Stage Of Liver Cirrhosis Research Articles

The Auxiliary Diagnostic Value of Serum Total Bile Acids in Liver Cirrhosis at Clinical Test

<i>Objective:</i> To investigate the auxiliary diagnostic value of serum total bile acid (TBA) in clinical testing of liver cirrhosis (LC). <i>Methods:</i> A total of 85 patients with LC and 77 patients with hepatitis who were treated in the Affiliated People's Hospital of Jiangsu University from June 2023 to April 2025 were included as the observation group, and 81 healthy people who underwent physical examination in this hospital during the same period were randomly selected as the control group. LC patients comprise 44 cases in the compensated stage and 41 cases in the decompensated stage. The general information of the respondents was collected, and the serum levels of TBA, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Prealbumin (PA), Gamma-Glutamyltransferase (GGT), Alkaline Phosphatase (ALP), and Adenosine Deaminase (ADA) were measured for patients in each group. Logistic regression was used to analyze the influencing factors of LC. The receiver operating characteristic (ROC) curve was used to evaluate the auxiliary diagnostic value of serum TBA level for LC. <i>Results: </i>Compared with the control group, the levels of TBA, AST, GGT, ALT, ALP, ADA in the LC group were significantly increased, while the level of PA was significantly decreased (p<0.05). Compared with patients in the compensated stage of LC, those in the decompensated stage exhibited a significantly elevated level of serum TBA and a notably reduced level of serum Prealbumin (PA) (P<0.05), while no significant differences were observed in the levels of other serum indicators. Logistic regression showed that TBA (<I>OR</I>=1.018, 95%<I>CI</I>: 1.002~1.034, <I>P</I><0.05) was an independent risk factor for LC, while PA (<I>OR</I>=0.984, 95%<I>CI</I>: 0.978~0.989, <I>P</I><0.01) was an independent protective factor for LC. The area under the receiver operating characteristic (ROC) curve (AUC) of serum TBA level in LC patients was 0.892, the 95% confidence interval (CI) was 0.851 to 0.933, and the corresponding sensitivity and specificity were 88.2% and 76.6%, respectively. The AUC of serum TBA level in patients with decompensated cirrhosis was 0.924, the 95% CI was 0.887-0.961, and the corresponding sensitivity and specificity were 97.6% and 74.1%, respectively. <i>Conclusion: </i>The detection of TBA in serum can be used as an auxiliary examination for patients with liver disease, which can provide a certain value for the diagnosis of LC.

Deciphering the Language of Intestinal Microbiota Associated with Sepsis, Organ Failure, and Mortality in Patients with Alcohol-Related Acute-on-Chronic Liver Failure (ACLF): A Pioneer Study in Latin America.

ACLF is a severe stage of liver cirrhosis, characterized by multiple organ failure, systemic inflammation, and high short-term mortality. The intestinal microbiota (IM) influences its pathophysiology; however, there are currently no studies in Latin American populations. Therefore, we analyzed IM and its relationships with sepsis, organ failure, and mortality. In parallel, we quantified serum lipopolysaccharides as a marker of bacterial translocation. Fecal samples from 33 patients and 20 healthy controls (HCs) were obtained. The IMs were characterized by 16S-rRNA amplicon sequencing, the metagenomic functional predictive profiles were analyzed by PICRUSt2, and LPS quantification was performed by ELISA. Patients with ACLF showed significant alterations in alpha and beta diversity compared to the HCs. A strong dominance index accurately predicted 28-day and 90-day mortalities. The IMs showed a polarization toward Proteobacteria associated with increased LPS. The LPS correlated with clinical severity, organ dysfunction, and higher pathogenic taxa. The Klebsiella/Faecalibacterium ratio showed good performance in identifying sepsis (AUROC = 0.83). Furthermore, Morganella, Proteus, and Klebsiella were enriched in patients with multiorgan failure. Lactobacillus, Escherichia/Shigella, Veillonella, and Ruminococcus gnavus exhibited potential in predicting 28- and 90-day mortalities. The IM alterations in ACLF may be useful as clinical biomarkers of poor prognosis, primarily for mortality and sepsis. These findings are representative of western Mexico.

