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"Cirrhosis"

Review Article

Burden of malnutrition and sarcopenia in patients with cirrhosis: pathophysiology, assessment, and management
Takao Miwa, Masahito Shimizu, Bernd Schnabl
Received October 2, 2025  Accepted December 10, 2025  Published online December 16, 2025  
DOI: https://doi.org/10.3350/cmh.2025.1126    [Accepted]
Malnutrition and sarcopenia are highly prevalent and robustly associated with reduced quality of life, disease progression, and poor outcomes, including complications and mortality, in patients with cirrhosis. Their pathophysiology is multifactorial, involving inadequate dietary intake and malabsorption, impaired liver functional reserves, altered energy, protein, and ammonia metabolism, systemic inflammation, hormonal dysregulation, and lifestyle or environmental influences. Despite extensive research, unresolved issues remain regarding optimal diagnostic criteria, as current approaches vary and lack global standardization. Regarding the diagnostic criteria for malnutrition, the usefulness of the Global Leadership Initiative on Malnutrition criteria has been proposed by international nutrition societies. However, evidence supporting their applicability in hepatology remains insufficient. For sarcopenia, differences in disease concept and diagnostic methods among societies indicate that no unified diagnostic standard exists, and clinicians should approach diagnosis with an understanding of the strengths and limitations of each method. Nutritional strategies emphasize adequate energy and protein intake, late evening snacks, and branched-chain amino acid supplementation, while deficiencies in micronutrients require tailored replacement. Nutritional therapy alone has limited effect on sarcopenia, but when combined with exercise it improves muscle mass, physical performance, and outcomes. Comprehensive approaches integrating optimized nutrition, micronutrient support, and structured exercise are essential to alleviate the burden of malnutrition and sarcopenia and to improve prognosis in patients with cirrhosis. This review addresses malnutrition and sarcopenia in cirrhosis by highlighting their prevalence, pathophysiology, clinical impact, and approaches for screening and diagnosis, and by emphasizing personalized nutritional, pharmacological, and exercise interventions to improve patient outcomes.
  • 695 View
  • 111 Download

Original Article

Hypothyroidism and the risk of liver-related events in patients with metabolic dysfunction-associated steatotic liver disease
Xinrui Jin, Sherlot Juan Song, Jimmy Che-To Lai, Grace Lai-Hung Wong, Alice Pik-Shan Kong, Nana Peng, Xiang Xiao, Vincent Wai-Sun Wong, Terry Cheuk-Fung Yip
Clin Mol Hepatol 2026;32(1):353-367.
Published online December 1, 2025
DOI: https://doi.org/10.3350/cmh.2025.0860
Background/Aims
Previous studies suggest that hypothyroidism is associated with metabolic dysfunction-associated steatotic liver disease (MASLD) and its histological severity, but clinical outcome data are largely lacking. We aimed to study the impact of hypothyroidism on liver-related events (LREs).
Methods
Patients with MASLD were identified from a territory-wide registry in Hong Kong during 2000–2024. Thyroid status was determined using diagnosis codes and thyroid function tests. The primary outcome, LRE, was defined as a composite of hepatic decompensation, hepatocellular carcinoma, liver transplantation, and liver-related death.
Results
A total of 20,478 patients with MASLD were included in the final analysis (mean age 56.4±13.2 years; 43.9% male). At baseline, 18,178 (88.8%) patients were euthyroid, 598 (2.9%) were hyperthyroid, and 1,702 (8.3%) were hypothyroid. Compared with euthyroid patients, both hyperthyroidism and overt hypothyroidism were associated with cirrhosis. At a median follow-up of 4.8 years, 179 patients developed LREs, and 26 died from liver disease. Compared with patients with normal serum thyroid-stimulating hormone (TSH) levels of 0.4–4 mIU/L, those with subclinical (4–10 mIU/L; adjusted time-dependent cause-specific hazard ratio [aCSHR], 2.49; 95% CI, 1.51–4.13) and overt hypothyroidism (>10 mIU/L; aCSHR, 4.91; 95% CI, 1.56–15.47) had an increased risk of LREs. Time-dependent, but not baseline, TSH and thyroid status were associated with LRE risk.
Conclusions
Subclinical and overt hypothyroidism are associated with an increased risk of LREs in a dose-dependent manner. The association with time-dependent but not baseline thyroid status underscores the importance of thyroid monitoring and suggests that correction of hypothyroidism may mitigate LRE risk.
  • 861 View
  • 115 Download

Review Article

Novel Biomarkers for Alcohol-Associated Liver Disease and Their Implications Across Clinical Settings
Kaanthi Rama, Vinay Jahagirdar, Francisco Idalsoaga, Hanna Blaney, S. Fisher Rhoads, Luis Antonio Díaz, Marco Arrese, Juan Pablo Arab
Received August 15, 2025  Accepted November 17, 2025  Published online November 25, 2025  
DOI: https://doi.org/10.3350/cmh.2025.0921    [Accepted]
Alcohol-associated liver disease (ALD) is a leading cause of preventable cirrhosis, hepatocellular carcinoma, and liver-related mortality, yet current laboratory and imaging tools detect only late-stage disease. This narrative review synthesizes emerging evidence on novel biomarkers that capture the multidimensional pathophysiology of ALD and discusses their utility for routine clinical practice. Traditional serum-based liver fibrosis markers (e.g., cytokeratin-18 fragments, Pro-C3, or the Enhanced Liver Fibrosis) improve non-invasive staging risk beyond aminotransferases, while elastography techniques, such as vibration-controlled transient elastography and magnetic resonance elastography, can also quantify liver stiffness with high precision. Among novel mechanistic biomarkers, genetic polymorphisms in PNPLA3, TM6SF2, MBOAT7, HSD17B13, and polygenic risk scores define lifetime risk, whereas sex-specific hormonal milieus also modify susceptibility and progression. Moreover, gut dysbiosis signatures, including reduced Faecalibacterium prausnitzii, Akkermansia muciniphila, and a lower Firmicutes/Bacteroidetes ratio, and their metabolites (short-chain fatty acids, bile acids, trimethylamine N-oxide) correlate with liver inflammation and fibrosis. Endocrine imbalances of cortisol, testosterone, and thyroid hormones further stratify metabolic vulnerability. Ultimately, multi-omics platforms (i.e., transcriptomics, lipidomics, proteomics, metabolomics, epigenomics) can reveal distinct molecular signatures that predict steatohepatitis, fibrogenesis, and early hepatocellular carcinoma. Integrating these biomarkers enables phase-specific enrichment strategies, earlier intervention windows, adaptive dose-finding, and mechanism-based endpoints in ALD trials. Remaining challenges include assay standardization, validation across diverse cohorts, and incorporation into regulatory frameworks. Future work could evaluate cost-effectiveness and feasibility in routine clinical practice. Widespread adoption promises earlier diagnosis, personalized risk reduction, and more efficient drug development for this globally prevalent disorder.
  • 1,228 View
  • 135 Download

Original Articles

Histological severity and hepatic outcomes in patients with metabolic dysfunction-associated steatotic liver disease and discrepant FIB-4 and liver stiffness measurement
Joseph Rabbat, Boyu Yang, Hye Won Lee, Huapeng Lin, Emmanuel Tsochatzis, Salvatore Petta, Elisabetta Bugianesi, Masato Yoneda, Ming-Hua Zheng, Hannes Hagström, Jérôme Boursier, José Luis Calleja, George Boon-Bee Goh, Wah-Kheong Chan, Rocio Gallego-Durán, Arun J. Sanyal, Victor de Lédinghen, Philip N Newsome, Jian-Gao Fan, Laurent Castéra, Michelle Lai, Céline Fournier-Poizat, Grace Lai-Hung Wong, Mirko Zoncape, Grazia Pennisi, Angelo Armandi, Atsushi Nakajima, Wen-Yue Liu, Ying Shang, Marc de Saint-Loup, Elba Llop, Kevin Kim Jun Teh, Carmen Lara-Romero, Amon Asgharpour, Sara Mahgoub, Mandy Sau-Wai Chan, Clemence M Canivet, Manuel Romero-Gomez, Vincent Wai-Sun Wong, Seung Up Kim, Terry Cheuk-Fung Yip
Clin Mol Hepatol 2026;32(1):289-304.
Published online November 11, 2025
DOI: https://doi.org/10.3350/cmh.2025.0888
Background/Aims
Current guidelines recommend a 2-step approach for identifying advanced fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD), using Fibrosis-4 index (FIB-4) followed by liver stiffness measurement (LSM) via vibration-controlled transient elastography (VCTE). However, some patients may exhibit discordant results. This study evaluates the histological severity and outcomes in patients with discordant FIB-4 and LSM results.
Methods
This secondary analysis of the VCTE-Prognosis study included 12,950 patients evaluated for MASLD at 16 tertiary centers, of whom 2,915 underwent liver biopsy. Patients were categorized into four groups based on established FIB-4 (1.3) and LSM (8 kPa) cutoffs.
Results
F3–F4 fibrosis was observed in 6.4%, 13.7%, 30.6%, and 62.4% in low-FIB-4-low-LSM (n=6,403), high-FIB-4-low-LSM (n=3,017), low-FIB-4-high-LSM (n=1,363), and high-FIB-4-high-LSM (n=2,167) groups, respectively. During a median follow-up of 47.4 months, 248 patients experienced hepatic decompensation, hepatocellular carcinoma, liver transplantation, or liver-related death. The incidence rates of liver-related events (LREs) were 0.67, 1.19, 2.58, and 21.30 per 1,000 person-years, respectively. Compared to low-FIB-4-low-LSM patients, those with low-FIB-4-high-LSM (adjusted subdistribution hazard ratio [aSHR] 4.12) and high-FIB-4-high-LSM (aSHR 21.38) had a significantly higher risk of LREs, while high-FIB-4-low-LSM patients did not. Similar findings were observed when hepatic decompensation and hepatocellular carcinoma were analyzed separately.
Conclusions
Approximately 30% of patients in tertiary centers exhibit discordant FIB-4 and LSM results, with LSM more likely reflecting true severity. While some patients with discordant results may have advanced fibrosis, the overall incidence of LREs remains low.
  • 1,846 View
  • 225 Download
Evaluating treatment response thresholds for cost-effective treatment in metabolic dysfunction-associated steatotic liver disease
Eileen L. Yoon, Jeong-Yeon Cho, Huiyul Park, Mimi Kim, Ji-Hyeon Park, Hye-Lin Kim, Dae Won Jun
Clin Mol Hepatol 2026;32(1):276-288.
Published online November 3, 2025
DOI: https://doi.org/10.3350/cmh.2025.0796
Background/Aims
The first metabolic dysfunction-associated steatotic liver disease (MASLD) drug was approved with an unsatisfactorily small effect size. This study aimed to determine key factors impacting the cost-effectiveness of a new hypothetical MASLD drug as well as its treatment efficacy.
Methods
A Markov model reflecting the natural history of MASLD was developed, incorporating fibrosis progression, cardiovascular disease risk, and mortality. Treatment effect of drug X (with $20,000 of annual cost) was assumed to achieve a ≥1 stage fibrosis regression, with a 25% gap of effect size in regression rate over non-treatment in the first year. The incremental cost-effectiveness ratio (ICER) over a 20-year horizon was estimated. And sensitivity analyses were conducted to explore uncertainty and identify influential factors.
Results
In the base case analysis, drug X provided an incremental gain of 1.32 quality-adjusted life years (QALYs) and 1.20 life years compared to the non-treatment, with an ICER of $68,010/QALY–below the $100,000/QALY willingnessto- pay threshold, indicating that drug X treatment is cost-effective. Two-way sensitivity analysis further highlighted that the drug should achieve at least a 15% initial regression gap and maintain a minimum 3% sustained durability gap to remain cost-effective. In addition baseline fibrosis stage distribution also acted as an influencing factor.
Conclusions
Long-term sustained durability of the hypothetical drug, patient distribution based on baseline fibrosis stage, as well as initial treatment response rate are key factors that influence the cost-effectiveness of new MASLD drugs.
  • 825 View
  • 92 Download

Editorials

Rethinking ACLF Prognosis: Can Machine Learning Outperform Conventional Scores? Editorial on: Predictive Machine Learning Model in ICU Patients with Acute-on-Chronic Liver Failure and Two or More Organ Failures
Jung Hee Kim
Received September 15, 2025  Accepted September 17, 2025  Published online September 23, 2025  
DOI: https://doi.org/10.3350/cmh.2025.1053    [Accepted]
  • 805 View
  • 50 Download
An editorial on “Human cytomegalovirus reactivation in cirrhosis patients with acute decompensation” by Hong et al. Title: Human cytomegalovirus reactivation in decompensated cirrhosis: marker of immunosuppression or contributor to severity?
Zhujun Cao, Richard Moreau
Received August 27, 2025  Accepted August 29, 2025  Published online September 1, 2025  
DOI: https://doi.org/10.3350/cmh.2025.0962    [Accepted]
  • 2,099 View
  • 28 Download

