Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how?

Background and Aims: Alcohol-associated hepatitis (AH) poses significant short-term mortality. Existing prognostic models lack precision for 90-day mortality. Utilizing artificial intelligence in a global cohort, we sought to derive and validate an enhanced prognostic model. Approach and Results: The Global AlcHep initiative, a retrospective study across 23 centers in 12 countries, enrolled patients with AH per National Institute for Alcohol Abuse and Alcoholism criteria. Centers were partitioned into derivation (11 centers, 860 patients) and validation cohorts (12 centers, 859 patients). Focusing on 30 and 90-day postadmission mortality, 3 artificial intelligence algorithms (Random Forest, Gradient Boosting Machines, and eXtreme Gradient Boosting) informed an ensemble model, subsequently refined through Bayesian updating, integrating the derivation cohort’s average 90-day mortality with each center’s approximate mortality rate to produce posttest probabilities. The ALCoholic Hepatitis Artificial INtelligence Ensemble score integrated age, gender, cirrhosis, and 9 laboratory values, with center-specific mortality rates. Mortality was 18.7% (30 d) and 27.9% (90 d) in the derivation cohort versus 21.7% and 32.5% in the validation cohort. Validation cohort 30 and 90-day AUCs were 0.811 (0.779–0.844) and 0.799 (0.769–0.830), significantly surpassing legacy models like Maddrey’s Discriminant Function, Model for End-Stage Liver Disease variations, age-serum bilirubin-international normalized ratio-serum Creatinine score, Glasgow, and modified Glasgow Scores (p < 0.001). ALCoholic Hepatitis Artificial INtelligence Ensemble score also showcased superior calibration against MELD and its variants. Steroid use improved 30-day survival for those with an ALCoholic Hepatitis Artificial INtelligence Ensemble score > 0.20 in both derivation and validation cohorts. Conclusions: Harnessing artificial intelligence within a global consortium, we pioneered a scoring system excelling over traditional models for 30 and 90-day AH mortality predictions. Beneficial for clinical trials, steroid therapy, and transplant indications, it’s accessible at: https://aihepatology.shinyapps.io/ALCHAIN/.

The evaluation of patients with early hepatocellular carcinoma (HCC) referred for liver resection is still a matter of debate. Aims: 1) to compare liver stiffness measurement (LSM) by transient elastography with hepatic venous pressure gradient (HVPG) in the prediction of decompensation after liver resection in patients with cirrhosis and early HCC; 2) to identify which definition for posthepatectomy liver failure is better associated with survival.Material and methods: Fifty-one patients (MELD score of 10±3) were included. In this group, 34 patients underwent HVPG measurement, of which 13 (38%) had clinically significant portal hypertension (CSPH) and 35 patients underwent LSM (21.8±17.9 kPa). The study’s end-points were: posthepatectomy liver failure (PHLF) defined according to International Study Group of Liver Surgery criteria and 3-month decompensation defined as de novo ascites, variceal bleeding, jaundice, hepatic encephalopathy and acute kidney injury. The performance of LSM compared to HVPG in predicting the end-points were assessed by AUROC curves and accuracy.Results: Twenty (39%) patients developed PHLF and 15 (29%) developed decompensationat 3 months. Three-month decompensation tended to be better correlated with survival. LSM performed well in predicting decompensation at 3 months (AUROC=0.78, 95%CI: 0.63-0.94; p=0.01), comparable with HVPG (AUROC=0.89, 95%CI: 0.79-1.00; p<0.01) (DeLong test p=0.21). LSM was not sufficiently accurate to predict PHLF.Conclusion: LSM has a similar performance to HVPG in predicting decompensation at 3 months in patients with early HCC submitted to liver resection. Three-month decompensation is better associated with survival.

Alcohol-associated liver disease (ALD) is a leading cause of liver disease worldwide, caused by hazardous alcohol use. Many patients with ALD also have alcohol use disorder (AUD), a chronic mental health condition characterized by a cluster of behavioral, cognitive, and physiological symptoms that indicate continued alcohol use despite significant alcohol-related problems. Comprehensive care of ALD often requires treatment of AUD, and evidence has demonstrated that treating the latter improves patient outcomes. However, only a minority of patients with AUD/ALD receive treatment. Integrative care models where hepatologists work alongside AUD specialists have been developed. These partnerships have been associated with improved outcomes, including decreased rates of return to alcohol use, decreased healthcare utilization, and even improved mortality. We review the epidemiology, diagnosis, and treatment of AUD and ALD, examples of successful integrated care models, and outcomes. We also discuss knowledge gaps and areas where future research is needed, including the role of integrated care in the peri-transplantation period for ALD, harm reduction approaches, and the need for efforts to support collaboration for integrative care. In conclusion, the dual pathologies of AUD and ALD necessitate multidisciplinary care, and integrated care models have been shown to be both feasible and effective. ^* Co-first author. Received: 22 June 2025 Accepted: 06 October 2025 Article published online: 28 October 2025 © 2025. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Background and Aims: Severe alcoholic hepatitis is characterized by an increased risk of infections. Polymorphisms in immune response-related genes may influence susceptibility to infections in alcoholic hepatitis. This study aimed to investigate the association between two clusters of differentiation 14’s (CD14) single nucleotide polymorphisms (SNPs), rs2569190 and rs5744455, and the occurrence of infections in severe alcoholic hepatitis, the response to corticotherapy and the mortality rates at one and three months. Methods: Patients with severe alcoholic hepatitis were genotyped for CD14 - rs2569190 and rs5744455 SNPs. Genotype and allele frequencies were compared between patients who presented infections and those who did not. Results: A total of 97 patients with biopsy proven sAH were included in the study, out of which 47 (48.4 %) had an associated infection. rs5744455 SNP was significantly associated with the presence of infection. Patients carrying the rs5744455T variant allele had a lower incidence of infections compared to those with the wild-type allele (32% vs 68%; p=0.002). In contrast, the rs2569190 SNP revealed no significant differences, either in the single genotype analysis (p=0.608) or under a dominant model (p=0.318). Community-acquired infections were primarily urinary tract infections (21.65%), followed by pulmonary infections (4.12%), with Escherichia coli responsible for 41.67% of cases. Healthcare-associated infections were more varied, including urinary tract (7.22%), respiratory (6.19%), digestive (7.21%), cutaneous (3.09%), and blood infections (5.15%). Klebsiella pneumoniae was the most prevalent strain, accounting for 16.67% of these infections. Conclusions: Our findings highlight a potential protective role of the CD14 rs5744455T variant allele against infections in sAH, suggesting that genetic variability may influence infection susceptibility in this population.