Explainable Artificial Intelligence for Diagnosis and Staging of Liver Cirrhosis Using Stacked Ensemble and Multi-Task Learning.

Background/Objectives: Liver cirrhosis is a critical chronic condition with increasing global mortality and morbidity rates, emphasizing the necessity for early and accurate diagnosis. This study proposes a comprehensive deep-learning framework for the automatic diagnosis and staging of liver cirrhosis using T2-weighted MRI images. Methods: The methodology integrates stacked ensemble learning, multi-task learning (MTL), and transfer learning within an explainable artificial intelligence (XAI) context to improve diagnostic accuracy, reliability, and transparency. A hybrid model combining multiple pre-trained convolutional neural networks (VGG16, MobileNet, and DenseNet121) with XGBoost as a meta-classifier demonstrated robust performance in binary classification between healthy and cirrhotic cases. Results: The model achieved a mean accuracy of 96.92%, precision of 95.12%, recall of 98.93%, and F1-score of 96.98% across 10-fold cross-validation. For staging (mild, moderate, and severe), the MTL framework reached a main task accuracy of 96.71% and an average AUC of 99.81%, with a powerful performance in identifying severe cases. Grad-CAM visualizations reveal class-specific activation regions, enhancing the transparency and trust in the model's decision-making. The proposed system was validated using the CirrMRI600+ dataset with a 10-fold cross-validation strategy, achieving high accuracy (AUC: 99.7%) and consistent results across folds. Conclusions: This research not only advances State-of-the-Art diagnostic methods but also addresses the black-box nature of deep learning in clinical applications. The framework offers potential as a decision-support system for radiologists, contributing to early detection, effective staging, personalized treatment planning, and better-informed treatment planning for liver cirrhosis.

Clinical manifestations of SARS-CoV-2 Omicron infection is associated with the stage of liver cirrhosis

Background & aimThe impact of Omicron variants on cirrhosis was largely unknown. Herein, we aimed to evaluate the impact of SARS-CoV-2 omicron variants infection on the clinical course and mortality of patients with liver cirrhosis.MethodsBetween 26 December 2022, and 27 January 2023, eighty-two hospitalized patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled. The clinical and pulmonary CT imaging features were retrospectively collected. A gender and age-matched cohort of 51 non-cirrhotic patients with COVID-19 were also included.ResultsOur results indicated the symptom heterogeneity in patients with cirrhosis infected with omicron variants. Patients with more severe liver disease tended to have less severe respiratory symptoms and less pulmonary lesions. SARS-CoV-2 omicron did not cause obvious perturbation of liver function or cirrhosis decompensation. In comparison with hospitalized COVID-19 patients without liver cirrhosis, cirrhotic patients showed more severe pulmonary lesions and higher levels of inflammatory cytokine IL-6, but no significant increase in mortality. Multivariate analysis identified lung lesions proportion, MELD ≥ 15 score, and APTT as independent predictors for 28-day-mortality in these patients.ConclusionSARS-CoV-2 omicron variants caused a more severe inflammatory response in cirrhotic patients than in non-cirrhotic patients, but no further deterioration of liver function. Instead, patients with advanced stage of liver cirrhosis showed milder respiratory symptoms and pulmonary lesions. These results underscore the intricate relationship between Omicron infection and cirrhosis, highlighting the necessity for personalized clinical approaches in managing this specific patient group.

