate a deep learning model based on two-dimensional (2D) shear wave elastography (SWE) for predicting prognosis in patients with acutely decompensated cirrhosis. We prospectively enrolled 288 acutely decompensated cirrhosis patients with a minimum 1-year follow-up, divided into a training cohort (202 patients, 1010 2D SWE images) and a test cohort (86 patients, 430 2D SWE images). Using transfer learning by Resnet-50 to analyze 2D SWE images, a SWE-based deep learning signature (DLswe) was developed for 1-year mortality prediction. A combined nomogram was established by incorporating deep learning SWE information and laboratory data through a multivariate Cox regression analysis. The performance of the nomogram was evaluated with respect to predictive discrimination, calibration, and clinical usefulness in the training and test cohorts. The C-index for DLswe was 0.748 (95% CI 0.666-0.829) and 0.744 (95% CI 0.623-0.864) in the training and test cohorts, respectively. The combined nomogram significantly improved the C-index, accuracy, sensitivity, and specificity of DLswe to 0.823 (95% CI 0.763-0.883), 86%, 75%, and 89% in the training cohort, and 0.808 (95% CI 0.707-0.909), 83%, 74%, and 85% in the test cohort (both p < 0.05). Calibration curves demonstrated good calibration of the combined nomogram. Decision curve analysis indicated that the nomogram was clinically valuable. The 2D SWE-based deep learning model holds promise as a noninvasive tool to capture valuable prognostic information, thereby improving outcome prediction in patients with acutely decompensated cirrhosis.

Novel Marker for Predicting Prognosis in Hepatitis B Virus-Associated Decompensated Cirrhosis: Monocyte-To-Albumin Ratio.

Early determination of the prognosis in hepatitis B virus-associated decompensated cirrhosis (HBV-DC) patients is important to improve their survival. The present study aimed to determine the predictive ability of monocyte-to-albumin ratio (MAR) for poor prognosis in HBV-DC. This work recruited 263 HBV-DC patients admitted to our hospital from November 2020 through March 2022. The clinical data, laboratory parameters, and clinical prognosis of the patients were retrospectively collected and analyzed. Mortality at 30 days was 20.2% (53/263). MAR was found to be higher in the non-survivors compared with the survivors. Higher MAR was associated with higher 30-day mortality, and MAR was identified as an independent predictor of poor prognosis in HBV-DC. Furthermore, the predictive values between MAR and Model for End-Stage Liver Disease score are comparable. MAR could be potentially used as a novel prognostic marker to predict prognosis in HBV-DC.

S1345 Clinical Outcomes of Antibiotic Use Before Paracentesis in Hospitalized Decompensated Cirrhosis Patients: A Retrospective Study

S1345 Clinical Outcomes of Antibiotic Use Before Paracentesis in Hospitalized Decompensated Cirrhosis Patients: A Retrospective Study

THE TREATMENT OF HEPATORENAL SYNDROME WITH TERLIPRESSIN: CONTINUOUS INTRAVENOUS INFUSION VS INTRAVENOUS BOLUSES A RANDOMISED CONTROLLED STUDY ON SYNDROME

Objective: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis, with terlipressin and albumin being the most common treatment. The study aimed to compare the effectiveness and safety of continuous intravenous infusion vs. intravenous boluses of terlipressin in treating type 1 h.&#x0D; Methods: A randomized controlled trial was conducted on cirrhosis patients with type 1 h. Patients were allocated to receive terlipressin via continuous infusion (TERLI-INF group) or intravenous boluses (TERLI-BOL group). Demographic, clinical, and laboratory data were collected, and treatment details were recorded. The primary endpoint was the frequency of drug-related adverse events. Secondary endpoints included therapy responsiveness and 90-day transplant-free survival.&#x0D; Results: Both groups exhibited similar baseline characteristics. While treatment length and cumulative albumin doses were comparable, TERLI-INF patients received lower terlipressin doses. Severe treatment-related adverse events differed between groups. Univariate analysis identified several baseline parameters significantly associated with response to terlipressin. The study supports continuous terlipressin infusion's superiority in treating type 1 h, with lower adverse event rates and improved patient response.&#x0D; Conclusion: The study concludes that continuous intravenous terlipressin infusion is safer and more effective in treating type 1 h in decompensated cirrhosis patients compared to intravenous boluses. Lower terlipressin dosages were effective in continuous infusion, indicating improved safety. The MELD score was an independent predictor of response, and therapy responsiveness was associated with improved 90 d survival.

Diagnostic utility of urine neutrophil gelatinase-associated lipocalin and renal resistive index in patients of decompensated cirrhosis with acute kidney injury.