Original Article

Predictive machine learning model in intensive care unit patients with acute-on-chronic liver failure and two or more organ failures
Yee Hui Yeo, Mengyi Zhang, Martin S. McCoy, Jian Zu, Yingli He, Yi Liu, Juan Li, Taotao Yan, Yuan Wang, Hirsh D. Trivedi, Ju Dong Yang, Vinay Sundaram, Xiaodan Sun, Zhujun Cao, Chun-Ying Wu, Jonel Trebicka, Fanpu Ji
Clin Mol Hepatol 2025;31(4):1355-1371.
Published online September 1, 2025
DOI: https://doi.org/10.3350/cmh.2025.0573
Background/Aims
Prediction of short-term mortality in patients with acute-on-chronic liver failure (ACLF) admitted to the intensive care unit (ICU) may enhance effective management.
Methods
To develop, explain, and validate a predictive machine learning (ML) model for short-term mortality in patients with ACLF with two or more organ failures (OFs). Utilizing a large ICU cohort with detailed clinical information, we identified ACLF patients with two or more OFs according to the EASL-CLIF and NACSELD definitions. ML model was developed for each definition to predict 30-day mortality. The Shapley value was estimated to explain the models. Validation and calibration of these models were performed.
Results
Of 5,994 patients with cirrhosis admitted to ICU, 1,511 met NACSELD criteria, and 1,692 met EASL-CLIF grade II or higher criteria. The CatBoost ACLF (CBA) model had the greatest accuracy in the NACSELD cohort (area under curve [AUC] of 0.87), while the Random Forest ACLF (RFA) model performed best in the EASL-CLIF cohort (AUC of 0.83). Both models showed robust calibration. The models were explained by SHAP score analysis, yielding a rank list, and the top twelve predictors were selected. Both simplified models demonstrated similar performance (CBA model: AUC 0.89, RFA model: AUC 0.81) and significantly outperformed contemporary scoring systems, including CLIF-C ACLF and MELD 3.0. The models were validated in both internal and external cohorts. A simple-to-use online tool was created to predict mortality rates.
Conclusions
We presented explainable, well-validated, and calibrated predictive models for ACLF patients with two or more OFs, which outperformed existing predictive scores.
  • 4,309 View
  • 371 Download

Editorial

Call for Preemptive Treatment of Cytomegalovirus in Patients with Cirrhosis and Acute Decompensation
Norihiro Imai
Received July 26, 2025  Accepted August 3, 2025  Published online August 6, 2025  
DOI: https://doi.org/10.3350/cmh.2025.0840    [Accepted]
  • 2,140 View
  • 26 Download

Snapshot

Decoding platelet function in liver cirrhosis: A shift from quantity to quality
Vibhuti Jakhmola, Sukriti Baweja, Chhagan Bihari
Clin Mol Hepatol 2025;31(4):1384-1386.
Published online July 29, 2025
DOI: https://doi.org/10.3350/cmh.2025.0809
  • 3,097 View
  • 67 Download

Original Article

Human cytomegalovirus reactivation in cirrhosis patients with acute decompensation
Changze Hong, Zuxiong Huang, Yingli He, Rongqi Wang, Jiaying Lin, Yushan Liu, Baicheng Liu, Xiaoqin Lan, Qinjun He, Wenfan Luo, Qintao Lai, Ling Zhou, Tingting Qi, Yali Ji, Miaoxia Liu, Qiaoping Wu, Yichen Yao, Weihao Liang, Xianbo Wang, Guohong Deng, Yanhang Gao, Yan Huang, Feng Liu, Xiaobo Lu, Zhongji Meng, Yuemin Nan, Hai Li, Beiling Li, Rajiv Jalan, Jinjun Chen
Clin Mol Hepatol 2025;31(4):1316-1332.
Published online July 4, 2025
DOI: https://doi.org/10.3350/cmh.2025.0332
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.
  • 3,568 View
  • 127 Download

Review

Update in the treatment of cirrhotic patients with portal vein thrombosis
Jialin Wu, Xinyi Deng, Junyang Luo, Zaibo Jiang, Fuda Xie, Bonan Chen, Hoi Wing Leung, Ge Zhang, Ka Fai To, Wei Kang
Clin Mol Hepatol 2025;31(4):1139-1166.
Published online June 24, 2025
DOI: https://doi.org/10.3350/cmh.2025.0411
Portal vein thrombosis (PVT) is characterized by the formation of a thrombus (blood clot) within the portal vein system, including main portal vein and its intrahepatic portal vein branches, and may extend to the superior mesenteric vein or splenic vein. The emergence of PVT is linked to diverse risk factors, encompassing liver conditions with cirrhosis, abdominal infections, previous abdominal surgeries, malignancies, inherited or acquired thrombophilias, and systemic hypercoagulable conditions. Recent studies revealed a possible connection between the occurrence of PVT and either contracting corona virus disease 2019 (COVID-19) or receiving a COVID-19 vaccination. Current treatment strategies were primarily based on symptom management, extent, and progression of thrombosis, but their efficacy was inconsistent and suboptimal. Untimely or inadequate treatment can lead to the progression of the thrombus and increase the risk of complications, such as portal hypertension, variceal bleeding, and hepatic decompensation, posing a significant risk to the patient’s life. Thus, early and appropriate initiation of pharmacologic and interventional treatments, as well as more aggressive strategies, is crucial for the management and prevention of PVT progression and recurrence. This review focuses on the literature on the recent advancements in the treatment of PVT using various therapeutic modalities, including anticoagulant therapy, thrombolysis, thrombectomy, interventional therapy and liver transplant in cirrhotic patients. In addition, we discuss pearls and pitfalls of these strategies for PVT, highlighting recent progress, identifying knowledge gaps, and proposing avenues towards precision management.

Citations

Citations to this article as recorded by  Crossref logo
  • Acute portal vein thrombosis in an elderly man with homozygous mutations of plasminogen activator inhibitor-1 and methylenetetrahydrofolate reductase genes
    Junxiu Chen, Haonan Zhao, Shengye Yang, Huiyuan Lu, Xingshun Qi
    Archives of Medical Science.2025;[Epub]     CrossRef
  • Prediction of bowel resection due to bowel necrosis in recent portal vein thrombosis based on CT presentations and clinical data
    Junyang Luo, Junwei Chen, Hua Tang, Jialin Wu, Xiaohong Wang, Zaibo Jiang, Jie Qin
    BMC Gastroenterology.2025;[Epub]     CrossRef
  • Long-term patency of the transjugular intrahepatic portosystemic shunt for portal and superior mesenteric vein thrombosis
    Junyang Luo, Churen Zhou, Yanyang Zhang, Haofan Wang, Caiyun Lu, Jialin Wu, Jie Qin, Zaibo Jiang, Junwei Chen
    Thrombosis Journal.2025;[Epub]     CrossRef
  • 4,206 View
  • 318 Download
  • 2 Web of Science
  • Crossref

Original Article

Distinct inflammatory imprint in non-cirrhotic and cirrhotic patients before and after direct-acting antiviral therapy
Moana Witte, Carlos Oltmanns, Jan Tauwaldt, Hagen Schmaus, Jasmin Mischke, Gordon Grabert, Mara Bretthauer, Lennart M. Roesner, Thomas Werfel, Katja Deterding, Benjamin Maasoumy, Heiner Wedemeyer, Tim Kacprowski, Anke R.M. Kraft, Markus Cornberg
Clin Mol Hepatol 2025;31(4):1269-1284.
Published online June 4, 2025
DOI: https://doi.org/10.3350/cmh.2025.0292
Background/Aims
Hepatitis C virus (HCV) infection remains a global health challenge, leading to chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC). Despite the high efficacy of direct-acting antiviral therapy in achieving sustained virologic response (SVR), concerns persist regarding long-term immune alterations and residual risks, particularly in cirrhotic patients.
Methods
This study investigates 75 soluble immune mediator (SIM) profiles in 102 chronic HCV patients, stratified by cirrhosis status, at therapy initiation, end of treatment, and long-term follow-up (median 96 weeks). Findings were compared with 51 matched healthy controls and validated in an independent cohort of 47 cirrhotic patients, 17 of whom developed HCC.
Results
We observed significant SIM alterations at baseline, with cirrhotic patients displaying a more profoundly dysregulated inflammatory milieu. Despite an overall decline in inflammatory markers following SVR, persistent alterations were evident, particularly in cirrhotic patients. Notably, those with liver stiffness exceeding 14 kPa exhibited sustained inflammatory dysregulation, correlating with liver elastography values. Key SIM such as interleukin (IL)-6, IL-8, urokinase plasminogen activator, and hepatocellular growth factor remained elevated and were associated with HCC development. Network analysis highlighted their roles in liver fibrosis, regeneration, and carcinogenesis.
Conclusions
These findings underscore the importance of early antiviral intervention to prevent cirrhosis-related sequelae. Future studies should explore the mechanistic pathways linking chronic inflammation, fibrosis, and oncogenesis to identify predictive biomarkers and novel therapeutic targets. Addressing persistent immune alterations post-HCV clearance may improve long-term outcomes, particularly in patients with advanced liver disease.

Citations

Citations to this article as recorded by  Crossref logo
  • HBV Dominance Is Associated With a Distinct Inflammatory Milieu in HBV/HCV Coinfection
    Carlos Oltmanns, Moana Witte, Anika Wranke, Katja Deterding, Heiner Wedemeyer, Christine S. Falk, Anke R. M. Kraft, Steffen B. Wiegand, Markus Cornberg
    Journal of Viral Hepatitis.2025;[Epub]     CrossRef
  • IFNL4-rs12979860 CC genotype predisposes to accelerated terminal exhaustion and senescence in HIV/HCV-chronic infection
    Sonia Arca-Lafuente, Violeta Lara-Aguilar, Manuel Llamas-Adán, Sergio Grande-García, Andrés Deza de la Casa, Luz Martín-Carbonero, Pablo Ryan, Ignacio de los Santos, Mariano Matarranz, Mª Ángeles Jiménez-Sousa, Amanda Fernández-Rodríguez, Verónica Briz
    Journal of Translational Medicine.2025;[Epub]     CrossRef
  • 3,110 View
  • 125 Download
  • 1 Web of Science
  • Crossref

Reply to Correspondence

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
Clin Mol Hepatol 2026;32(1):e106-e108.
Published online April 16, 2025
DOI: https://doi.org/10.3350/cmh.2025.0391
  • 4,065 View
  • 19 Download

Editorials

vibraA non-invasive risk stratification tool for hepatitis B-related liver cirrhosis: The Baveno VI-SSM combined model: Editorial on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
Ruiling He, Bingtian Dong, Xiaolong Qi
Clin Mol Hepatol 2026;32(1):395-399.
Published online March 19, 2025
DOI: https://doi.org/10.3350/cmh.2025.0281

Citations

Citations to this article as recorded by  Crossref logo
  • 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
  • Revisiting the role of liver cirrhosis in surgical treatment for hepatocellular carcinoma
    Qi Ke, Bujiangcun Luo, Zunyi Zhang, Zhiyong Huang, Erlei Zhang
    Medicine Plus.2025; 2(3): 100096.     CrossRef
  • 3,672 View
  • 69 Download
  • Crossref
Predicting decompensation risk in compensated HBV cirrhosis: Eternal sunshine for a spotless mind?: Editorial on “Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis”
Mathias Jachs, Mattias Mandorfer
Clin Mol Hepatol 2026;32(1):390-394.
Published online March 19, 2025
DOI: https://doi.org/10.3350/cmh.2025.0280

Citations

Citations to this article as recorded by  Crossref logo
  • 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
  • 4,126 View
  • 38 Download
  • Crossref

Letter to the Editor

Letter to the editor on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
Weixiong Zhu, Xuefan Zeng, Zengxi Yang, Yusheng Cheng, Wence Zhou
Clin Mol Hepatol 2025;31(3):e252-e253.
Published online February 26, 2025
DOI: https://doi.org/10.3350/cmh.2025.0189
  • 8,242 View
  • 76 Download

Reply to Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

Decreasing systemic inflammation after TIPS: Still hope for the liver: Reply to correspondence on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis”
Georg Semmler, Lorenz Balcar, Mattias Mandorfer
Clin Mol Hepatol 2025;31(2):e224-e225.
Published online February 17, 2025
DOI: https://doi.org/10.3350/cmh.2025.0149

Citations

Citations to this article as recorded by  Crossref logo
  • Systemic inflammatory indexes as predictors of 18-month mortality among cirrhotic patients receiving transjugular intrahepatic portosystemic shunt
    Jie Cheng, Xiaobing Wang, Lihua Zhou, Xiaojia Chen, Nuer Tang, Feng Zhou, Feng Ding, Yuan Yang, Jun Lin, Liping Chen
    Annals of Medicine.2025;[Epub]     CrossRef
  • 5,178 View
  • 41 Download
  • 1 Web of Science
  • Crossref

Editorial

Can SAFE score be utilized as a universal hepatocellular carcinoma prediction score?: Editorial on “High Steatosis-Associated Fibrosis Estimator scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction-associated steatotic liver disease”
Michael Kwan-Lung Ko, Loey Lung-Yi Mak
Clin Mol Hepatol 2026;32(1):371-373.
Published online February 11, 2025
DOI: https://doi.org/10.3350/cmh.2025.0118