Аnalysis of lethal cases in patients with HIV infection based on the experience of Voronezh regional aids clinical center

Despite the organizational and preventive measures, the prevalence of HIV infection continues to increase in Russian Ferderation. The course of the disease is exacerbated by comorbidities such as tuberculosis and chronic hepatitis. This requires a special approach to treatment. The increase in the number of comorbid cases, insufficient screening coverage in risk groups have an impact on the progression of HIV and cause an increase in mortality both in the Russian Federation and Voronezh region over the past decade. Researchers note that many patients died from mycobacterial infections, pneumonia, lymphomas, and other somatic diseases during the first year after diagnosis.The aim of the study. Conduct a comparative analysis of the social, demographic, and medical characteristics, as well as the causes of death, of patients with HIV infection between 2013 and 2023. Materials and methods. A complete sample was selected from medical records of 120 patients who were admitted to the Voronezh Regional AIDS Prevention and Control Center clinic and died during that time period. Statistical analysis was performed using Excel 2019 and included calculation of the Student’s t-test (p<0.05) and Spearman’s rank correlation coefficient.Results and discussion. For the period under study 2013 and 2023 the highest percentage of deaths were observed in the age group from 31 to 40 years old in 2013 and 2023 — 41,7% and 43,3%, respectively, as well as in the age group of 41 to 50 years, which was 23,3% and 43,3%. Both groups were predominantly male, but by 2023 the proportion of young women had increased from 31,7% to 40%, increasing the demographic significance of the problem. Although in the Voronezh region, as well as in the Russian Federation as a whole, HIV infection is mainly transmitted through the sexual contact, our study revealed a high prevalence of patients with experience in places of deprivation of liberty who use drugs and alcohol, highlighting the need for in-depth monitoring and interdisciplinary study of these issues. In the mortality structure, it is necessary to note first of all a significant increase in HIV infection rate, as main cause of death from 11,7 to 25%, an increase in mortality due to external causes from 20% to 25%, and also a decrease in mortality from tuberculosis (TB): from 28,3% to 15%, bacterial infections (extra-hospital bilateral pneumonia and its complications): 11,7% to 8,3%; somatic diseases: 20% to 15%, chronic viral hepatitis C (HCV) in the stage of liver cirrhosis: 8,3% to 6,6%. The negative trend in HIV mortality is due to a number of reasons: improved approaches to clarifying and detailing causes of death have allowed us to better define the role of HIV infection and opportunistic infections (OI). New diagnostic techniques, including telemedicine consultations, could also be introduced. The increase in HIV and AIDS is thought to be related to improved awareness of symptoms and signs of these diseases, leading to earlier diagnosis and lower mortality. However, more research is needed to better understand the causes. Among the somatic diseases that have been the cause of death, an increase in mortality from oncological diseases has been noted (doubling from 3,3% to 6,6%). There were no changes in the mortality rate from cardiovascular disease, but a decrease in mortality from gastrointestinal diseases from 5% to 1,7%. In the group of diseases registered as background pathology, hepatitis C were frequently observed in liver cirrhosis (increase by 11,7% in 2023), gastrointestinal trac diseases (increase by 5% in 2023), nervous system (NS) (increase by 7,3% in 2023) and etc. In contrast to the main group, people living with HIV (PLHIV) between 31 and 50 years of age showed an increase in somatic diseases as a major cause of death (by 2,5%), while the main group decreased by 5%. The increase in mortality from HIV infection and OI from 2013 to 2023 was significantly lower: by 14,3% in the main group and by 2,9% in the age group 31–50 years. The number of deaths from bacterial infections doubled in this group, while the main group showed a decrease. In contrast to the main group, PLHIV at age 31–50 years was observed an increase of somatic diseases (by 2,5%) as the main cause of death while in the main group the same figure decreased by 5%.Conclusion. Thus, this study provides information on the characteristics of PLHIV deaths, which is useful for understanding the mortality structure and designing measures to improve health. Further studies taking into account regional specificities will help to identify trends in the mortality structure and develop effective measures to improve health for people living with HIV