The differentiation between types of acute kidney injury(AKI) in decompensated cirrhosis(DC) patients in clinical practice is done by clinical adjudication. Biomarkers have good diagnostic accuracy for predicting acute tubular necrosis(ATN), however they are not available routinely. We compared the diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin(UNGAL) and renal resistive index(RRI) in predicting type of AKI among DC patients. Consecutive DC patients with AKI stage≥1B seen between June/2020 to May/2021 were evaluated. UNGAL levels and RRI were measured at diagnosis of AKI(Day 0) and 48hrs(Day 3) after volume expansion. Diagnostic accuracy of UGNAL and RRI was compared for differentiating ATN and non-ATN AKI by area under receiver operating characteristic curve(AUROC), using clinical adjudication as gold standard. 388 DC patients were screened, 86 patients(Pre-renal AKI[PRA] n=47,55%; Hepatorenal syndrome[HRS] n=25,29%;ATN n= 14,16%) were included. The AUROC of UNGAL for differentiating ATN-AKI and non-ATN AKI at day 0 was 0.97(95%CI, 0.95-1.0) and on day 3 was 0.97(95%CI, 0.94-1.0). The AUROC of RRI for differentiating ATN and non-ATN AKI at day 0 was 0.68(95%CI, 0.55-0.80) and on day 3 was 0.74(95%CI, 0.63-0.84). UNGAL has an excellent diagnostic accuracy in predicting ATN-AKI in DC patients both at day 0 and 3.

Prevalence of obstructive sleep apnea risk and quality of sleep in chronic liver cell disease patients admitted to a tertiary care centre

Introduction: Cirrhosis and associated complications result in significant morbidity and mortality. In the absence of a liver transplant, the prognosis, and the quality of life of decompensated cirrhosis patients are dismal. Hepatic encephalopathy, a complication of cirrhosis; defined as potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction, has sleep disturbances as an integral part. But cirrhosis patients also suffer from various other sleep disorders including obstructive sleep apnea (OSA) which are independent of hepatic encephalopathy manifestations. But diagnosing OSA is challenging in this patient population. But when diagnosed early OSA can be treated successfully preventing further complications and improving the quality of life of cirrhotic patients. Methods: A cross-sectional study was conducted among cirrhosis patients admitted to Colombo South Teaching Hospital using investigator administered questionnaires to assess the risk of OSA. Internationally validated STOP­Bang and Pittsburgh Sleep Quality Index (PSQI) were used to screen for OSA and sleep quality respectively.Results: Out of 42 participants, two-thirds were males, and the mean age of the study population was 58 years. Most of the patients were in Child-Pugh class C (76.2%) Of the study population, 38.1 % were having high STOP­Bang scores (&gt;5) and were in the high-risk group for obstructive sleep apnea. The percentage of poor sleepers with PSQI scores of more than 5 was as high as 85.7%. Higher severity of cirrhosis was associated with high PSQI scores and high-risk STOPBANG scores. Having ascites conferred a high risk for OSA. Conclusions: Higher severity of cirrhosis is associated with poorer sleep quality as well as increased risk for OSA.

Red cell distribution width-to-albumin ratio is a predictor of survival in hepatitis B virus-associated decompensated cirrhosis.

The aim of this study was to ascertain whether red cell distribution width-to-albumin ratio (RAR) is associated with survival in hepatitis B virus (HBV)-associated decompensated cirrhosis (DC) patients. A cohort of 167 patients with confirmed HBV-DC was enrolled in our study. Demographic characteristics and laboratory data were obtained. The main endpoint was mortality at 30days. The receiver operating characteristic curve and multivariable regression analysis were used to assess the power of RAR for predicting prognosis. Mortality at 30days was 11.4% (19/167). The RAR levels were higher in the nonsurvivors than the survivors, and elevated RAR levels were clearly associated with poor prognosis. Moreover, the predictive powers of RAR and Model for End-Stage Liver Disease score were not obviously different. Our data indicate that RAR is a novel potential prognostic biomarker of mortality in HBV-DC.

The impact of concomitant metabolic dysfunction-associated fatty liver disease on adverse outcomes in patients with hepatitis B cirrhosis: a propensity score matching study.