Citations

Citations to this article as recorded by  Crossref logo
  • HCC predictors in routine practice for patients with chronic liver diseases: Correspondence to editorial on “High SAFE scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction associated steatotic liver disease”
    Tung-Hung Su, Jia-Horng Kao
    Clinical and Molecular Hepatology.2026; 32(1): e52.     CrossRef
  • 4,066 View
  • 39 Download
  • Crossref

Correspondence

Liver fibrosis, cirrhosis, and portal hypertension

TIPS insertion and systemic inflammation: Is it ever too late to lower portal pressure? Correspondence to editorial on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis”
Anja Tiede, Benjamin Maasoumy
Clin Mol Hepatol 2025;31(2):e176-e179.
Published online February 10, 2025
DOI: https://doi.org/10.3350/cmh.2025.0135

Citations

Citations to this article as recorded by  Crossref logo
  • Decreasing systemic inflammation after TIPS: Still hope for the liver: Reply to correspondence on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrh
    Georg Semmler, Lorenz Balcar, Mattias Mandorfer
    Clinical and Molecular Hepatology.2025; 31(2): e224.     CrossRef
  • Advancing our understanding of recompensated cirrhosis - the new “holy grail” of decompensated cirrhosis
    Thomas Reiberger, Benjamin Maasoumy
    Journal of Hepatology.2025; 83(3): 615.     CrossRef
  • TIPS Outcomes in Cirrhosis with Sarcopenia: Overt Hepatic Encephalopathy, Improvement in Sarcopenia and Mortality— Systematic Review and Meta-analysis
    Maria de Brito Nunes, Maria Gabriela Delgado, Jaume Bosch, Annalisa Berzigotti
    JHEP Reports.2025; : 101699.     CrossRef
  • 5,842 View
  • 28 Download
  • 1 Web of Science
  • Crossref

Letter to the Editor

Letter to the editor on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
Chi-Kuei Hsu, Po-Yu Huang, Chih-Cheng Lai
Clin Mol Hepatol 2025;31(3):e247-e248.
Published online February 6, 2025
DOI: https://doi.org/10.3350/cmh.2025.0073
  • 7,930 View
  • 53 Download

Original Article

Baveno VI-SSM stratifies the risk of portal hypertension-related events in patients with HBV-related cirrhosis
Haiyu Wang, Weihao Liang, Ling Zhou, Jiankang Song, Biao Wen, Qiaoping Wu, Yuanjian Zhang, Xiaofeng Zhang, Haoran Ke, Yujun Tang, Fuyuan Zhou, Youfu Zhu, Weiqun Wen, Zhihua Liu, Yali Ji, Qintao Lai, Qinjun He, Wenfan Luo, Tingting Qi, Miaoxia Liu, Xiaoqin Lan, Yongpeng Chen, Ranran Xi, Junting Wan, Lin Dai, Yuan Li, Jinjun Chen
Clin Mol Hepatol 2025;31(3):866-880.
Published online February 5, 2025
DOI: https://doi.org/10.3350/cmh.2024.0609
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  Crossref logo
  • 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
  • Ammonia‐to‐Urea Ratio: A Noninvasive First‐Line Tool for Detecting Clinically Significant Portal Hypertension
    Hatime Ouahbi, Vincent Haghnejad, Alexia Audouy, Maël Silva Rodriguez, Françoise Barbé, Jean‐Louis Guéant, Jean‐Pierre Bronowicki, Abderrahim Oussalah
    JGH Open.2025;[Epub]     CrossRef
  • 9,722 View
  • 208 Download
  • 1 Web of Science
  • Crossref

Reply to Correspondence

Steatotic liver disease

Reply to correspondence on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
Jing Zeng, Jian-Gao Fan
Clin Mol Hepatol 2025;31(2):e218-e220.
Published online February 3, 2025
DOI: https://doi.org/10.3350/cmh.2025.0070
  • 5,454 View
  • 32 Download

Correspondence

Correspondence to editorial on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
Nicholas A. Rouillard, Linda Henry, Mindie H. Nguyen
Clin Mol Hepatol 2025;31(2):e173-e175.
Published online January 9, 2025
DOI: https://doi.org/10.3350/cmh.2025.0001

Citations

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  • Reply to correspondence on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Jing Zeng, Jian-Gao Fan
    Clinical and Molecular Hepatology.2025; 31(2): e218.     CrossRef
  • 5,742 View
  • 32 Download
  • 1 Web of Science
  • Crossref

Original Articles

Alcohol-related liver disease

Global epidemiology of alcohol-related liver disease, liver cancer, and alcohol use disorder, 2000–2021
Pojsakorn Danpanichkul, Luis Antonio Díaz, Kanokphong Suparan, Primrose Tothanarungroj, Supapitch Sirimangklanurak, Thanida Auttapracha, Hanna L. Blaney, Banthoon Sukphutanan, Yanfang Pang, Siwanart Kongarin, Francisco Idalsoaga, Eduardo Fuentes-López, Lorenzo Leggio, Mazen Noureddin, Trenton M. White, Alexandre Louvet, Philippe Mathurin, Rohit Loomba, Patrick S. Kamath, Jürgen Rehm, Jeffrey V. Lazarus, Karn Wijarnpreecha, Juan Pablo Arab
Clin Mol Hepatol 2025;31(2):525-547.
Published online January 9, 2025
DOI: https://doi.org/10.3350/cmh.2024.0835
Background/Aims
Alcohol represents a leading burden of disease worldwide, including alcohol use disorder (AUD) and alcohol-related liver disease (ALD). We aim to assess the global burden of AUD, ALD, and alcohol-attributable primary liver cancer between 2000–2021.
Methods
We registered the global and regional trends of AUD, ALD, and alcohol-related liver cancer using data from the Global Burden of Disease 2021 Study, the largest and most up-to-date global epidemiology database. We estimated the annual percent change (APC) and its 95% confidence interval (CI) to assess changes in age-standardized rates over time.
Results
In 2021, there were 111.12 million cases of AUD, 3.02 million cases of ALD, and 132,030 cases of alcohol-attributable primary liver cancer. Between 2000 and 2021, there was a 14.66% increase in AUD, a 38.68% increase in ALD, and a 94.12% increase in alcohol-attributable primary liver cancer prevalence. While the age-standardized prevalence rate for liver cancer from alcohol increased (APC 0.59%; 95% confidence interval [CI] 0.52 to 0.67%) over these years, it decreased for ALD (APC –0.71%; 95% CI –0.75 to –0.67%) and AUD (APC –0.90%; 95% CI –0.94 to –0.86%). There was significant variation by region, socioeconomic development level, and sex. During the last years (2019–2021), the prevalence, incidence, and death of ALD increased to a greater extent in females.
Conclusions
Given the high burden of AUD, ALD, and alcohol-attributable primary liver cancer, urgent measures are needed to prevent them at both global and national levels.

Citations

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    Youxin Wang, Ruiqiu Chen, Shi Yan Lee, Eunice X.X. Tan, Mark Muthiah, Zhou Yu, Margaret L.P. Teng, Jazleen Leo, Cheng Han Ng, Ashok Choudhury, Daniel Q. Huang
    JHEP Reports.2026; 8(1): 101646.     CrossRef
  • An Integrated Systematic Review and Meta‐Analysis From the Bloodstream to Identify Potential Biomarkers for ALD, MASLD, and HCC Without a Viral Background
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  • Letter: Global Burden of Metabolic Dysfunction‐Associated Steatotic Liver Disease‐Related Liver Cancer—Results From the Global Burden of Disease Study 2021. Authors' Reply
    Pojsakorn Danpanichkul, Donghee Kim, Markos Kalligeros, Amit G. Singal, Ju Dong Yang, Karn Wijarnpreecha
    Alimentary Pharmacology & Therapeutics.2025; 61(6): 1080.     CrossRef
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    Luis Antonio Diaz, Juan Pablo Arab, Francisco Idalsoaga, Javiera Perelli, Javier Vega, Melisa Dirchwolf, Javiera Carreño, Bárbara Samith, Cynthia Valério, Rodrigo Oliveira Moreira, Mónica Acevedo, Javier Brahm, Nelia Hernández, Adrian Gadano, Claudia P. O
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    Pojsakorn Danpanichkul, Karn Wijarnpreecha
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  • Disproportionately rising mortality rates of alcohol-associated acute Pancreatitis: Analysis from centers for Disease Control and prevention database (2011–2020)
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High Steatosis-Associated Fibrosis Estimator scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction-associated steatotic liver disease
Tung-Hung Su, Sheng-Shun Yang, Mei-Hsuan Lee, Wei-Yu Kao, Shang-Chin Huang, Fen-Fang Chen, Francis SK Poon, Lung-Wen Tsai, Yi-Ting Chen, Che Lin, Weichung Wang, W Ray Kim, Jia-Horng Kao
Clin Mol Hepatol 2025;31(3):796-809.
Published online January 6, 2025
DOI: https://doi.org/10.3350/cmh.2024.0822
Background/Aims
There are no hepatocellular carcinoma (HCC) surveillance recommendations for non-viral chronic liver diseases (CLD), such as metabolic dysfunction-associated steatotic liver disease (MASLD). We explored the Steatosis-Associated Fibrosis Estimator (SAFE) score to predict HCC in MASLD and other CLD etiologies.
Methods
Patients with various CLDs were included from medical centers in Taiwan. The SAFE score, consisting of age, body mass index, diabetes, and laboratory data, was calculated at baseline, and patients were traced for new development of HCC. The predictability of the SAFE score for HCC was analyzed using the sub-distribution hazard model with adjustments for competing risks.
Results
Among 12,963 CLD patients with a median follow-up of 4 years, 258 developed HCC. The SAFE score classifies 1-, 3-, and 5-year HCC risk regardless of CLD etiologies. High (≥100) and intermediate (0–100) SAFE scores increased 11 and 2 folds HCC risks compared to low (<0) SAFE scores. Combining two lower risk tiers (SAFE<100), a high SAFE score (≥100) was associated with a 7.5-fold risk of HCC (adjusted sub-distributional hazard ratio [aSHR] 7.54; 95% confidence interval (CI) 5.38–10.60). A high SAFE score increased the risks of HCC in subgroups of viral hepatitis, non-viral hepatitis (aSHR 11.10; 95% CI 3.97–31.30) and MASLD (aSHR 4.23; 95% CI 1.43–12.50). A hospital cohort (n=8,103) and a community MASLD cohort (n=120,166) validated the high SAFE score (≥100) for HCC risk prediction.
Conclusions
The SAFE score stratifies high risks for HCC in CLD patients regardless of etiologies and helps to select at-risk candidates for HCC surveillance.

Citations

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  • HCC predictors in routine practice for patients with chronic liver diseases: Correspondence to editorial on “High SAFE scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction associated steatotic liver disease”
    Tung-Hung Su, Jia-Horng Kao
    Clinical and Molecular Hepatology.2026; 32(1): e52.     CrossRef
  • Can SAFE score be utilized as a universal hepatocellular carcinoma prediction score?: Editorial on “High Steatosis-Associated Fibrosis Estimator scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction-associated
    Michael Kwan-Lung Ko, Loey Lung-Yi Mak
    Clinical and Molecular Hepatology.2026; 32(1): 371.     CrossRef
  • Risk stratification for hepatocellular carcinoma in metabolic dysfunction-associated steatotic liver disease: Editorial on “High Steatosis-Associated Fibrosis Estimator scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic
    Ho Soo Chun, Minjong Lee
    Clinical and Molecular Hepatology.2026; 32(1): 368.     CrossRef
  • 12,536 View
  • 388 Download
  • Crossref

Editorial

Steatotic liver disease

Vibration-controlled transient elastography in shaping the epidemiology and management of steatotic liver disease: Editorial on “Current burden of steatotic liver disease and fibrosis among adults in the United States, 2017–2023”
Xiao-Dong Zhou, Terry Cheuk-Fung Yip, Daniel Q Huang, Mark Dhinesh Muthiah, Mazen Noureddin, Ming-Hua Zheng
Clin Mol Hepatol 2025;31(2):620-624.
Published online December 26, 2024
DOI: https://doi.org/10.3350/cmh.2024.1131

Citations

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  • Liver Fibrosis and the Risk of Coronary Artery Disease, Stent Thrombosis, Restenosis and Adverse Clinical Outcomes
    Na Tian, Tie Xiao, Tianyi Xia, Hai‐Yang Yuan, Michael D. Shapiro, Gregory Y. H. Lip, Cheng‐Han Fanren, Li‐You Lian, Chen‐Xiao Huang, Yi‐Xuan Wei, Giovanni Targher, Christopher D. Byrne, Cheng‐Lv Hong, Shenghong Ju, Ming‐Hua Zheng
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  • Editorial: Does Metabolic Dysfunction‐Associated Steatotic Liver Disease With Advanced Fibrosis Also Equate to Risk of Advanced Coronary Artery Disease? Authors' Reply
    Xiao‐Dong Zhou, Yusuf Yilmaz, Ming‐Hua Zheng
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    Xiao-Dong Zhou, Mark D. Muthiah, Ming-Hua Zheng
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    Donghee Kim, Pojsakorn Danpanichkul, Karn Wijarnpreecha, George Cholankeril, Rohit Loomba, Aijaz Ahmed
    Clinical and Molecular Hepatology.2025; 31(2): e180.     CrossRef
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    Lin Cheng, Shumeng Li, Hui Li, Jiafeng You, Mingwei Yu, Guowang Yang
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  • Long-Term Glycemic Control and the Risk of Liver Stiffness Progression and Liver-Related Events in MASLD
    Xiao-Dong Zhou, Qin-Fen Chen, Seung Up Kim, Terry Cheuk-Fung Yip, Salvatore Petta, Atsushi Nakajima, Emmanuel Tsochatzis, Jérôme Boursier, Elisabetta Bugianesi, Hannes Hagström, Wah-Kheong Chan, Manuel Romero-Gomez, José Luis Calleja, Victor de Lédinghen,
    Clinical Gastroenterology and Hepatology.2025;[Epub]     CrossRef
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Review

Hepatic neoplasm

Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment
Soo Young Hwang, Pojsakorn Danpanichkul, Vatche Agopian, Neil Mehta, Neehar D. Parikh, Ghassan K. Abou-Alfa, Amit G. Singal, Ju Dong Yang
Clin Mol Hepatol 2025;31(Suppl):S228-S254.
Published online December 26, 2024
DOI: https://doi.org/10.3350/cmh.2024.0824
Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated magnetic resonance imaging (MRI) are being investigated. Multiphasic computed tomography or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease, immune checkpoint inhibitor-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.