Fibrotic diseases in the gastrointestinal tract : Liver fibrosis and more

Chronic liver damage, such as metabolic dysfunction-associated steatotic liver disease (MASLD), viral hepatitisB orC, cholestatic hepatitis (PBC, PSC), toxic damage (alcohol) or genetic alterations (hemochromatosis, Wilson's disease, etc.) usually cause achronic inflammatory response in liver cells or bile duct epithelial cells. In the long term this chronic inflammatory response can lead to scarring of the liver, acondition known as fibrosis. The development of liver fibrosis is largely independent of the causative agent, although the pattern of initial fibrosis (periportal, pericentral or sinusoidal) can vary. Untreated and progressive fibrosis can sometimes lead to complete architectural deconstruction and deposition of connective tissue in the liver, intestines and other parenchymal organs, with agradual loss of function. In the end stage of liver cirrhosis, portal hypertension, encephalopathy, bleeding or carcinomas, e.g., hepatocellular carcinoma (HCC) and intrahepatic cholangiocellular carcinoma (iCCCa), can occur. Intestinal fibrosis is one of the most devastating complications of Crohn's disease. With novel and consistent therapeutic interventions, fibrotic processes can be stopped and reversed. New research technologies have substantially improved our knowledge of liver fibrogenesis and intestinal fibrosis. The focus of this review article is on MASLD and Crohn's disease, chronic inflammatory diseases of the liver and intestines with increasing prevalence and amajor impact on the general population. The current principles and potential possibilities of preventive and therapeutic antifibrotic interventions are illustrated.

Role of Intestinal Barrier Disruption to Acute-on-Chronic Liver Failure.

Acute-on-chronic liver failure (ACLF) is a severe condition in patients with decompensated liver cirrhosis, marked by high short-term mortality. Recent experimental and clinical evidence has linked intestinal dysfunction to both the initiation of ACLF as well as disease outcome. This review discusses the significant role of the gut-liver axis in ACLF pathogenesis, highlighting recent advances. Gut mucosal barrier disruption, gut dysbiosis, and bacterial translocation emerge as key factors contributing to systemic inflammation in ACLF. Different approaches of therapeutically targeting the gut-liver axis via farnesoid X receptor agonists, nonselective beta receptor blockers, antibiotics, and probiotics are discussed as potential strategies mitigating ACLF progression. The importance of understanding the distinct pathophysiology of ACLF compared with other stages of liver cirrhosis is highlighted. In conclusion, research findings suggest that disruption of intestinal integrity may be an integral component of ACLF pathogenesis, paving the way for novel diagnostic and therapeutic approaches to manage this syndrome more effectively.

The mediating role of social support in self-management and quality of life in patients with liver cirrhosis

Patients with liver cirrhosis often experience factors such as malnutrition and lack of exercise, leading to reduced quality of life. Insufficient social support is related to self-management in patients with chronic diseases. Therefore, this study explores the mediating role of social support in the relationship between self-management and quality of life, analyzing the impact of exercise frequency and malnutrition risk assessment on social support, self-management, and quality of life. Using a convenience sampling method, cross-sectional data were collected from 257 patients with liver cirrhosis at the infectious disease department of a tertiary hospital in Zunyi, China, from 2021 to 2022. The patients were evaluated using a demographic questionnaire, the Self-Management Behavior Scale for Liver Cirrhosis Patients, the Social Support Rating Scale (SSRS), the Chronic Liver Disease Questionnaire (CLDQ), and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT). Data were analyzed using SPSS and PROCESS software.Patients in the decompensated stage of liver cirrhosis and those classified in Child–Pugh class B/C had lower scores in self-management, quality of life, and social support compared to patients in the compensated stage of liver cirrhosis and those classified in Child–Pugh Class A.Quality of life was positively correlated with both social support and self-management (r = 0.668, r = 0.665, both P < 0.001).Mediation analysis showed that self-management had a direct predictive effect on quality of life. Social support had a mediating effect between self-management and quality of life, with an indirect effect of 0.489 (95% CI: 0.362, 0.629), accounting for 40.58% of the total effect.Exercise frequency and malnutrition risk assessment were independent influencing factors for social support, self-management, and quality of life.In the regression model, after excluding confounding factors, Model I explained 14% of the variance in quality of life due to control variables, Model II explained 49.5%, and when social support was added, Model III explained 56.9% of the variance in quality of life. Under the mediating role of social support, self-management can improve quality of life. Exercise frequency and malnutrition risk assessment, as independent influencing factors, also modulate social support and self-management. These findings underscore the importance of strengthening social support and developing self-management programs targeting exercise and nutrition to enhance the quality of life in patients with liver cirrhosis.

