Background/Aims The role of reactivation of human cytomegalovirus (HCMV) in determining outcomes of cirrhotic patients with acute decompensation (AD) is unknown. We aimed to investigate HCMV incidence and potential correlation with hepatic outcomes in AD patients.
Methods Two prospective multicentre cohorts with AD patients were investigated. Patients in cohort 1 were recruited from 4 centres, while patients in cohort 2 were randomly selected from a second multicentre cohort. HCMV reactivation was established with quantitative real-time polymerase chain reaction assay in seropositive patients.
Results HCMV reactivation was found in 35 patients from cohort 1 (n=722) and 14 from cohort 2 (n=291), with an incidence of 4.8% in both cohorts. Bacterial infection and liver failure were independently correlated with HCMV reactivation. HCMV reactivation was an independent predictor of 90-day mortality. Among bacterial infection populations in these two cohorts, patients with HCMV reactivation had worse prognosis compared to those without. Incidence of acute-on-chronic liver failure (ACLF) was higher in patients with HCMV reactivation compared to those without and was also independently correlated with development of ACLF. In a total of 49 HCMV reactivation cases, 8 patients were treated with ganciclovir, in whom a significantly lower 90-day mortality compared with those not treated was observed. All 3 patients who underwent liver transplantation with reactivation of HCMV died.
Conclusions In AD patients, HCMV reactivation was common, especially in those with bacterial infection or liver failure, and they were more prone to having ACLF and 90‑day mortality. The data propose the need for active surveillance for HCMV infection in AD patients.
Background/Aims Cirrhotic patients with liver stiffness measurement (LSM) <20 kPa and platelet count ≥150×109/L (Baveno VI criteria), otherwise spleen stiffness measurement (SSM) ≤40 kPa (Baveno VI-SSM criteria) can avoid endoscopy screening; however, no prospective data for their hepatic outcomes.
Methods Compensated cirrhosis with HBV were prospectively enrolled from April 2019 to April 2022 and followed until July 2023. All patients underwent LSM, SSM and esophagogastroduodenoscopy assessment.
Results Among 1,224 patients enrolled with median follow-up of 30 months (interquartile range, 21–42), the incidence of decompensation was greater in 560 patients with unfavored Baveno VI criteria (0.5 vs. 20.4 per 1,000 person-years, P=0.0004) than that in 664 patients with favored Baveno VI-SSM criteria. The Baveno VI-SSM model identified more patients (54.2%) as low-risk for decompensation than Baveno VII-SSM model (single cutoff) (48.4%, P=0.004) and than Baveno VI criteria (34.6%, P<0.0001) did. Patients with high-risk varices diagnosed via endoscopy following Baveno VI-SSM model assessment had greater probability of decompensation compared to those identified by the Baveno VII-SSM model (single cutoff) (42.8 vs. 21.1 per 1,000 person-years, P=0.0088). Additionally, among the 493 patients who underwent endoscopic re-assessment, 242 patients with favored Baveno VI-SSM criteria had much lower incidence of EV progression (2.6 vs. 99.5 per 1,000 person-years, P=0.0004) and lower risk of decompensation compared to 140 patients with unfavored Baveno VI-SSM model (0 vs. 34.2 per 1,000 person-years, P=0.0256).
Conclusions Baveno VI-SSM model could identify HBV-related cirrhosis patients at low risk of decompensation, which was greatly improved upon Baveno VI-SSM reassessment.
Citations
Citations to this article as recorded by
Correspondence to editorial 1 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis” Haiyu Wang, Jinjun Chen Clinical and Molecular Hepatology.2026; 32(1): e58. CrossRef
Correspondence to editorial 2 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis” Haiyu Wang, Jinjun Chen Clinical and Molecular Hepatology.2026; 32(1): e62. CrossRef
Correspondence to editorial 3 on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis” Haiyu Wang, Jinjun Chen Clinical and Molecular Hepatology.2026; 32(1): e65. CrossRef
Reply to correspondence on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis” Mathias Jachs, Mattias Mandorfer Clinical and Molecular Hepatology.2026; 32(1): e106. CrossRef
Background/Aims Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT).
Methods Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test.
Results The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis.
Conclusions The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.
Citations
Citations to this article as recorded by
Racing toward the future of chronic hepatitis B management: Achieving functional cure and enhancing hepatocellular carcinoma surveillance through precision medicine Yaru Shi, Rong Fan Interdisciplinary Medicine.2025;[Epub] CrossRef
La prise en charge de l'hépatite B chronique: mise à jour 2025 des lignes directrices de l'Association canadienne pour l'étude du foie et de l'Association pour la microbiologie médicale et l'infectiologie Canada Carla Osiowy, Fernando Alvarez, Carla S. Coffin, Curtis L. Cooper, Scott K. Fung, Hin Hin Ko, Sébastien Poulin, Jennifer van Gennip Canadian Liver Journal.2025; 8(2): 402. CrossRef
The management of chronic hepatitis B: 2025 Guidelines update from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease Canada Carla Osiowy, Fernando Alvarez, Carla S Coffin, Curtis L Cooper, Scott K Fung, Hin Hin Ko, Sébastien Poulin, Jennifer van Gennip Canadian Liver Journal.2025; 8(2): 368. CrossRef
Prediction Model for Familial Aggregated HBV‐Associated Hepatocellular Carcinoma Based on Serum Biomarkers Linmei Zhong, Guole Nie, Qiaoping Wu, Honglong Zhang, Haiping Wang, Jun Yan Cancer Reports.2025;[Epub] CrossRef
LEAST as a novel prediction model of hepatocellular carcinoma development in patients with chronic hepatitis B: a multi-center study Jingjing Song, Jie Li, Zhigang Ren, Wen Xie, Jinhua Shao, Xiaoxiao Zhang, Yang Zhou, Fajuan Rui, Xiaoqing Wu, Qiuling Wang, Zuxiong Huang, Chao Sun, Yuemin Nan BMC Medicine.2025;[Epub] CrossRef
Validation of the Texas Hepatocellular Carcinoma Risk Index Predictive Model for Hepatocellular Carcinoma in Asian Cohort Jeong-Ju Yoo, Young-Gi Song, Ji Eun Moon, Young Seok Kim, Sang Gyune Kim Clinical Gastroenterology and Hepatology.2024; 22(9): 1953. CrossRef
Risk predictive model for the development of hepatocellular carcinoma before initiating long‐term antiviral therapy in patients with chronic hepatitis B virus infection Junjie Chen, Tienan Feng, Qi Xu, Xiaoqi Yu, Yue Han, Demin Yu, Qiming Gong, Yuan Xue, Xinxin Zhang Journal of Medical Virology.2024;[Epub] CrossRef
Correspondence to editorial on “Hepatocellular carcinoma prediction model performance decreases with long-term antiviral therapy in chronic hepatitis B patients” Xiaoqian Xu, Hong You, Jidong Jia, Yuanyuan Kong Clinical and Molecular Hepatology.2024; 30(4): 994. CrossRef
Decreasing performance of HCC prediction models during antiviral therapy for hepatitis B: what else to keep in mind: Editorial on “Hepatocellular carcinoma prediction model performance decreases with long-term antiviral therapy in chronic hepatitis B pati Beom Kyung Kim Clinical and Molecular Hepatology.2024; 30(4): 656. CrossRef
Reply to correspondence on “Hepatocellular carcinoma prediction model performance decreases with long-term antiviral therapy in chronic hepatitis B patients” Beom Kyung Kim Clinical and Molecular Hepatology.2024; 30(4): 1044. CrossRef
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