In cirrhotic patients, the clinical relevance of metabolic dysfunction-associated fatty liver disease (MAFLD) is unclear. We aimed to research the relationship between MAFLD and adverse clinical outcomes in patients with hepatitis B cirrhosis. A total of 439 patients with hepatitis B cirrhosis were enrolled. Abdominal MRI and computed tomography were used to calculate liver fat content in order to evaluate steatosis. The Kaplan-Meier method was implemented to generate survival curves. The independent risk factors for prognosis were identified by multiple Cox regression. Propensity score matching (PSM) was used to reduce the influence of confounding factors. This study explored the relevance between MAFLD and mortality, first decompensation and further decompensation. In our study, most patients were decompensated cirrhosis (n = 332, 75.6%) and the ratio of decompensated cirrhosis patients in non-MAFLD to MAFLD group was 199 : 133. Compared to the non-MAFLD group, patients with MAFLD had worse liver function which mainly reflected that there were more Child-Pugh C patients and higher model for end-stage liver disease score in the MAFLD group. A total of 207 adverse clinical events occurred in the total cohort during a median follow-up of 47 months, including 45 deaths, 28 hepatocellular carcinoma, 23 first decompensation and 111 further decompensation. Cox multivariate analysis showed that MAFLD was an independent risk factor for death [hazard ratio (HR) 1.931; 95% confidence interval (CI) 1.019-3.660; P = 0.044 HR 2.645; 95% CI, 1.145-6.115; P = 0.023] and further decompensation (HR 1.859; 95% CI, 1.261-2.741; P = 0.002 HR 1.953; 95% CI, 1.195-3.192; P = 0.008) before and after PSM. In decompensated group with MAFLD, diabetes had a more significant effect on adverse prognosis than overweight or obesity and other metabolic risk factors. In patients with hepatitis B cirrhosis, concomitant MAFLD can predict a higher risk of further decompensation and death among decompensated individuals. According to patients among MAFLD, diabetes may be a major factor in the occurrence of adverse clinical events.

FRI-556 - Parvovirus B19 infection associated with adverse outcomes in decompensated cirrhosis patients

FRI-556 - Parvovirus B19 infection associated with adverse outcomes in decompensated cirrhosis patients

FRI-536 - Microbial cell-free DNA next-generation sequencing of ascites in acutely decompensated cirrhosis patients: a proof-of-concept study

FRI-536 - Microbial cell-free DNA next-generation sequencing of ascites in acutely decompensated cirrhosis patients: a proof-of-concept study

Evaluation of iMELD score for early predicting prognosis of decompensated cirrhosis patients caused by hepatitis virus

Background: The iMELD (integrated-MELD) score is constructed based on the combination of the MELD score, serum sodium value, and age to enhance the prognostic ability in patients with decompensated cirrhosis. This study aims to apply the iMELD score in early prognosis of hospitalized patients with decompensated cirrhosis due to viral hepatitis. Methods: A prospective observational study was conducted to monitor clinical outcomes in 48 hospitalized patients with decompensated cirrhosis due to viral hepatitis within the hospital stay and the first 6 weeks. Results: The mean value of iMELD was 40.70 ± 7.435. For the prediction of mortality within the first 6 weeks, the iMELD score had an area under the receiver operating characteristic curve of 0.801, a sensitivity of 71.4%, and a specificity of 82.9% with a cutoff point of 45.18 better than MELD and MELD-Na scores (p &lt; 0.05). Conclusion: Based on these results, the iMELD score has a valuable prognostic value for early mortality prediction within the first 6 weeks and can be routinely used in clinical practice. Key words: cirrhosis, hepatitis virus, MELD, MELD-Na, iMELD

Analysis of Serum Cys-C, TBA, and Routine Blood Parameters of Patients with Hepatitis B-Related Decompensated Cirrhosis

Objective: To study the levels of serum cystatin C (Cys-C), total bile acid (TBA), and other routine blood parameters on patients with decompensated hepatitis B cirrhosis. Methods: Study group 1 consisted of 30 patients with hepatitis B-related decompensated cirrhosis, and study group 2 consisted of 30 patients with hepatitis B; while the control group consisted of 30 healthy people who underwent physical examination. The blood parameters were used to evaluate the clinical treatment effect of patients. Results: The TBA, Cys-C, alanine transaminase (ALT), total bilirubin (TBIL), aspartate aminotransferase (AST), and international normalized ratio (INR) in study group 1 were significantly higher than those of study group 2 and the control group; while the platelet count (PLT), hemoglobin (Hb), albumin (ALB), and estimated glomerular filtration rate (eGFR) were significantly lower in the study group 1 compared to the control group and study group 2 (P &lt; 0.05). The Cys-C, PLT, TBA, AST, TBIL, and INR of patients in study group 1 who were successfully treated were significantly lower than the patients who were not successfully treated (P &lt; 0.05). Conclusion: Serum Cys-C, TBA, and routine blood parameters are useful in predicting the condition and the prognosis of patients of hepatitis B-related decompensated cirrhosis.