Impact of unique hemodynamic characteristics and paradoxical ventricular function on clinical outcome of portopulmonary hypertension

Abstract Background Limited data are available on hemodynamic characteristics, outcomes, and liver transplantation candidacy for portopulmonary hypertension (PoPH). This study aimed to evaluate the hemodynamic characteristics, natural course, and outcomes following liver transplantation in PoPH patients. Methods Patients diagnosed with PoPH by right heart catheterization at two referral centers were retrospectively analyzed. PoPH was defined as Group 1 pulmonary arterial hypertension with clinical evidence of portal hypertension. Results We included 43 patients with PoPH (median age: 52 years; 19 men). Advanced liver cirrhosis was associated with higher cardiac index and tricuspid annular plane systolic excursion (TAPSE). Mean pulmonary arterial pressure (PAP) and right atrial pressure increased with increasing pulmonary vascular resistance (PVR), while the cardiac index declined but was mostly preserved within normal limits. Of the 34 patients without liver transplantation, 13 (38%) died during a median follow-up of 2.2 years. Severity of liver cirrhosis and an increased TAPSE were significant predictors of mortality (per 1 mm increase, adjusted hazard ratio 1.17, 95% confidence interval 1.01-1.35, p=0.042). Among the nine patients who underwent liver transplantation, six had a mean PAP of 35–45 mmHg and PVR &amp;gt;3 Wood units; of these, one died after liver transplantation, from reasons unrelated to pulmonary hypertension. Conclusion In PoPH patients, a higher cardiac index with right ventricular hypercontraction was prominent in advanced stages of liver cirrhosis. Higher TAPSE was identified as a risk factor for mortality in patients without liver transplantation. Establishing optimal PoPH candidates for liver transplantation is essential for improving patient survival.

Activation of AMP-activated Protein Kinase by Metformin Inhibits Dedifferentiation of Platelet-derived Growth Factor-BB-induced Vascular Smooth Muscle Cells to Improve Arterial Remodeling in Cirrhotic Portal Hypertension.

Activation of AMP-activated Protein Kinase by Metformin Inhibits Dedifferentiation of Platelet-derived Growth Factor-BB-induced Vascular Smooth Muscle Cells to Improve Arterial Remodeling in Cirrhotic Portal Hypertension.

Ensemble and Non-Ensemble Machine Learning-Based Classification of Liver Cirrhosis Stages

Cirrhosis is a chronic liver condition characterized by gradual scarring of the tissue in the liver, which then leads to one of the more serious health problems. Early diagnosis and detection of this condition are critical to managing the patient's situation and planning his treatment. Machine learning is a computer science field in which many complex issues have otherwise been successfully resolved, especially in medicine. This work focuses on constructing an artificial intelligence system, assisted by machine learning algorithms, to help professionals diagnose liver cirrhosis at its early stage. In this paper, four different models have been constructed with the aid of clinical parameters of patients and machine learning techniques: Random Forest, KNN, histogram-based Gradient Boosting, and Soft Voting. Two Feature selection methods (Chi-Square and mutual information) have been combined to select the most relevant features in the dataset. Then non-ensemble and ensemble methods are used to detect the condition. The random forest model achieved the highest score among other model with 97.4 % accuracy with a 10-fold Cross-validation method.

