Kidney disease in cirrhosis is now viewed as a continuum encompassing acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD), rather than three different disorders. Contemporary diagnostic criteria for AKI integrate urine output (UO) parameters and acknowledge the intricate relationship and possibility of overlap between functional and structural as well as acute and chronic entities, including hepatorenal syndrome (HRS). AKI demonstrates a propensity for progression to AKD and CKD, particularly in the context of recurrent and severe insults. The diagnostic complexity is further compounded by limitations in serum creatinine measurements, prompting the integration of novel biomarkers and the need to accurately estimate glomerular filtration rate. The diagnosis, phenotyping, and management of AKI should be prompt and early; the initial step should always be volume and UO assessment. A personalized approach is needed and the possibility of co-existing structural or functional kidney disease should be borne in mind. The earlier concept of waiting for 48 hours to diagnose HRS has evolved and early diagnosis and prompt treatment are advised now. Kidney replacement therapy and simultaneous liver and kidney transplantation may be required in resistant cases.
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Association between the C-reactive protein–triglyceride–glucose index (CTI) and the risk of acute kidney injury in critically ill patients with cirrhosis Lu-Huai Feng, Tianbao Liao, Tingting Su, Xuefei Zhou, Yang Lu, Lina Huang, Zhenhua Yang BMC Nephrology.2025;[Epub] CrossRef
Background/Aims Acute liver failure (ALF) has high mortality predominantly due to compromised immune system and increased vulnerability to bacterial and fungal infections.
Methods Plasma lipidome and fungal peptide-based community (mycobiome) analysis were performed in discovery cohort (ALF=40, healthy=5) and validated in a validation cohort of 230 patients with ALF using high-resolution-mass-spectrometry, artificial neural network (ANN) and machine learning (ML).
Results Untargeted lipidomics identified 2,013 lipids across 8 lipid group. 5 lipid-species—phosphatidylcholine (PC)[15:0/17:0], PC[20:1/14:1], PC[26:4/10:0], PC[32:0] and TG[4:0/10:0/23:6]—significantly differentiated ALF-NS (FC>10, P<0.05, FDR<0.01). Mycobiome alpha/beta diversity was significantly higher and showed 4 phyla and >20 species significantly dysregulated in ALF-NS linked with lipid metabolism, fatty acid elongation in ER, and others (P<0.05). Lipid and mycobiome diversity values in ALF-NS were strongly correlated (r2>0.7, P<0.05). Multi-modular correlation network showed striking associations between lipid, fungal peptide modules, and clinical parameters specific to ALF-NS (P<0.05). Cryptococcus amylolentus CBS6039 and Penicillium oxalicum 1142 directly correlated with phosphatidylcholine, triglycerides, and severity in ALF-NS (r2>0.85, P<0.05). POD-fungus and POD-lipids showed direct association with infection, necrosis, and hepatic encephalopathy (Beta>1.2, P<0.05). POD-lipid (AUC=0.969 and HR=1.99 [1.02–2.04]) superseded POD-fungus and severity indices for early-mortality prediction. Finally, significant increase in PC (15:0/17:0) level showed highest normalized importance, and ANNs and ML predicted early mortality with >95% accuracy, sensitivity, and specificity. Interestingly, fungal surveillance protein Clec7a was significantly downregulated (>2-fold), leading to a notable increase in fungal infection-mediated choline/phosphatidylcholine and associated enzymes (FC>1.5; Kennedy cycle). This contributed to phosphatidic acid-mediated hyper-inflammation in ALF-NS.
Conclusions In ALF, the plasma lipidome and mycobiome are dysregulated. Increased circulating phosphatidylcholine could stratify ALF predisposed to early mortality or require emergency liver transplantation.
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Editorial
Liver fibrosis, cirrhosis, and portal hypertension
Correspondence to editorial on “Carvedilol to prevent hepatic decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by new non-invasive model (CHESS2306)” Chuan Liu, Ling Yang, Hong You, Gao-Jun Teng, Xiaolong Qi Clinical and Molecular Hepatology.2025; 31(2): e155. CrossRef
Background/Aims Liver cirrhosis is an important cause of morbidity and mortality globally. Every episode of decompensation and hospitalization reduces survival. We studied the clinical profile and long-term outcomes comparing alcohol-related cirrhosis (ALC) and non-ALC.
Methods Cirrhosis patients at index hospitalisation (from January 2010 to June 2017), with ≥1 year follow-up were included.
Results Five thousand and one hundred thirty-eight cirrhosis patients (age, 49.8±14.6 years; male, 79.5%; alcohol, 39.5%; Child-A:B:C, 11.7%:41.6%:46.8%) from their index hospitalization were analysed. The median time from diagnosis of cirrhosis to index hospitalization was 2 years (0.2–10). One thousand and seven hundred seven patients (33.2%) died within a year; 1,248 (24.3%) during index hospitalization. 59.5% (2,316/3,890) of the survivors, required at least one readmission, with additional mortality of 19.8% (459/2,316). ALC compared to non-ALC were more often (P<0.001) male (97.7% vs. 67.7%), younger (40–50 group, 36.2% vs. 20.2%; P<0.001) with higher liver related complications at baseline, (P<0.001 for each), sepsis: 20.3% vs. 14.9%; ascites: 82.2% vs. 65.9%; spontaneous bacterial peritonitis: 21.8% vs. 15.7%; hepatic encephalopathy: 41.0% vs. 25.0%; acute variceal bleeding: 32.0% vs. 23.7%; and acute kidney injury 30.5% vs. 19.6%. ALC patients had higher Child-Pugh (10.6±2.0 vs. 9.0±2.3), model for end-stage liver-disease scores (21.49±8.47 vs. 16.85±7.79), and higher mortality (42.3% vs. 27.3%, P<0.001) compared to non-ALC.