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Original Article

Viral hepatitis

Longitudinal profile of plasma pregenomic RNA in patients with chronic hepatitis B infection on long-term nucleoside analogues and its interaction with clinical parameters
Lung-Yi Mak, Mark Anderson, Michael Stec, Matthew Shing-Hin Chung, Danny Ka-Ho Wong, Rex Wan-Hin Hui, Wai-Kay Seto, Gavin Cloherty, Man-Fung Yuen
Clin Mol Hepatol 2025;31(2):460-473.
Published online December 26, 2024
DOI: https://doi.org/10.3350/cmh.2024.0724
Backgrounds/Aims
Plasma pregenomic hepatitis B virus RNA (pgRNA) is a novel biomarker in chronic hepatitis B infection (CHB). We aimed to describe the longitudinal profile of pgRNA and factors influencing its levels in CHB patients on nucleoside analogue (NUC).
Methods
Serial plasma samples from 1,354 CHB patients started on first-line NUC were evaluated. Time of NUC initiation was taken as baseline (year 0), followed by 1-year, 3-year and 5-year of NUC therapy. pgRNA was measured by Research Use Only RealTime HBV RNA v2.0 (0.2 mL) (Abbott Diagnostics) with lower limit of detection of 0.8 log U/mL (~20 copies/mL).
Results
Among 1,354 subjects (median age at baseline 49.8 [interquartile range, IQR 40.2–57.3]) years, 65.2% male, 16.1% hepatitis B e antigen (HBeAg)-positive, 28.6% cirrhotic), baseline median HBV RNA was 3.68 (IQR 2.42–5.19) log U/mL. Upon NUC therapy, median pgRNA levels were 2.45 (IQR 1.82–3.62), 2.23 (IQR 1.67–3.05) and 2.14 (IQR 1.48–2.86) log U/mL at 1, 3 and 5 years, respectively, with the corresponding log U/mL reductions of 0.82, 1.20 and 1.54. Undetectable/ unquantifiable pgRNA was achieved in 13.5%, 15.9% and 20.1% of patients at 1, 3 and 5 years, respectively. Older age, male sex, HBeAg-negativity and high PAGE-B score were associated with lower pgRNA.
Conclusions
Plasma pgRNA declines are modest under NUC therapy, with only 16.3% achieving RNA undetectability after 5 years of first-line NUC indicating cccDNA silencing has not been achieved in the majority of patients. Clinical characteristics should be taken into consideration when interpreting the plasma pgRNA level.

Citations

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  • Robust mission-driven responses to infectious disease threats delivered by the Abbott pandemic defense coalition
    Mary A. Rodgers, Francisco Averhoff, Michael G. Berg, Mark Anderson, Carolyn Strobel, Julissa Inostroza, James Moy, Jorge Mera, Paul J. Utz, Scott C. Weaver, Charles Y. Chiu, Judith C. De Arcos, Joshua J. Anzinger, Jean H. Henrys, Juan P. Hernandez-Ortiz,
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Editorial

Steatotic liver disease

A leap in the dark: Bariatric surgery for treatment of metabolic dysfunction-associated steatotic liver disease related cirrhosis: Editorial on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
Jing Zeng, Jian-Gao Fan
Clin Mol Hepatol 2025;31(2):610-614.
Published online December 17, 2024
DOI: https://doi.org/10.3350/cmh.2024.1099

Citations

Citations to this article as recorded by  Crossref logo
  • Correspondence to editorial on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Nicholas A. Rouillard, Linda Henry, Mindie H. Nguyen
    Clinical and Molecular Hepatology.2025; 31(2): e173.     CrossRef
  • Reply to correspondence on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Jing Zeng, Jian-Gao Fan
    Clinical and Molecular Hepatology.2025; 31(2): e218.     CrossRef
  • 6,729 View
  • 51 Download
  • 2 Web of Science
  • Crossref

Review

Viral hepatitis

Mechanisms of hepatocellular carcinoma and cirrhosis development in concurrent steatotic liver disease and chronic hepatitis B
Saisai Zhang, Lung-Yi Mak, Man-Fung Yuen, Wai-Kay Seto
Clin Mol Hepatol 2025;31(Suppl):S182-S195.
Published online November 21, 2024
DOI: https://doi.org/10.3350/cmh.2024.0837
Chronic hepatitis B (CHB) poses a major global public health challenge and is a leading cause of cirrhosis and liver cancer. Hepatic steatosis is common in individuals with CHB compared to the non-CHB population and is particularly prevalent in hepatitis B virus (HBV)-endemic regions, affecting about one-third of CHB patients. The interaction between hepatic steatosis and CHB-related disease progression is complex and still under debate. Evidence demonstrates that co-existing steatosis may worsen liver fibrosis while paradoxically increasing the likelihood of achieving better HBV control. In particular, despite the association of steatotic liver disease (SLD) with lower HBV viral loads and higher rates of HBsAg seroclearance, the coexistence of CHB and SLD can potentially accelerate liver disease progression. Factors such as fat deposition, lipotoxicity, oxidative stress, and chronic inflammation in SLD may foster a pro-fibrotic and pro-carcinogenic environment, accelerating the disease progression. Additionally, loss of global DNA methylation, changes in the immune microenvironment, and genetic susceptibility further contribute to the development of CHB-related cirrhosis and hepatocellular carcinoma (HCC). This review examines the mechanisms driving liver disease progression and the heightened risk of cirrhosis and HCC in patients with concurrent CHB and steatotic liver disease, underscoring the importance of prioritizing antiviral therapy for CHB in addition to addressing SLD.

Citations

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  • Diagnostic Performance of Ultrasound-Derived Fat Fraction and Automated Point Shear Wave Elastography for Hepatic Steatosis and Fibrosis in Suspected Steatotic Liver Disease: A Prospective Multicenter Study
    Jing Liang, Xueqi Li, Guangwen Cheng, Huixiong Xu, Yuli Zhu, Zhe Ma, Dong Jiang, Hao Han, Lin Chen, Liyun Xue, Xiaohui Qiao, Hong Ding
    Ultrasound in Medicine & Biology.2026; 52(1): 227.     CrossRef
  • Pollutants in Microenvironmental Cellular Interactions During Liver Inflammation Cancer Transition and the Application of Multi-Omics Analysis
    Yulun Jian, Yuhan Li, Yanfeng Zhou, Wei Mu
    Toxics.2025; 13(3): 163.     CrossRef
  • Identification and evaluation of biomarkers for diagnosis of chronic hepatitis B using RNA-seq
    Hong Hong, Xintong Han, Qiuxiang Hu, Huafeng Song, Bing Han
    Virus Research.2025; 358: 199589.     CrossRef
  • Unraveling the metabolic thread: Type 2 diabetes and fibrosis in chronic hepatitis B with steatosis
    Won-Mook Choi, Wai-Kay Seto
    Hepatology.2025;[Epub]     CrossRef
  • Exosome in HBV infection: current concepts and future perspectives
    XueLan Yuan, ChunXia Huang, Yan Ran
    Frontiers in Cellular and Infection Microbiology.2025;[Epub]     CrossRef
  • Impact of Concurrent Steatotic Liver Disease and Chronic Hepatitis B on Treatment Response to Nucleos(t)ide Analogs
    Angela Chau, Jie Li, Dae Won Jun, Yao‐Chun Hsu, Hidenori Toyoda, Ming‐Lun Yeh, Tsunamasa Watanabe, Takashi Honda, Huy Trinh, Akito Nozaki, Haruki Uojima, Toru Ishikawa, Daniel Q. Huang, Philip Vutien, Sebastián Marciano, Hiroshi Abe, Masanori Atsukawa, Ma
    Journal of Viral Hepatitis.2025;[Epub]     CrossRef
  • Preoperative HBsAg seroclearance affects long-term outcomes for hepatitis B virus-related hepatocellular carcinoma after liver resection: a multicenter analysis
    Si-Yu Liu, Lin Zhu, Wen-Feng Lu, Gui-Lin Xie, Lei Liang, Jun-Wei Liu, Bin Ye, Mu-Gen Dai
    BMC Cancer.2025;[Epub]     CrossRef
  • Efficacy and safety of bifidobacterium triple viable capsules combined with entecavir in the treatment of Hepatitis B cirrhosis
    Rongquan Liu, Yun Ji, Jie Zhang
    Biomedical Papers.2025;[Epub]     CrossRef
  • EMP1 + hepatic stellate cells drive hepatic fibrosis progression to hepatocellular carcinoma and predict prognosis
    Jie You, Yihuan Huang, Chenhao Jiang, Jiaqi Xiao, Jiebin Zhang, Yasong Liu, Xin Sui, Yingcai Zhang, Jia Yao, Tongyu Lu
    Journal of Translational Medicine.2025;[Epub]     CrossRef
  • Prognostic Value of the PET/CT-Derived Maximum Standardized Uptake Value Combined with the Neutrophil–Lymphocyte Ratio in Patients with Hepatocellular Carcinoma Undergoing Hepatectomy
    Tianyi Zhou, Chaoliu Dai
    Current Oncology.2025; 33(1): 13.     CrossRef
  • 8,904 View
  • 251 Download
  • 10 Web of Science
  • Crossref

Original Articles

Liver fibrosis, cirrhosis, and portal hypertension

Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis
Anja Tiede, Lena Stockhoff, Zhaoli Liu, Hannah Rieland, Jim B. Mauz, Valerie Ohlendorf, Birgit Bremer, Jennifer Witt, Anke Kraft, Markus Cornberg, Jan B. Hinrichs, Bernhard C. Meyer, Heiner Wedemeyer, Cheng-Jian Xu, Christine S. Falk, Benjamin Maasoumy
Clin Mol Hepatol 2025;31(1):240-255.
Published online November 21, 2024
DOI: https://doi.org/10.3350/cmh.2024.0587
Background/Aims
Systemic Inflammation (SI) is considered a key mechanism in disease progression and development of complications in decompensated liver cirrhosis. SI is mainly driven by portal hypertension and bacterial translocation. Transjugular intrahepatic portosystemic shunt (TIPS) insertion represents an effective treatment for portal hypertension. This study aims to investigate the impact of TIPS insertion on SI and bacterial translocation.
Methods
We prospectively included 59 cirrhotic patients undergoing TIPS insertion. Blood samples were collected at TIPS insertion and follow-up (FU) 1, 3, 6, and 12 months thereafter. At all time points, we performed a comprehensive analysis of SI including 43 soluble inflammatory markers (SIMs), and surrogates of bacterial translocation (sCD14, sCD163). To investigate long-term kinetics of SI, C-reactive protein (CRP) and white blood cells (WBC) were retrospectively analyzed in a cohort of 177 patients up to 3 years after TIPS insertion.
Results
At TIPS insertion, 30/43 SIMs, sCD14, and sCD163 measured significantly higher in cirrhotic patients compared to healthy controls. By FU6 25 SIMs and sCD14 measured at significantly lower levels compared to baseline. Interestingly, in patients with TIPS indication of refractory ascites, IL-6 decreased to levels documented in earlier stages of cirrhosis. In long-term follow-up, CRP levels significantly decreased after TIPS insertion, which translated into lower mortality in Cox regression analysis (HR 0.968, p=0.042). Notably, patients with residual ascites post-TIPS showed significantly higher CRP and IL-6 levels across all follow-ups compared to patients with resolved ascites.
Conclusions
Decreasing portal hypertension via TIPS insertion leads to a significant attenuation of SI and bacterial translocation over time.