Predicting Stages of Liver Cirrhosis Using Data Mining and Machine Learning Techniques

Predicting Stages of Liver Cirrhosis Using Data Mining and Machine Learning Techniques

Low albumin-to-creatinine ratio: a novel predictor of 90-day mortality in hepatocellular carcinoma with liver cirrhosis

BackgroundDespite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. Lowered serum albumin in hepatocellular carcinoma, an advanced stage of liver cirrhosis, indicates a worsening condition. Hepatorenal syndrome, marked by increased serum creatinine, is a key mortality indicator. The aim of this study was to determine the serum albumin-to-creatinine ratio (sACR) as a predictor of mortality in patients with HCC and liver cirrhosis. MethodsThis retrospective cohort study included 37 patients with HCC and liver cirrhosis. Patient characteristics, sACR, model of end-stage liver disease (MELD) score, and Child-Turcotte-Pugh (CTP) score were obtained from medical records. The optimal cut-off point for the sACR was determined using receiver operating characteristic (ROC) analysis to evaluate its predictive ability for 90-day mortality. Survival analysis was conducted using the Kaplan-Meier method with a log-rank test, and Cox regression was employed to obtain hazard ratios (HR) to estimate the patient’s prognosis. ResultsA low sACR cut-off of 2.32 was identified. Kaplan-Meier analysis confirmed that sACR met the proportional hazard assumption. sACR &lt;2.32 was a significant predictor of 90-day mortality (HR 6.52; 95% CI 1.80-23.63; p=0.004), comparable to MELD 40 (HR 41.3; 95% CI 1.98-862.90; p=0.016) and CTP category (HR =2.19;95%CI: 0.79-6.06;p=0.131). Conclusion The sACR is a novel predictor of 90-day mortality in HCC patients with liver cirrhosis. Lower sACR is associated with overall survival and may help to design strategies to personalize management approaches among patients with HCC and liver cirrhosis.

Mathematical model of liver cirrhosis formation during morphological and molecular-genetic preclinical studies

BACKGROUND: Currently, researchers describe challenges in developing new treatments for fibrosis and cirrhosis: poor quality of preclinical models, insufficient trial duration, and lack of markers of therapeutic response. A separate task is to standardize the process of liver cirrhosis formation in preclinical trials, which is necessary to obtain accurate quantitative estimates in a short timeframe. AIM: This study aimed to develop a mathematical model for the formation of liver cirrhosis during preclinical trials. MATERIALS AND METHODS: Liver fibrosis and cirrhosis were induced in male Wistar rats using freshly prepared thioacetamide solution for 17 weeks. The area of connective tissue was determined as a percentage of the image area. The area of interlobular veins was measured in µm2. The numbers of cells expressing the FAP marker and the α-SMA marker were counted. The level of mRNA expression of the Vegfa and Yap1 genes was assessed by real-time polymerase chain reaction. A mathematical model for classifying observations into stages was constructed using multiple logistic regression with stepwise selection of predictors, followed by calculation of sensitivity, specificity, and area under the curve with a 95% confidence interval based on ROC analysis. RESULTS: As a result of the analysis, a mathematical model of liver cirrhosis formation was developed. The model is based on the values of two indicators: FAP+ cells and Yap1 mRNA and demonstrated good quality. The resulting value of the area under the ROC curve of 0.883 suggests good results for classifying cases. CONCLUSIONS: The mathematical model makes it possible to differentiate the stage of liver cirrhosis from the stage of fibrosis during preclinical studies. It provides a foundation for studying the pathogenesis of liver fibrosis and cirrhosis, identifying new potential molecular targets for antifibrotic therapy, and reducing the number of expensive, labor-intensive laboratory tests.

Top-Down Proteomics Identifies Plasma Proteoform Signatures of Liver Cirrhosis Progression

Top-Down Proteomics Identifies Plasma Proteoform Signatures of Liver Cirrhosis Progression

Metabolic Differences among Patients with Cirrhosis Using Q Exactive Hybrid Quadrupole Orbitrap Mass Spectrometry Technology.