Conclusions One-third of cirrhosis patients die in index hospitalization. 60% of the survivors require at least one rehospitalization within a year. ALC patients present with higher morbidity and mortality and at a younger age.
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Burden of caregiving of alcohol related liver disease patients: a possible role of training and caregiver groups frequency. Proposal of a method, preliminary results Patrizia BALBINOT, Rinaldo PELLICANO, Gianni TESTINO Minerva Gastroenterology.2024;[Epub] CrossRef
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Alcohol consumption, alcohol use disorder and organ transplantation Gianni TESTINO, Rinaldo PELLICANO, Fabio CAPUTO Minerva Gastroenterology.2024;[Epub] CrossRef
Outcomes and Recurrence Rate of Esophageal Varices after Endoscopic Treatment in Patients with Alcoholic Cirrhosis and Viral Cirrhosis Yoshihiro Furuichi, Ryohei Nishiguchi, Takeshi Shimakawa, Tomoyuki Fujiwara, Koichiro Sato, Hiroyuki Kato Journal of Nippon Medical School.2024; 91(2): 180. CrossRef
Acute kidney injury development is associated with mortality in Japanese patients with cirrhosis: impact of amino acid imbalance Takao Miwa, Yuki Utakata, Tatsunori Hanai, Masashi Aiba, Shinji Unome, Kenji Imai, Koji Takai, Makoto Shiraki, Naoki Katsumura, Masahito Shimizu Journal of Gastroenterology.2024; 59(9): 849. CrossRef
Incidence and risk factors of acute kidney injury in cirrhosis: a systematic review and meta-analysis of 5,202,232 outpatients, inpatients, and ICU-admitted patients Vasileios Lekakis, Aikaterini Gkoufa, John Vlachogiannakos, George V. Papatheodoridis, Evangelos Cholongitas Expert Review of Gastroenterology & Hepatology.2024; 18(7): 377. CrossRef
Association of Alcohol Consumption With Liver Cancer and All-Cause Mortality in Chronic Hepatitis B Patients Without Cirrhosis BYUNGYOON Yun, JUYEON OH, SANG HOON AHN, JIN-HA Yoon, BEOM KYUNG Kim Clinical Gastroenterology and Hepatology.2023; 21(12): 3191. CrossRef
Current and future treatment for alcoholic‐related liver diseases Eileen L. Yoon, Won Kim Journal of Gastroenterology and Hepatology.2023; 38(8): 1218. CrossRef
Excess mortality in elderly hip fracture patients: An Indian experience Jaiben George, Vijay Sharma, Kamran Farooque, Vivek Trikha, Samarth Mittal, Rajesh Malhotra Chinese Journal of Traumatology.2023; 26(6): 363. CrossRef
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Liver cirrhosis Garima Singh, Suman Bala, Sonal Katoch, Lakhvinder Kaur, Anil Kumar, Abhishek Kumar, Alok Bharadwaj, Ardhariksa Zukhruf Kurniullah International journal of health sciences.2022; : 5547. CrossRef
Microbiome-Based Metabolic Therapeutic Approaches in Alcoholic Liver Disease Ji Ye Hyun, Seul Ki Kim, Sang Jun Yoon, Su Been Lee, Jin-Ju Jeong, Haripriya Gupta, Satya Priya Sharma, Ki Kwong Oh, Sung-Min Won, Goo Hyun Kwon, Min Gi Cha, Dong Joon Kim, Raja Ganesan, Ki Tae Suk International Journal of Molecular Sciences.2022; 23(15): 8749. CrossRef
Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis Anca Trifan, Horia Minea, Adrian Rotaru, Carol Stanciu, Remus Stafie, Ermina Stratina, Sebastian Zenovia, Robert Nastasa, Ana-Maria Singeap, Irina Girleanu, Cristina Muzica, Laura Huiban, Tudor Cuciureanu, Stefan Chiriac, Catalin Sfarti, Camelia Cojocariu Medicina.2022; 58(12): 1859. CrossRef
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Background/Aims The aim of this study was to study the efficacy and safety of zolpidem for sleep disturbances in patients with cirrhosis.
Methods Fifty-two Child-Turcotte-Pugh (CTP) class A or B cirrhotics with Pittsburgh Sleep Quality Index >5 were randomized to either zolpidem 5 mg daily (n=26) or placebo (n=26) for 4 weeks.
Results The therapy of 4 weeks was completed by 23 patients receiving zolpidem (3 stopped treatment due to excessive daytime drowsiness) and 24 receiving placebo (2 refused to continue the study). In the zolpidem group, after 4 weeks of therapy, there was significant increase in total sleep time (TST) and sleep efficiency compared to baseline and improvement in polysomnographic parameters of sleep initiation and maintenance (i.e., decrease in sleep latency time, decrease in wake time, and decreases in number of arousals and periodic limbs movements per hour of sleep), without any significant change in sleep architecture.
Conclusions Four weeks of 5 mg daily zolpidem in CTP class A or B cirrhosis patients with insomnia led to significant increases in TST and sleep efficiency and improvement in polysomnographic parameters of sleep initiation and maintenance without any significant change in sleep architecture.
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