Citations

Citations to this article as recorded by  Crossref logo
  • Treatment response to bulevirtide is linked to amelioration of portal hypertension in patients with chronic hepatitis D
    Lisa Sandmann, Mathias Jachs, Tammo L. Tergast, Lukas Hartl, Birgit Bremer, Martin A. Kabelitz, Michael Schwarz, Julius F.M. Egge, Lorenz Balcar, Benedikt Silvester Hofer, Christine S. Falk, Albert Friedrich Stättermayer, Markus Cornberg, Michael Trauner,
    JHEP Reports.2026; 8(1): 101643.     CrossRef
  • Systemic inflammatory indexes as predictors of 18-month mortality among cirrhotic patients receiving transjugular intrahepatic portosystemic shunt
    Jie Cheng, Xiaobing Wang, Lihua Zhou, Xiaojia Chen, Nuer Tang, Feng Zhou, Feng Ding, Yuan Yang, Jun Lin, Liping Chen
    Annals of Medicine.2025;[Epub]     CrossRef
  • Advancing our understanding of recompensated cirrhosis - the new “holy grail” of decompensated cirrhosis
    Thomas Reiberger, Benjamin Maasoumy
    Journal of Hepatology.2025; 83(3): 615.     CrossRef
  • Transjugular Intrahepatic Portosystemic Shunt (TIPS) Promotes Wound Healing in Cirrhotic Patients With Post‐Splenectomy Complications
    Na Han, Xulong Yuan, Zhengcai Liu, Yuanping Xu, Shuqiang Yue, Yongquan Shi, Jun Tie
    Portal Hypertension & Cirrhosis.2025; 4(3): 189.     CrossRef
  • TIPSEMS‐VB Trial Reappraised: Infection Control, HE Prophylaxis, and Ischemic Hepatitis Considerations
    Kaiyu Bian, Yujie Zhang, Xiang Ma
    Liver International.2025;[Epub]     CrossRef
  • Refining Prognosis in Cirrhosis Patients With Ascites: Impact of Acute vs. Non‐Acute Decompensation
    Lucie Simonis, Lorenz Balcar, Anna Schedlbauer, Marta Tonon, Nikolaj Torp, Valeria Santori, Katharina Stopfer, Jan Embacher, Christian Sebesta, Leonie Hafner, Benedikt Silvester Hofer, Nina Dominik, Georg Kramer, Paul Thöne, Michael Trauner, Aleksander Kr
    Alimentary Pharmacology & Therapeutics.2025; 62(11-12): 1202.     CrossRef
  • Reply
    Martin A. Kabelitz, Lisa Sandmann, Benjamin Maasoumy
    Clinical Gastroenterology and Hepatology.2025;[Epub]     CrossRef
  • Editorial: Redefining Decompensation in Cirrhosis—More Than an Academic Playground?
    Anja Tiede, Benjamin Maasoumy
    Alimentary Pharmacology & Therapeutics.2025; 62(11-12): 1230.     CrossRef
  • Editorial: Redefining Decompensation in Cirrhosis—More Than an Academic Playground? Authors' Reply
    Lucie Simonis, Lorenz Balcar, Georg Kramer, Thomas Reiberger, Georg Semmler
    Alimentary Pharmacology & Therapeutics.2025; 62(11-12): 1233.     CrossRef
  • Effectiveness of controlled-expansion transjugular intrahepatic portosystemic shunt (CX-TIPS) in an interdisciplinary setting at a large tertiary center
    Marlene Hintersteininger, Julia Kappel, Theresa Müllner-Buscics, Susanna Riegler, Nina Dominik, Georg Kramer, Christian Sebesta, Paul Thöne, Albert Friedrich Stättermayer, Lukas Reider, Maria Schoder, Catharina Klausenitz, Raoul Varga, Fredrik Waneck, Mic
    Wiener klinische Wochenschrift.2025;[Epub]     CrossRef
  • Prävention der Dekompensation bei einer fortgeschrittenen Lebererkrankung
    Marlene Reincke, Lukas Sturm, Robert Thimme, Dominik Bettinger
    DMW - Deutsche Medizinische Wochenschrift.2025; 150(21): 1267.     CrossRef
  • Neurofilament Light Chains in Serum Predict Post—Transjugular Intrahepatic Portosystemic Shunt Hepatic Encephalopathy
    Christian Labenz, Eva Maria Schleicher, Myriam Meineck, Martin A. Kabelitz, Alena F. Ehrenbauer, Anja Tiede, Jim B. Mauz, Sven Danneberg, Michael Bernhard Pitton, Falk Steffen, Julia Weinmann‐Menke, Peter Robert Galle, Stefan Bittner, Felix Lüssi, Jens Uw
    MedComm.2025;[Epub]     CrossRef
  • Decreasing interleukin-6 levels after TIPS predict outcomes in decompensated cirrhosis
    Andrea Kornfehl, Anja Tiede, Paul Hemetsberger, Julia Kappel, Theresa Müllner-Bucsics, Lena Stockhoff, Hannah Rieland, Lukas Reider, Nina Dominik, Georg Kramer, Michael Trauner, Mattias Mandorfer, Christine Falk, Benjamin Maasoumy, Thomas Reiberger, Lukas
    JHEP Reports.2024; : 101308.     CrossRef
  • 7,858 View
  • 285 Download
  • 17 Web of Science
  • Crossref

Steatotic liver disease

Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis
Nicholas A. Rouillard, Scott D. Barnett, Xinrong Zhang, Leslie Kam, Richie Manikat, Ramsey Cheung, Mindie H. Nguyen
Clin Mol Hepatol 2025;31(1):227-239.
Published online November 14, 2024
DOI: https://doi.org/10.3350/cmh.2024.0564
Background/Aims
With the obesity pandemic, metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease and a leading cause of end-stage liver disease and liver-related deaths in the USA. Therefore, we aimed to compare the long-term outcomes of patients with MASLD and cirrhosis with and without bariatric surgery.
Methods
Patients were retrospectively identified from the California Department of Healthcare Access and Information database, 2005 to 2019, for a population-based cohort study. Propensity score matching (PSM) was used to balance background risks between patients with cirrhosis who underwent bariatric surgery and those who did not. Overall, liver-related and non-liver-related mortality were analyzed.
Results
Of 91,708 eligible patients with MASLD and cirrhosis, PSM yielded 2,107 patients who underwent bariatric surgery and 8,428 non-bariatric controls. Compared to matched controls, patients who underwent bariatric surgery had lower 5-year overall (24.9% vs. 37.1%; p<0.0001), liver-related (3.3% vs. 14%; p<0.0001), and non-liver-related mortality (22.3% vs. 26.9%; p=0.046). In multivariable analysis, bariatric surgery was associated with decreased overall mortality (adjusted hazard ratio [aHR]=0.63; p<0.0001), liver-related (aHR=0.24; p<0.0001), and non-liverrelated (aHR=0.81; p=0.0026) mortality. However, only laparoscopic surgeries were associated with lower overall mortality (aHR=0.39; p<0.0001) whereas open surgeries were associated with higher overall mortality (aHR=1.24; p=0.022).
Conclusions
Patients with MASLD and cirrhosis who underwent bariatric surgery, specifically laparoscopic approaches, had significantly lower mortality risk than non-surgical counterparts.

Citations

Citations to this article as recorded by  Crossref logo
  • Differential Characteristics and Survival Outcomes of Patients With Cirrhosis According to Underlying Liver Aetiology
    Yu Shi, Nicholas Chien, Ashley Fong, Vy H. Nguyen, Surya Teja Gudapati, Angela Chau, Sally Tran, Linda Henry, Ramsey Cheung, Changqing Zhao, Minjuan Jin, Mindie H. Nguyen
    Alimentary Pharmacology & Therapeutics.2025; 61(10): 1622.     CrossRef
  • A leap in the dark: Bariatric surgery for treatment of metabolic dysfunction-associated steatotic liver disease related cirrhosis: Editorial on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic live
    Jing Zeng, Jian-Gao Fan
    Clinical and Molecular Hepatology.2025; 31(2): 610.     CrossRef
  • Letter to the editor on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Wei Wang, Yating Xie, Ailei Xu
    Clinical and Molecular Hepatology.2025; 31(2): e143.     CrossRef
  • Advancing precision medicine in metabolic dysfunction-associated steatotic liver disease
    Bryan A. Priego-Parra, Rocío Gallego-Durán, Berenice M. Román-Calleja, José Antonio Velarde-Ruiz Velasco, Manuel Romero-Gómez, Jordi Gracia-Sancho
    Trends in Endocrinology & Metabolism.2025; 36(11): 1000.     CrossRef
  • Correspondence to editorial on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Nicholas A. Rouillard, Linda Henry, Mindie H. Nguyen
    Clinical and Molecular Hepatology.2025; 31(2): e173.     CrossRef
  • Reply to correspondence on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Jing Zeng, Jian-Gao Fan
    Clinical and Molecular Hepatology.2025; 31(2): e218.     CrossRef
  • Letter to the editor on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Weixiong Zhu, Xuefan Zeng, Zengxi Yang, Yusheng Cheng, Wence Zhou
    Clinical and Molecular Hepatology.2025; 31(3): e252.     CrossRef
  • Association between body roundness index and risks of all-cause and cardiovascular mortality in adults with metabolic dysfunction-associated steatotic liver disease: NHANES 1999–2018
    Yanshan Yi, Li Yang
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • Letter to the editor on “Bariatric surgery reduces long-term mortality in patients with metabolic dysfunction-associated steatotic liver disease and cirrhosis”
    Chi-Kuei Hsu, Po-Yu Huang, Chih-Cheng Lai
    Clinical and Molecular Hepatology.2025; 31(3): e247.     CrossRef
  • Efficacy and Safety of Bariatric Surgery in Well-Compensated Liver Cirrhosis: A Systematic Review and a Single-Arm Meta-analysis
    Pandora Fonseca, Leonardo Pereira, João Gabriel Braga, Giovanna Macanhã Scremin, Luísa de Araujo, Julia Alves, Gabriel de França, Pedro Bregion, Rafael Rego, Maria Farias, Victor Ivano
    Obesity Surgery.2025; 35(10): 4246.     CrossRef
  • Metabolic Dysfunction Associated to Steatotic Liver Disease: A Review
    Janna Vanessa Diaz Torres, Vanessa Rocío Villanueva Guerrero, Jennifer Patricia Vargas Gómez, Fredy Javier Pacheco Miranda, Lorena Rocío Orozco Álvarez, Joseph David León Insignares, Marian Mares, Héctor Mario Rodríguez Ortiz, Evelyn Mendoza-Torres
    Metabolic Syndrome and Related Disorders.2025; 23(10): 427.     CrossRef
  • Endoscopic Bariatric Therapies for Metabolic Dysfunction-Associated Steatotic Liver Disease: Mechanistic Insights and Metabolic Implications
    Wissam Ghusn, Mira Sridharan, Rachel Fromer, Muhammet Ozdemir, Madeleine G. Haff, Eric J. Vargas
    Biomedicines.2025; 13(10): 2437.     CrossRef
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  • 179 Download
  • 10 Web of Science
  • Crossref

Review

Hepatitis E as a trigger for acute-on-chronic liver failure
Maria Buti, Juan Carlos Ruiz-Cobo, Rafael Esteban, Mar Riveiro-Barciela
Clin Mol Hepatol 2025;31(Suppl):S196-S204.
Published online November 11, 2024
DOI: https://doi.org/10.3350/cmh.2024.0758
Acute hepatitis E virus (HEV) infection is typically self-limiting and has a favourable prognosis. However, certain populations such as patients with pre-existing chronic liver disease may experience severe manifestations, including progression to acute-on-chronic liver failure (ACLF). Among viral hepatitis types, hepatitis A, E, and B are major causes of ACLF. Active screening and early diagnosis of HEV infection in patients with cirrhosis, especially those who develop ACLF, can improve management and enable timely antiviral therapy. Preventive measures, including HEV vaccination for high-risk groups, could reduce the morbidity and mortality associated with hepatitis E.