The hospitalization and mortality rates of patients gradually increase following the onset and progression of liver cirrhosis (LC). We aimed to help define clinical stage and better target interventions by detecting the expression of specific metabolites in patients with different stages of LC via Q Exactive hybrid quadrupole orbitrap mass spectrometry (UPLC-Q-Exactive) technology. This noninterventional observation case-control study involved 139 patients with LC or acute-on-chronic liver failure (ACLF) in a Chinese hospital between October 2022 and April 2023. Serum specimens were analyzed for multiple metabolite levels using UPLC-Q-Exactive. Data were processed to screen for differentially accumulated metabolites (DAMs). Short time-series expression miner (STEM) analysis and enrichment analysis were performed to assess cirrhosis progression biomarkers. Following univariate and multivariate analyses, a Venn diagram indicated nine significant DAMs in common among groups. STEM analysis showed 8'-hydroxyabscisic acid, HDCA, pyruvate-3-phosphate, indospicine, eplerenone, and DEHP as significant; their levels first peaked [Child-Turcotte-Pugh (CTP) class B peaked] and then decreased with CTP grade aggravation. Significant differences among 8'-hydroxyabscisic acid, eplerenone, and DEHP were observed among LC comorbidities and between subgroups. Therefore, serum levels of six DAMs may characterize metabolomic changes, determine the severity of LC, and predict the development of ACLF.

VALUE OF AMINOTRANSFERASES IN LIVER CIRRHOSIS

Aim: To ditermine values of ASAT and ALAT and their ratio in different stages of liver cirrhosis. Material and methods: A retrospective study was conducted, including patients with newly diagnosed liver cirrhosis from 01.01. 2017 to 31.12. 2021. Of all, 258 (71%) were men and 103 (29%) were women. The mean age of the study population was 57±11.4 years, with alcohol as the leading etiology in 262 (72.6%) of all cases. AT were measured at an upper reference limit of 40UI/ml. All were staged by Child-Pough and MELD Na score. IBM SPSS 26 and Excel statistics for data processing were used at a significant level of p&lt; 0.05. Results: Of all 361 individuals, normal AT were measured at 89 (24.7%), at 96 (25.76%) only with normal ASAT and at 233 (66.77%) only with normal ALAT. The mean value of ASAT increases significantly depending on the Child stage (p=.004) and is close to the significance of MELD Na (p=.036). Mean ALAT values were minimal to moderately elevated, with no significant association with them (p=.647, p=.020). 90% of individuals had an ASAT/ALAT ratio above 1, which showed substantial dependence on Child and MELD Na (p=.000, p=.000). A ratio above 2 was found at 194 (53.7%) mainly in Child C, which was associated with alcohol etiology. Conclusion: The absolute values of ASAT and ALAT have no relationship with the severity of liver cirrhosis, unlike their ratio, which significantly increases.

Immediate and Long-Term Results of Portacaval Shunt Surgeries in Portal Hypertension: 10-Year Clinical Experience of a Regional Vascular Surgery Department

INTRODUCTION: The number of patients with liver cirrhosis (LC) makes 20–40 cases per 100 thousand populations and rises steadily. A five-year survival rate of patients with LC in the compensation stage is 50%–62%, in the decompensation stage — 11%–40%. In the overwhelming majority of patients (80%–90%), LC leads to the compensatory formation of esophageal and gastric varices (EV and GV, respectively), which is further complicated with a life-threatening bleeding in 30% of patients. AIM: To evaluate 5-year results of partial portacaval shunt surgeries. MATERIALS AND METHODS: The paper describes a 10-year clinical experience of the vascular surgery department of Yaroslavl Regional Clinical Hospital in surgical treatment of patients with LC with a clinical presentation of portal hypertension, with recorded esophageal and gastric variceal bleeding. The study included 26 patients (of them 11 men; the mean age 48 ± 7.3 years) with LC (A and B classes on Child-Pugh scale), who underwent planned reconstructive surgery on the portal system. By the type of anastomosis, the patients were divided into 3 groups: group 1 — mesocaval anastomosis (n = 6); group 2 — distal splenorenal anastomosis with preservation of spleen (n = 10); group 3 — splenorenal H-shaped shunt. The primary end points of the study were survival of the patients, rebleeding from EV, shunt patency. Secondary end points were dynamics of EV size, changes in the spleen size, dynamics of the portal and splenic veins size, blood flow directions in the portal system, the presence of hepatic encephalopathy. Postoperative mortality was 3.8%. RESULTS: Survival at 1, 3 and 5 years was 96%, 90% and 58, respectively, and patency of anastomoses was 96%, 96% and 91%, respectively. Rebleeding at 1 year made 4% (n = 1), at 3 years — 0, at 5 years — 17% (n = 2). Changes in the hemodynamics of the portal system were recorded after formation of all types of anastomoses: reduction of the diameter of the portal vein by on average 5 mm, of the splenic vein by 3 mm, of the spleen size by 210 cm3. Shunt thrombosis occurred in two of 26 patients (7.7%) at 1 year (splenorenal H-shaped shunt with use of prosthesis) and 4 years (splenorenal autovenous shunt), respectively. CONCLUSION: The formation of partial portacaval anastomoses in patients with portal hypertension and episodes of bleeding from esophageal varices is a reliable prevention of rebleeding. The first bleeding episode is an indication for an open surgery in case the transjugular intrahepatic stenting is impossible. Survival rate of patients after portacaval shunt surgeries is determined by the initial degree of hepatic failure and patency of the formed anastomoses.