Citations

Citations to this article as recorded by  Crossref logo
  • Efficacy and safety of mesenchymal stem cell therapy in acute on chronic liver failure: a systematic review and meta-analysis of randomized controlled clinical trials
    Wenming Lu, Longxiang Yan, Lulu Peng, Xuesong Wang, Xingkun Tang, Jing Du, Jing Lin, Zhengwei Zou, Lincai Li, Junsong Ye, Lin Zhou
    Stem Cell Research & Therapy.2025;[Epub]     CrossRef
  • Hepatitis A and E Viruses Are Important Agents of Acute Severe Hepatitis in Asia: A Narrative Review
    Reina Sasaki-Tanaka, Tatsuo Kanda, Takeshi Yokoo, Hiroyuki Abe, Kazunao Hayashi, Akira Sakamaki, Hiroteru Kamimura, Shuji Terai
    Pathogens.2025; 14(5): 454.     CrossRef
  • The role of bacterial outer membrane vesicles in inflammatory response of acute-on-chronic liver failure
    Xiaojing Qin, Shuang Wang, Zhanyao Yan, Ninghui Zhao, Jia Yao
    Frontiers in Microbiology.2025;[Epub]     CrossRef
  • Ribavirina como tratamiento de hepatitis E aguda grave sobre hepatopatía crónica: experiencia clínica
    Alba Rabadán Mata, María Dolores Antón Conejero, José María Paredes Arquiola
    Medicina Clínica.2025; 165(6): 107187.     CrossRef
  • Ribavirin as a treatment for severe acute hepatitis E on chronic liver disease: Clinical experience
    Alba Rabadán Mata, María Dolores Antón Conejero, José María Paredes Arquiola
    Medicina Clínica (English Edition).2025; 165(6): 107187.     CrossRef
  • 6,636 View
  • 180 Download
  • 4 Web of Science
  • Crossref

Editorial

Steatotic liver disease

Essential tools for assessing advanced fibrosis in metabolic dysfunction-associated steatotic liver disease: Editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis”
Won Sohn
Clin Mol Hepatol 2025;31(1):277-280.
Published online October 11, 2024
DOI: https://doi.org/10.3350/cmh.2024.0823

Citations

Citations to this article as recorded by  Crossref logo
  • Liver Fibrosis and the Risk of Coronary Artery Disease, Stent Thrombosis, Restenosis and Adverse Clinical Outcomes
    Na Tian, Tie Xiao, Tianyi Xia, Hai‐Yang Yuan, Michael D. Shapiro, Gregory Y. H. Lip, Cheng‐Han Fanren, Li‐You Lian, Chen‐Xiao Huang, Yi‐Xuan Wei, Giovanni Targher, Christopher D. Byrne, Cheng‐Lv Hong, Shenghong Ju, Ming‐Hua Zheng
    Alimentary Pharmacology & Therapeutics.2026; 63(1): 70.     CrossRef
  • Correspondence to editorial on “Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: a systematic review and meta-analy
    Young Eun Chon, Jung Hwan Yu, Seung Up Kim
    Clinical and Molecular Hepatology.2025; 31(1): e61.     CrossRef
  • Impact of Short-Term Liraglutide Therapy on Non-Invasive Markers of Liver Fibrosis in Patients with MASLD
    Aleksandra Bołdys, Maciej Borówka, Łukasz Bułdak, Bogusław Okopień
    Metabolites.2025; 15(8): 510.     CrossRef
  • Hepatic enhancement and signal intensity analysis on magnetic resonance imaging as prognostic biomarkers in advanced chronic liver disease
    Bogdan-Ioan Stanciu, Marcela Iojiban, Andreea Morariu-Barb, Cosmin Caraiani, Bogdan Procopet, Horia Stefanescu, Monica Lupsor-Platon
    World Journal of Hepatology.2025;[Epub]     CrossRef
  • 6,468 View
  • 54 Download
  • 4 Web of Science
  • Crossref

Review

Artificial intelligence, epidemiology, methodology, or others

Roles of X-box binding protein 1 in liver pathogenesis
Jihoon Tak, Yun Seok Kim, Sang Geon Kim
Clin Mol Hepatol 2025;31(1):1-31.
Published online October 2, 2024
DOI: https://doi.org/10.3350/cmh.2024.0441
The prevalence of drug-induced liver injury (DILI) and viral liver infections presents significant challenges in modern healthcare and contributes to considerable morbidity and mortality worldwide. Concurrently, metabolic dysfunctionassociated steatotic liver disease (MASLD) has emerged as a major public health concern, reflecting the increasing rates of obesity and leading to more severe complications such as fibrosis and hepatocellular carcinoma. X-box binding protein 1 (XBP1) is a distinct transcription factor with a basic-region leucine zipper structure, whose activity is regulated by alternative splicing in response to disruptions in endoplasmic reticulum (ER) homeostasis and the unfolded protein response (UPR) activation. XBP1 interacts with a key signaling component of the highly conserved UPR and is critical in determining cell fate when responding to ER stress in liver diseases. This review aims to elucidate the emerging roles and molecular mechanisms of XBP1 in liver pathogenesis, focusing on its involvement in DILI, viral liver infections, MASLD, fibrosis/cirrhosis, and liver cancer. Understanding the multifaceted functions of XBP1 in these liver diseases offers insights into potential therapeutic strategies to restore ER homeostasis and mitigate liver damage.

Citations

Citations to this article as recorded by  Crossref logo
  • Early oxidative protein modifications and gut damage/leakiness contribute to drug-induced acute liver failure
    Wiramon Rungratanawanich, Ying Qu, Andrew Holmes, Neil Kaplowitz, Byoung-Joon Song
    Clinical and Molecular Hepatology.2026; 32(1): e29.     CrossRef
  • Association between estimated glucose disposal rate and the risk of MAFLD in American adults: a cross-sectional study
    Yuhang Zhou, Bang Wang, Miaoxin Wu, Han Hong, Gaochao Li, Minhui Xu
    Scientific Reports.2025;[Epub]     CrossRef
  • The Cardiohepatic Axis in Metabolic Disease
    Andrew Hakeem, Jop van Berlo, Xavier S. Revelo
    JACC: Basic to Translational Science.2025; 10(7): 101309.     CrossRef
  • Beyond ER Stress: The Pleiotropic Roles of XBP1 in Development and Regeneration
    Delan Huang, Fan Gu, Jingzhi Ma, Zhi Chen
    Biomedicines.2025; 13(11): 2663.     CrossRef
  • Association between estimated glucose disposal rate and metabolic-associated fatty liver disease among US adults: A cross-sectional study
    Rong He, Kecen Zhao
    Medicine.2025; 104(44): e45652.     CrossRef
  • Inositol-requiring enzyme 1 alpha is essential for dentinogenesis
    Qian Xu, Tian Liang, Jiahe Li, Suzhen Wang, Hua Zhang, Julie Hollien, Takao Iwawaki, Chunlin Qin, Yongbo Lu
    Frontiers in Physiology.2025;[Epub]     CrossRef
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  • 224 Download
  • 5 Web of Science
  • Crossref

Editorials

Liver fibrosis, cirrhosis, and portal hypertension

Unveiling the distinctive gut microbiota and metabolites in liver cirrhosis and its complications: Novel diagnostic biomarkers: Editorial on “Gut microbiome and metabolome signatures in liver cirrhosis-related complications”
Soon Kyu Lee, Jong Young Choi
Clin Mol Hepatol 2025;31(1):301-303.
Published online August 30, 2024
DOI: https://doi.org/10.3350/cmh.2024.0716

Citations

Citations to this article as recorded by  Crossref logo
  • Correspondence to editorial on: “Gut microbiome and metabolome signatures in liver cirrhosis-related complications”
    Satya Priya Sharma, Ki Tae Suk
    Clinical and Molecular Hepatology.2025; 31(1): e74.     CrossRef
  • The crosstalk between gut microbiota and microbiota-derived metabolites in hepatocellular carcinoma
    Sang Jun Yoon, Seul Ki Han, Tae Suk Kim, Ki Tae Suk, Dae Hee Choi, Young Don Kim, Moon Young Kim, Gab Jin Cheon, Soon Koo Baik, Dong Joon Kim
    Critical Reviews in Microbiology.2025; 51(6): 1315.     CrossRef
  • Gut-Liver Axis: The Role of Intestinal Microbiota and Their Metabolites in the Progression of Metabolic Dysfunction-Associated Steatotic Liver Disease
    Chao Cui, Shuai Gao, Jingfei Shi, Kai Wang
    Gut and Liver.2025; 19(4): 479.     CrossRef
  • 7,272 View
  • 97 Download
  • 2 Web of Science
  • Crossref

Liver fibrosis, cirrhosis, and portal hypertension

From invasive to intuitive: The emerging role of non-invasive models in hepatic decompensation: Editorial on “Carvedilol to prevent hepatic decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by new non-invasive model (CHESS2306)”
Akhil Deshmukh, Rakhi Maiwall
Clin Mol Hepatol 2025;31(2):577-580.
Published online August 19, 2024
DOI: https://doi.org/10.3350/cmh.2024.0661

Citations

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  • 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
  • 7,899 View
  • 54 Download
  • 1 Web of Science
  • Crossref

Original Articles

Microbiome

Gut microbiome and metabolome signatures in liver cirrhosis-related complications
Satya Priya Sharma, Haripriya Gupta, Goo-Hyun Kwon, Sang Yoon Lee, Seol Hee Song, Jeoung Su Kim, Jeong Ha Park, Min Ju Kim, Dong-Hoon Yang, Hyunjoon Park, Sung-Min Won, Jin-Ju Jeong, Ki-Kwang Oh, Jung A Eom, Kyeong Jin Lee, Sang Jun Yoon, Young Lim Ham, Gwang Ho Baik, Dong Joon Kim, Ki Tae Suk
Clin Mol Hepatol 2024;30(4):845-862.
Published online July 25, 2024
DOI: https://doi.org/10.3350/cmh.2024.0349
Background/Aims
Shifts in the gut microbiota and metabolites are interrelated with liver cirrhosis progression and complications. However, causal relationships have not been evaluated comprehensively. Here, we identified complication-dependent gut microbiota and metabolic signatures in patients with liver cirrhosis.
Methods
Microbiome taxonomic profiling was performed on 194 stool samples (52 controls and 142 cirrhosis patients) via V3-V4 16S rRNA sequencing. Next, 51 samples (17 controls and 34 cirrhosis patients) were selected for fecal metabolite profiling via gas chromatography mass spectrometry and liquid chromatography coupled to time-of-flight mass spectrometry. Correlation analyses were performed targeting the gut-microbiota, metabolites, clinical parameters, and presence of complications (varices, ascites, peritonitis, encephalopathy, hepatorenal syndrome, hepatocellular carcinoma, and deceased).
Results
Veillonella bacteria, Ruminococcus gnavus, and Streptococcus pneumoniae are cirrhosis-related microbiotas compared with control group. Bacteroides ovatus, Clostridium symbiosum, Emergencia timonensis, Fusobacterium varium, and Hungatella_uc were associated with complications in the cirrhosis group. The areas under the receiver operating characteristic curve (AUROCs) for the diagnosis of cirrhosis, encephalopathy, hepatorenal syndrome, and deceased were 0.863, 0.733, 0.71, and 0.69, respectively. The AUROCs of mixed microbial species for the diagnosis of cirrhosis and complication were 0.808 and 0.847, respectively. According to the metabolic profile, 5 increased fecal metabolites in patients with cirrhosis were biomarkers (AUROC >0.880) for the diagnosis of cirrhosis and complications. Clinical markers were significantly correlated with the gut microbiota and metabolites.
Conclusions
Cirrhosis-dependent gut microbiota and metabolites present unique signatures that can be used as noninvasive biomarkers for the diagnosis of cirrhosis and its complications.

Citations

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  • Associations between changes in the gut microbiota and liver cirrhosis: a systematic review and meta-analysis
    Ye Liu, Ziwei Chen, Chang Li, Tianhan Sun, Xuanmei Luo, Boyue Jiang, Meilan Liu, Qing Wang, Tong Li, Jianfu Cao, Yayu Li, Yuan Chen, Lu Kuai, Fei Xiao, Hongtao Xu, Hongyuan Cui
    BMC Gastroenterology.2025;[Epub]     CrossRef
  • Study on the Influence of Intestinal Flora on the Pathogenesis and Treatment Strategy of Related Complications of Liver Cirrhosis
    莎 王
    Advances in Clinical Medicine.2025; 15(04): 2009.     CrossRef
  • Multi-omics reveals the associations among the fecal metabolome, intestinal bacteria, and serum indicators in patients with hepatocellular carcinoma
    Jing Feng, Jun-Ping Wang, Jian-Ran Hu, Ping Li, Pin Lv, Hu-Cheng He, Xiao-Wei Cheng, Zheng Cao, Jia-Jing Han, Qiang Wang, Qian Su, Li-Xin Liu
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  • The crosstalk between gut microbiota and microbiota-derived metabolites in hepatocellular carcinoma
    Sang Jun Yoon, Seul Ki Han, Tae Suk Kim, Ki Tae Suk, Dae Hee Choi, Young Don Kim, Moon Young Kim, Gab Jin Cheon, Soon Koo Baik, Dong Joon Kim
    Critical Reviews in Microbiology.2025; 51(6): 1315.     CrossRef
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    Xiaojing Qin, Shuang Wang, Zhanyao Yan, Ninghui Zhao, Jia Yao
    Frontiers in Microbiology.2025;[Epub]     CrossRef
  • Gut-Liver Axis: The Role of Intestinal Microbiota and Their Metabolites in the Progression of Metabolic Dysfunction-Associated Steatotic Liver Disease
    Chao Cui, Shuai Gao, Jingfei Shi, Kai Wang
    Gut and Liver.2025; 19(4): 479.     CrossRef
  • Phocaeicola dorei ameliorates progression of steatotic liver disease by regulating bile acid, lipid, inflammation and proliferation
    Jieun Choi, Ye Rin Choi, Min Kyo Jeong, Hyun Ho Song, Jeong Seok Yu, Seol Hui Song, Jeong Ha Park, Min Ju Kim, Hyunjoon Park, Young Lim Ham, Sang Hak Han, Dong Joon Kim, Do Yup Lee, Ki Tae Suk
    Gut Microbes.2025;[Epub]     CrossRef
  • Validation of combo ichroma as a reliable concentration-based alternative for AST and ALT measurement in liver disease monitoring
    Minsoo Kim, Su A Kim, Jeong Min Kim, Hee Young Kim, Ho Yeong Yoon, Sung Won Park, Daegyun Park, Ji Sook Han, Ki Tae Suk
    Methods.2025; 243: 66.     CrossRef
  • Gut-derived indole propionic acid alleviates liver fibrosis by targeting profibrogenic macrophages via the gut‒liver axis
    Yuanyuan Luo, Yarong Hao, Chunyan Sun, Zhi Lu, Hao Wang, Yuhan Lin, Yaping Guan, Lingyan Cai, Chenhong Ding, Binbin Li, Fei Chen, Yiting Lu, Yong Lin, Xin Zeng
    Cellular & Molecular Immunology.2025; 22(11): 1414.     CrossRef
  • Prognostic Role of Short-Chain Fatty Acid-Producing Gut Microbiota and Gut Microbial Dynamics in Patients with Hepatocellular Carcinoma Receiving Chemoembolization: A Prospective Study
    Jiwon Yang, Jihye Lim, Eun Hye Kim, Jihyun An, Danbi Lee, Han Chu Lee, Jin-Yong Jeong, Ju Hyun Shim
    Journal of Hepatocellular Carcinoma.2025; Volume 12: 1991.     CrossRef
  • Probiotic-Derived Strain-Specific Metabolites Ameliorate Metabolic Dysfunction–Associated Steatotic Liver Disease through Modulation of the Gut-Liver Axis
    Sang Jun Yoon, Jieun Choi, Sung-Min Won, Jeong Seok Yu, Hee Young Kim, Hyun Chae Joung, In Gyu Park, Jung A Eom, Sang Hak Han, Do Yup Lee, Ki Tae Suk
    Probiotics and Antimicrobial Proteins.2025;[Epub]     CrossRef
  • Phocaeicola plebeius oral treatment improve fibrosis by reversing cirrhosis-related hepatic gene dysregulation
    Satya Priya Sharma, Min-Gi Cha, Goo-Hyun Kwon, Seol Hee Song, Jeong Ha Park, Min Ju Kim, Jung A Eom, Kyeong Jin Lee, Sang Jun Yoon, Hyunjoon Park, Sung-Min Won, Ki-Kwang Oh, Young Lim Ham, Gwang Ho Baik, Dong Joon Kim, Ki Tae Suk
    Life Sciences.2025; 381: 123979.     CrossRef
  • Gut microbiome and its metabolites in liver cirrhosis: mechanisms and clinical implications
    Luyuan Chang, Yang Liu, Haipeng Li, Jiaqi Yan, Wenzong Wu, Nuo Chen, Chunyu Ma, Xinyi Zhao, Juan Chen, Jing Zhang
    Frontiers in Cellular and Infection Microbiology.2025;[Epub]     CrossRef
  • Gut microbiota involvement in the alteration of inflammatory cell infiltration and gut barrier integrity in liver cirrhosis
    Kaiduan Xie, Yiwang Zhang, Shuyan Tan, Jiajie Luo, Xingtong Ou, Siwei Tan
    Biomedical Reports.2025; 23(6): 1.     CrossRef
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    Yan Wang, Zhongyuan Bai, Jing Sun, Qi Gong, Wentao Miao, Zhiqiang Niu, Xiang Li, Jun Xu, Zhiyong Lai
    Journal of Translational Medicine.2025;[Epub]     CrossRef
  • Research Progress on the Relationship between Gut Microbiota and Metabolites and Hepatitis B-Related Liver Disease
    欢 何
    Advances in Clinical Medicine.2024; 14(11): 316.     CrossRef
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    Oh Ki-Kwang, Lee Sang Youn, Kwon Goo-Hyun, Eom Jung-A, Lee Kyeong Jin, Kim Dong Joon, Suk Ki-Tae
    Food Bioscience.2024; 62: 105530.     CrossRef
  • Etiology-Dependent Microbiome Differences in Hepatocellular Carcinoma Development
    Nevena Todorovic, Serena Martinelli, Giulia Nannini, Ralf Weiskirchen, Amedeo Amedei
    International Journal of Molecular Sciences.2024; 25(24): 13510.     CrossRef
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Liver fibrosis, cirrhosis, and portal hypertension

Carvedilol to prevent hepatic decompensation of cirrhosis in patients with clinically significant portal hypertension stratified by new non-invasive model (CHESS2306)
Chuan Liu, Hong You, Qing-Lei Zeng, Yu Jun Wong, Bingqiong Wang, Ivica Grgurevic, Chenghai Liu, Hyung Joon Yim, Wei Gou, Bingtian Dong, Shenghong Ju, Yanan Guo, Qian Yu, Masashi Hirooka, Hirayuki Enomoto, Amr Shaaban Hanafy, Zhujun Cao, Xiemin Dong, Jing LV, Tae Hyung Kim, Yohei Koizumi, Yoichi Hiasa, Takashi Nishimura, Hiroko Iijima, Chuanjun Xu, Erhei Dai, Xiaoling Lan, Changxiang Lai, Shirong Liu, Fang Wang, Ying Guo, Jiaojian Lv, Liting Zhang, Yuqing Wang, Qing Xie, Chuxiao Shao, Zhensheng Liu, Federico Ravaioli, Antonio Colecchia, Jie Li, Gao-Jun Teng, Xiaolong Qi
Clin Mol Hepatol 2025;31(1):105-118.
Published online July 11, 2024
DOI: https://doi.org/10.3350/cmh.2024.0198
Backgrounds/Aims
Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model.
Methods
Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort.
Results
In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM).
Conclusions
Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Citations

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  • Endoscopic variceal ligation combined with carvedilol versus endoscopic variceal ligation combined with propranolol for the treatment of oesophageal variceal bleeding in cirrhosis: study protocol for a multicentre, randomised controlled trial
    Yiling Li, Li Du, Shuairan Zhang, Chuan Liu, Chao Ma, Xiaochao Liu, Huanhai Xu, Zhixu Fan, Shengjuan Hu, Jing Wang, Lichun Shao, Lijun Peng, Huiling Xiang, Xuan Liang, Wenhui Zhang, Hongyun Zhao, Pengyuan He, Jingyi Xu, Qianlong Li, Ling Yang, Yunhai Wu,
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    Yanqiu Li, Zihang Qiao, Jinze Li, Bingbing Zhu, Yu Lu, Ying Feng, Xianbo Wang
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  • Revolutionising portal hypertension diagnosis: the rise of non-invasive techniques in liver cirrhosis
    Bocheng Gao, Yumeng Lin, Huimin Zhang, Yulin Li, Shuhua Gou, Peiling Ma, Xueni Zhao, Yue Zhou, Qian Chen, Lan Yuan, Zhongyu Han, Chang Yu
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Editorial: Non‐selective beta‐blockers: A lifesaving shield for critically ill patients with acute decompensation of cirrhosis?
    Ling Yang, Chuan Liu, Jimmy Che‐To Lai, Xiaolong Qi
    Alimentary Pharmacology & Therapeutics.2024; 60(7): 965.     CrossRef
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  • 372 Download
  • 8 Web of Science
  • Crossref

Review

Steatotic liver disease

Role of noninvasive tests in the prognostication of metabolic dysfunction-associated steatotic liver disease
Yue Wang, Sherlot Juan Song, Yichong Jiang, Jimmy Che-To Lai, Grace Lai-Hung Wong, Vincent Wai-Sun Wong, Terry Cheuk-Fung Yip
Clin Mol Hepatol 2025;31(Suppl):S51-S75.
Published online June 27, 2024
DOI: https://doi.org/10.3350/cmh.2024.0246
In managing metabolic dysfunction-associated steatotic liver disease, which affects over 30% of the general population, effective noninvasive biomarkers for assessing disease severity, monitoring disease progression, predicting the development of liver-related complications, and assessing treatment response are crucial. The advantage of simple fibrosis scores lies in their widespread accessibility through routinely performed blood tests and extensive validation in different clinical settings. They have shown reasonable accuracy in diagnosing advanced fibrosis and good performance in excluding the majority of patients with a low risk of liver-related complications. Among patients with elevated serum fibrosis scores, a more specific fibrosis and imaging biomarker has proved useful to accurately identify patients at risk of liver-related complications. Among specific fibrosis blood biomarkers, enhanced liver fibrosis is the most widely utilized and has been approved in the United States as a prognostic biomarker. For imaging biomarkers, the availability of vibration-controlled transient elastography has been largely improved over the past years, enabling the use of liver stiffness measurement (LSM) for accurate assessment of significant and advanced fibrosis, and cirrhosis. Combining LSM with other routinely available blood tests enhances the ability to diagnose at-risk metabolic dysfunction-associated steatohepatitis and predict liver-related complications, some reaching an accuracy comparable to that of liver biopsy. Magnetic resonance imaging-based modalities provide the most accurate quantification of liver fibrosis, though the current utilization is limited to research settings. Expanding their future use in clinical practice depends on factors such as cost and facility availability.

Citations

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  • Correspondence to editorial on “Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease”
    Hye Won Lee, Seung Up Kim
    Clinical and Molecular Hepatology.2026; 32(1): e87.     CrossRef
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    Leyi Wang, Xue Zhang, Yinggang Li, Min Zhao, Gang Xu, Zhenyu Duan, Qiyong Gong, Kui Luo
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    Ho Soo Chun, Minjong Lee
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    Fredrik Åberg, Ville Männistö
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    Javier Díaz Carnicero, Inma Saurí-Ferrer, Josep Redon, Jorge Navarro, Gonzalo Fernández, Carlos Hurtado, Karine Ferreira, Carolina Alvarez-Ortega, Antón Gómez, Carlos J. Martos-Rodríguez, David Martí-Aguado, Desamparados Escudero, Marta Cedenilla
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    Jimmy Che-To Lai, Boyu Yang, Hye Won Lee, Huapeng Lin, Emmanuel A Tsochatzis, Salvatore Petta, Elisabetta Bugianesi, Masato Yoneda, Ming-Hua Zheng, Hannes Hagström, Jerome Boursier, Jose Luis Calleja, George Boon-Bee Goh, Wah-Kheong Chan, Rocìo Gallego-Du
    Gut.2025; 74(12): 2050.     CrossRef
  • Effect of Antidiabetic Drug Classes on the Risk of Liver-Related Events in Individuals With T2D and MASLD
    Yu Shi, Seung Up Kim, Terry Cheuk-Fung Yip, Emmanuel Tsochatzis, Salvatore Petta, Atsushi Nakajima, Hannes Hagström, Elisabetta Bugianesi, Wah-Kheong Chan, Jérôme Boursier, Boon-Bee George Goh, Arun J. Sanyal, Manuel Romero-Gomez, José Luis Calleja, Victo
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  • Risk stratification by noninvasive tests in patients with metabolic dysfunction-associated steatotic liver disease
    Hye Won Lee, Jae Seung Lee, Mi Na Kim, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Seung Up Kim
    Clinical and Molecular Hepatology.2025; 31(3): 1018.     CrossRef
  • Non-invasive tests of fibrosis in the management of MASLD: revolutionising diagnosis, progression and regression monitoring
    Gong Feng, Vincent Wai-Sun Wong, Giovanni Targher, Christopher D Byrne, Ming-Hua Zheng
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    Thomas J. Wang, Ajaypal Singh
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    Heechul Nam, Sung Won Lee
    Hepatology.2025;[Epub]     CrossRef
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    Yanqiu Li, Zihang Qiao, Jinze Li, Yongqi Li, Ying Feng, Xianbo Wang
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    Said A. Al-Busafi, Mohammed Eslam
    Transplantology.2025; 6(4): 35.     CrossRef
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    Jialin Wu, Junlong Huang, Shiyu Cao, Yang Lyu, Peiyao Yu, Tiejun Feng, Bonan Chen, Fuda Xie, Ge Zhang, Kangmin Zhuang, Aimin Li, Ka Fai To, Wei Kang
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  • Preface
    Seung Up Kim
    Clinical and Molecular Hepatology.2024; 30(Suppl): S3.     CrossRef
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Editorial

Acute liver injury and Acute liver failure

Modified quick-SOFA score: Can it enhance prognostic assessment for hospitalized patients with chronic liver diseases?: Editorial on “Dynamic analysis of acute deterioration in chronic liver disease patients using modified quick sequential organ failure assessment”
Simone Incicco, Salvatore Piano
Clin Mol Hepatol 2024;30(4):695-697.
Published online June 3, 2024
DOI: https://doi.org/10.3350/cmh.2024.0409

Citations

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  • RAC1 as a novel therapeutic target for acute liver failure
    Barbara Bueloni, Esteban Fiore, María José Cantero, Lucia Lameroli, Catalina Atorrasagasti, Matías Ciarlantini, Andrea Barquero, Lucía Gandolfi Donadio, Daiana Ganiewich, Francisco Orozco, Martín Fauda, Julieta Comin, Ali Canbay, Juan Bayo, Guillermo Mazz
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    Do Seon Song, Dong Joon Kim
    Clinical and Molecular Hepatology.2024; 30(4): 1012.     CrossRef
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  • Crossref

Snapshot

Liver fibrosis, cirrhosis, and portal hypertension

Examining the therapeutic landscape of beta-blockers in portal hypertension
Anna Brujats, Càndid Villanueva
Clin Mol Hepatol 2024;30(4):1055-1059.
Published online March 6, 2024
DOI: https://doi.org/10.3350/cmh.2024.0144