Serum thymosin beta 10 level as a potential prognosis prediction of hepatocellular carcinoma and hepatic diseases

Thymosin Beta 10 (TMSB10) is a thymosin family member that has been identified as being overexpressed in a wide variety of human cancers. This study aimed to determine the expression level of TMSB10 in sera of patients with hepatocellular carcinoma (HCC) and liver cirrhosis. And to reveal the association between TMSB10 and different stages in patients with HCC. We also wanted to know how TMSB10 is predictive in HCC patients and its relation to the Barcelona Clinic's staging system. The study included 41 HCC patients, 15 liver cirrhosis patients, and 15 normal control subjects. The enzyme-linked immunosorbent assay was used to determine serum levels of TMSB10 and alpha-fetoprotein (AFP) in serum of normal control individuals and patients with liver cirrhosis and different stages of HCC, and to evaluate the relationship of AFP with TMSB10. The TMSB10 levels in patients with HCC were statistically different than in the control group and in the different stages of HCC. We found a statistically significant difference in the distribution of TMSB10 between the three study groups (p&lt; 0.001). There was an association between TMSB10 concentration and AFP. The level of TMSB10 in the serum of the HCC subgroups was then analyzed. The TMSB10 level increased with the advance of HCC stages. The TMSB10 level in HCC patients did not correlate with levels of liver function tests including aminotransferase, aspartate aminotransferase, albumin, prothrombin, bilirubin, or alkaline phosphatase. In conclusion, serum TMSB10 levels can be used as a potential prognostic marker for clinical stages of HCC.

Malnutrition among Patients with Liver Cirrhosis in a Tertiary Care Centre

Introduction: Cirrhosis of the liver is a progressively worsening condition. Nutritional interventions to improve the nutritional status of malnourished patients can significantly enhance prognosis. Traditional methods of nutritional assessment, such as body mass index and waist circumference, are often unreliable. This study aims to find out the prevalence of malnutrition among patients with cirrhosis in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital from 01 December 2022 to 01 May 2023 after obtaining ethical approval from the Institutional Review Board. Patients at any stage of liver cirrhosis were included in the study. Patients with hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, uncontrolled diabetes mellitus, acquired immunodeficiency syndrome, tuberculosis, chronic renal failure, hepatocellular carcinoma, or any malignancy were excluded from the study. Convenience sampling method was used. Data were entered into Microsoft Excel 2016 and descriptive statistical analysis was done using IBM SPSS Statistics version 16.0. Point estimate and 90%confidence interval were calculated. Results: Among 54 patients with cirrhosis, malnutrition was seen among 22 (40.74%) [29.77%–51.71%, 90% Confidence Interval] according to mid-upper arm muscle circumference, 32 (59.26%) according to triceps skin fold thickness, and 36 (66.67%) as per hand grip strength. Conclusions: The prevalence of malnutrition among patients with cirrhosis was found to be lower than the studies done in similar settings.