Citations

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  • Decreasing systemic inflammation after TIPS: Still hope for the liver: Reply to correspondence on “Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrh
    Georg Semmler, Lorenz Balcar, Mattias Mandorfer
    Clinical and Molecular Hepatology.2025; 31(2): e224.     CrossRef
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    Daisy K. Maclaine, Kosha J. Mehta
    SN Comprehensive Clinical Medicine.2025;[Epub]     CrossRef
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    Aditya K. Gupta, Amanda Liddy, Tong Wang, Su Yong Choi, Elizabeth A. Cooper
    Journal of Dermatological Treatment.2025;[Epub]     CrossRef
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Original Article

Steatotic liver disease

Global incidence of adverse clinical events in non-alcoholic fatty liver disease: A systematic review and meta-analysis
Michael H. Le, David M. Le, Thomas C. Baez, Hansen Dang, Vy H. Nguyen, KeeSeok Lee, Christopher D. Stave, Takanori Ito, Yuankai Wu, Yee Hui Yeo, Fanpu Ji, Ramsey Cheung, Mindie H. Nguyen
Clin Mol Hepatol 2024;30(2):235-246.
Published online January 26, 2024
DOI: https://doi.org/10.3350/cmh.2023.0485
Background/Aims
Nonalcoholic fatty liver disease (NAFLD) is associated with a multitude of adverse outcomes. We aimed to estimate the pooled incidence of NAFLD-related adverse events.
Methods
We performed a systematic review and meta-analysis of cohort studies of adults with NAFLD to evaluate the pooled incidence of adverse events.
Results
19,406 articles were screened, 409 full-text articles reviewed, and 79 eligible studies (1,377,466 persons) were included. Mean age was 51.47 years and body mass index 28.90 kg/m2. Baseline comorbidities included metabolic syndrome (41.73%), cardiovascular disease (CVD) (16.83%), cirrhosis (21.97%), and nonalcoholic steatohepatitis (NASH) (58.85%). Incidence rate per 1,000 person-years for mortality included: all-cause (14.6), CVD-related (4.53), non-liver cancer-related (4.53), and liver-related (3.10). Incidence for liver-related events included overall (24.3), fibrosis progression (49.0), cirrhosis (10.9), liver transplant (12.0), and hepatocellular carcinoma (HCC) (3.39). Incidence for non-liver events included metabolic syndrome (25.4), hypertension (25.8), dyslipidemia (26.4), diabetes (19.0), CVD (24.77), renal impairment (30.3), depression/anxiety (29.1), and non-liver cancer (10.5). Biopsy-proven NASH had higher incidence of HCC (P=0.043) compared to non-NASH. Higher rates of CVD and mortality were observed in North America and Europe, hypertension and non-liver cancer in North America, and HCC in Western Pacific/Southeast Asia (P<0.05). No significant differences were observed by sex. Time-period analyses showed decreasing rates of cardiovascular and non-liver cancer mortality and increasing rates of decompensated cirrhosis (P<0.05).
Conclusions
People with NAFLD have high incidence of liver and non-liver adverse clinical events, varying by NASH, geographic region, and time-period, but not sex.

Citations

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    Tae Seop Lim, Sujin Kwon, Sung A. Bae, Hye Yeon Chon, Seol A. Jang, Ja Kyung Kim, Chul Sik Kim, Seok Won Park, Kyoung Min Kim
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    Xinrong Zhang, Sovann Linden, Charles R. Levesley, Xinyuan He, Zhanpeng Yang, Scott D. Barnet, Ramsey Cheung, Fanpu Ji, Mindie H. Nguyen
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  • County-Level Factors and Preventable Premature Liver Mortality in Metabolic Dysfunction–Associated Steatotic Liver Disease
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    JAMA Network Open.2025; 8(10): e2538385.     CrossRef
  • Lean Metabolic Dysfunction‐Associated Steatotic Liver Disease: A Wolf in Sheep's Clothing
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  • The Role of Metabolites in CSF on NAFLD Development: A Mendelian Randomisation Analysis
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Letter to the Editor

Artificial intelligence, epidemiology, methodology, or others

Letter 1 regarding “Assessing the performance of ChatGPT in answering questions regarding cirrhosis and hepatocellular carcinoma”
Hinpetch Daungsupawong, Viroj Wiwanitkit
Clin Mol Hepatol 2024;30(1):111-112.
Published online October 13, 2023
DOI: https://doi.org/10.3350/cmh.2023.0394
  • 6,920 View
  • 77 Download

Original Article

Viral hepatitis

Prognostic role of computed tomography analysis using deep learning algorithm in patients with chronic hepatitis B viral infection
Jeongin Yoo, Heejin Cho, Dong Ho Lee, Eun Ju Cho, Ijin Joo, Sun Kyung Jeon
Clin Mol Hepatol 2023;29(4):1029-1042.
Published online August 29, 2023
DOI: https://doi.org/10.3350/cmh.2023.0190
Background/Aims
The prediction of clinical outcomes in patients with chronic hepatitis B (CHB) is paramount for effective management. This study aimed to evaluate the prognostic value of computed tomography (CT) analysis using deep learning algorithms in patients with CHB. Methods: This retrospective study included 2,169 patients with CHB without hepatic decompensation who underwent contrast-enhanced abdominal CT for hepatocellular carcinoma (HCC) surveillance between January 2005 and June 2016. Liver and spleen volumes and body composition measurements including subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle indices were acquired from CT images using deep learning-based fully automated organ segmentation algorithms. We assessed the significant predictors of HCC, hepatic decompensation, diabetes mellitus (DM), and overall survival (OS) using Cox proportional hazard analyses. Results: During a median follow-up period of 103.0 months, HCC (n=134, 6.2%), hepatic decompensation (n=103, 4.7%), DM (n=432, 19.9%), and death (n=120, 5.5%) occurred. According to the multivariate analysis, standardized spleen volume significantly predicted HCC development (hazard ratio [HR]=1.01, P=0.025), along with age, sex, albumin and platelet count. Standardized spleen volume (HR=1.01, P<0.001) and VAT index (HR=0.98, P=0.004) were significantly associated with hepatic decompensation along with age and albumin. Furthermore, VAT index (HR=1.01, P=0.001) and standardized spleen volume (HR=1.01, P=0.001) were significant predictors for DM, along with sex, age, and albumin. SAT index (HR=0.99, P=0.004) was significantly associated with OS, along with age, albumin, and MELD. Conclusions: Deep learning-based automatically measured spleen volume, VAT, and SAT indices may provide various prognostic information in patients with CHB.

Citations

Citations to this article as recorded by  Crossref logo
  • Reply to: “A machine learning model to predict liver-related outcomes after the functional cure of chronic hepatitis B: Is cirrhosis driving the performance?”
    Moon Haeng Hur, Jeong-Hoon Lee
    Journal of Hepatology.2025; 82(3): e143.     CrossRef
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    Nanai Xie, Yiwen Liang, Zixin Luo, Jing Hu, Ruiquan Ge, Xiang Wan, Changmiao Wang, Guannan Zou, Feng Guo, Yi Jiang
    Abdominal Radiology.2025;[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
  • Deep learning assisted biomarker development in patients with chronic hepatitis B: Editorial on “Prognostic role of computed tomography analysis using deep learning algorithm in patients with chronic hepatitis B viral infection”
    Yong Eun Chung
    Clinical and Molecular Hepatology.2024; 30(4): 669.     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
  • Assessment of body composition and prediction of infectious pancreatic necrosis via non-contrast CT radiomics and deep learning
    Bingyao Huang, Yi Gao, Lina Wu
    Frontiers in Microbiology.2024;[Epub]     CrossRef
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  • 8 Web of Science
  • Crossref

Correspondence

Artificial intelligence, epidemiology, methodology, or others

Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”
Ji Young Ryu, Seon Ha Baek, Sejoong Kim
Clin Mol Hepatol 2023;29(4):1048-1049.
Published online August 14, 2023
DOI: https://doi.org/10.3350/cmh.2023.0261
Correction in: Clin Mol Hepatol 2024;30(1):134
  • 6,742 View
  • 48 Download

Review

Artificial intelligence, epidemiology, methodology, or others

Evidence-based hyponatremia management in liver disease
Ji Young Ryu, Seon Ha Baek, Sejoong Kim
Clin Mol Hepatol 2023;29(4):924-944.
Published online June 5, 2023
DOI: https://doi.org/10.3350/cmh.2023.0090
Hyponatremia is primarily a water balance disorder associated with high morbidity and mortality. The pathophysiological mechanisms behind hyponatremia are multifactorial, and diagnosing and treating this disorder remains challenging. In this review, the classification, pathogenesis, and step-by-step management approaches for hyponatremia in patients with liver disease are described based on recent evidence. We summarize the five sequential steps of the traditional diagnostic approach: 1) confirm true hypotonic hyponatremia, 2) assess the severity of hyponatremia symptoms, 3) measure urine osmolality, 4) classify hyponatremia based on the urine sodium concentration and extracellular fluid status, and 5) rule out any coexisting endocrine disorder and renal failure. Distinct treatment strategies for hyponatremia in liver disease should be applied according to the symptoms, duration, and etiology of disease. Symptomatic hyponatremia requires immediate correction with 3% saline. Asymptomatic chronic hyponatremia in liver disease is prevalent and treatment plans should be individualized based on diagnosis. Treatment options for correcting hyponatremia in advanced liver disease may include water restriction; hypokalemia correction; and administration of vasopressin antagonists, albumin, and 3% saline. Safety concerns for patients with liver disease include a higher risk of osmotic demyelination syndrome.

Citations

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  • Hyponatremia in Cirrhosis: Comparative Evaluation of MELD and MELD-Na Scores for Predicting Short- and Long-Term Mortality
    Goutami V. Kohir, Nagaraj Kotli
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    Clinical Nutrition ESPEN.2025; 66: 262.     CrossRef
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    Expert Review of Gastroenterology & Hepatology.2025; : 1.     CrossRef
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    Goce Spasovski
    Kidney and Dialysis.2024; 4(1): 37.     CrossRef
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  • Hyponatraemia—treatment standard 2024
    Goce Spasovski
    Nephrology Dialysis Transplantation.2024; 39(10): 1583.     CrossRef
  • Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”
    Ji Young Ryu, Seon Ha Baek, Sejoong Kim
    Clinical and Molecular Hepatology.2023; 29(4): 1048.     CrossRef
  • Letter regarding “Evidence-based hyponatremia management in liver disease”
    Daphne J. Theodorou, Stavroula J. Theodorou, Ioannis V. Mitselos
    Clinical and Molecular Hepatology.2023; 29(4): 1043.     CrossRef
  • Pulmonary Complications in Patients with Liver Cirrhosis
    Seul Ki Han, Soon Koo Baik, Moon Young Kim
    The Korean Journal of Gastroenterology.2023; 82(5): 213.     CrossRef
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  • Crossref

Correspondence

Artificial intelligence, epidemiology, methodology, or others

Correspondence on Letter 1 regarding “Assessing the performance of ChatGPT in answering questions regarding cirrhosis and hepatocellular carcinoma”
Yee Hui Yeo, Jamil S. Samaan, Wee Han Ng
Clin Mol Hepatol 2023;29(3):821-822.
Published online May 31, 2023
DOI: https://doi.org/10.3350/cmh.2023.0183

Citations

Citations to this article as recorded by  Crossref logo
  • The application of large language models in medicine: A scoping review
    Xiangbin Meng, Xiangyu Yan, Kuo Zhang, Da Liu, Xiaojuan Cui, Yaodong Yang, Muhan Zhang, Chunxia Cao, Jingjia Wang, Xuliang Wang, Jun Gao, Yuan-Geng-Shuo Wang, Jia-ming Ji, Zifeng Qiu, Muzi Li, Cheng Qian, Tianze Guo, Shuangquan Ma, Zeying Wang, Zexuan Guo
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  • Providers’ Knowledge and Perceptions of Bariatric Surgery: a Systematic Review
    Nithya D. Rajeev, Jamil S. Samaan, Agnes Premkumar, Erin Yu, Nitin Srinivasan, Kamran Samakar
    Obesity Surgery.2023; 33(11): 3571.     CrossRef
  • 9,540 View
  • 80 Download
  • 2 Web of Science
  • Crossref
Letter to the Editor

Artificial intelligence, epidemiology, methodology, or others

Letter 1 regarding “Assessing the performance of ChatGPT in answering questions regarding cirrhosis and hepatocellular carcinoma”
Hassam Ali
Clin Mol Hepatol 2023;29(3):813-814.
Published online May 19, 2023
DOI: https://doi.org/10.3350/cmh.2023.0120

Citations

Citations to this article as recorded by  Crossref logo
  • Artificial intelligence in dental radiology: improving patient communication with ChatGPT – a comparative study (Preprint)
    Daniel Stephan, Annika Bertsch, Sophia Schumacher, Behrus Puladi, Mathias Burwinkel, Bilal Al-Nawas, Peer W Kämmerer, Daniel GE Thiem
    Journal of Medical Internet Research.2025;[Epub]     CrossRef
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    Muhammad Hasyimsyah BATUBARA, Awal Kurnia Putra NASUTION , NURMALINA, Fachrur RIZHA
    Applied Computer Science.2024; 20(3): 96.     CrossRef
  • 6,599 View
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  • Crossref
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