Background: Primary biliary cholangitis (PBC) patients in the decompensated stage face poor prognoses, with recompensation being crucial for improving long‐term outcomes.Aim: This study aims to evaluate the predictive value of the lymphocyte‐to‐monocyte ratio (LMR) for recompensation in decompensated PBC patients.Methods: We retrospectively analysed 410 patients with PBC‐related decompensated cirrhosis receiving ursodeoxycholic acid (UDCA) treatment. The association between the LMR and recompensation was examined using Cox regression analysis, with additional trend analysis performed based on LMR quartiles. The predictive accuracy of the LMR, neutrophil‐to‐lymphocyte ratio (NLR), systemic immune‐inflammation index (SII) and platelet‐to‐lymphocyte ratio (PLR) was evaluated using receiver operating characteristic (ROC) curve analysis. Sensitivity analyses were conducted to confirm the robustness of the findings.Results: During follow‐up, among 401 patients with decompensated cirrhosis (age: 60.0 [IQR: 53.0–69.0] years; 88.3% female), 105 patients (26.18%) achieved recompensation. Multivariate Cox regression analysis showed that higher LMR was an independent promoting factor for recompensation after adjusting for all confounding factors in the model (HR = 1.415, 95% CI: 1.264–1.585, p < 0.001), with a linear positive correlation trend. ROC curve analysis demonstrated that LMR had superior predictive performance compared to other inflammatory markers (SII, PLR, NLR), with an area under the curve (AUC) of 0.787 (95% CI: 0.736–0.838, p < 0.001).Conclusion: LMR serves as a robust independent predictor for recompensation in decompensated PBC patients.

Ursodeoxycholic acid (UDCA) is the first-line treatment for primary biliary cholangitis (PBC), but 20–40% of patients do not respond well to UDCA. We aimed to develop and validate a prognostic model for the early prediction of patients who nonresponse to UDCA. This retrospective analysis was conducted among patients with primary biliary cholangitis(N = 257) to develop a predictive model for early-stage nonresponse to ursodeoxycholic acid (UDCA) therapy. The model’s reliability was subsequently confirmed through external validation in an independent cohort(N = 71). Multivariate cox regression analysis was used to evaluate variables that were significant in the univariate analysis. Total cholesterol, alkaline phosphatase (ALP), and neutrophil-to-lymphocyte ratio (NLR) were the three independent risk factors associated with early biochemical nonresponse to UDCA treatment. Based on these factors, we established a predictive model that possessed good discriminative ability, as reflected by an AUC of 0.862(95%CI = 0.813–0.911). The ROC curve of the external validation set calculated the AUC of 0.916(95%CI:0.823–1.000). In summary, we developed an early predictive model that could identify potential nonresponse factors to UDCA at baseline, which could facilitate risk evaluation and stratification for PBC patients. The NLR and total cholesterol provided a supplementary means for effectively managing PBC patients.

Background: Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease characterized by inflammation of the interlobular bile ducts. Ursodeoxycholic acid (UDCA) is the only FDA approved first-line therapy for PBC, but up to 40% of patients with PBC have an incomplete response to UDCA. Neutrophil-to-lymphocyte (NLR) has been used to predict prognosis in various liver diseases. There is limited evidence on the treatment response to UDCA in PBC patients. Our study aimed to evaluate the relationship between NRL and the response to UDCA treatment in PBC patients. Methods: A total of 257 primary biliary cholangitis (PBC) patients treated with UDCA (13–15 mg/kg/d) were enrolled in this retrospective study. The response to treatment was evaluated based on alkaline phosphatase levels ≤1.67 times the upper limit of the normal value after 12 months of UDCA treatment. Multivariable logistic regression analysis was performed to investigate the association between NLR at baseline and the response to 12 months of UDCA treatment after adjusting for important confounding variables. The stability of the results was evaluated by unadjusted and adjusted models. Results: The results of multiple regression analysis showed that NLR at baseline was positively associated with the nonresponse to UDCA treatment after adjustments for potential confounders (age, sex, BMI, hypertension, arterial plaque, thyroid disease, jaundice, albumin, globulin, total bile acid, ALP, GGT, LDLC, total cholesterol, hemoglobin, and APTT) (OR = 1.370, 95% CI 1.066–1.761). These results reveal that NLR is an independent risk factor for UDCA treatment nonresponse. Conclusions: Our results suggest that PBC patients with a high NLR had a worse response to UDCA therapy.

OBJECTIVES: This study aimed to systematically assess the methodological quality and key recommendations of the guidelines for the diagnosis and treatment of liver failure (LF), furnishing constructive insights for guideline developers and equipping clinicians with evidence-based information to facilitate informed decision-making. DATA SOURCES: Electronic databases and manual searches from January 2011 to August 2023. STUDY SELECTION: Two reviewers independently screened titles and abstracts, then full texts for eligibility. Fourteen guidelines were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data and checked by two others. Methodological quality of the guidelines was appraised using the Appraisal of Guidelines for Research and Evaluation II tool. Of the 14 guidelines, only the guidelines established by the Society of Critical Care Medicine and the American College of Gastroenterology (2023) achieved an aggregate quality score exceeding 60%, thereby meriting clinical recommendations. It emerged that there remains ample room for enhancement in the quality of the guidelines, particularly within the domains of stakeholder engagement, rigor, and applicability. Furthermore, an in-depth scrutiny of common recommendations and supporting evidence drawn from the 10 adult LF guidelines unveiled several key issues: controversy exists in the recommendation, the absence of supporting evidence and confusing use of evidence for recommendations, and a preference in evidence selection. CONCLUSIONS: There are high differences in methodological quality and recommendations among LF guidelines. Improving these existing problems and controversies will benefit existing clinical practice and will be an effective way for developers to upgrade the guidelines.

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease characterized by inflammation of the interlobular bile ducts, often associated with malabsorption of fat-soluble vitamins and osteoporosis. Thus, evaluating the nutritional status of patients with PBC and implementing appropriate interventions are significant. But CPNI in determining the nutritional status and forecasting survival outcome among patients with PBC remains unclear. A total of 262 patients with PBC were retrospectively enrolled at the Second Affiliated Hospital of Kunming Medical University between January 2013 and November 2023. We used the receiver operating characteristic (ROC) curve, Kaplan–Meier survival curve, and logistic regression analysis to evaluate the predictive effects of several nutritional assessments. These assessments included the controlling nutritional status (CONUT), geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and Cholesterol-modified Prognostic Nutritional Index (CPNI), which were evaluated for their predictive effect on the prognosis of PBC patients. In our study, after adjusting for various confounding factors, multivariate cox regression analyses revealed that CPNI (HR: 1.114, 95% CI: 1.003–1.237, P = 0.044), age (HR: 1.071, 95% CI: 1.018–1.127, P < 0.009), total bilirubin (HR:1.019, 95% CI:1.009–1.09, P < 0.001) were independent risk factors for death in patients with PBC. The Kaplan–Meier curves and ROC curves used to assess predictive accuracy showed that CPNI(0.788) had superior prognostic performance for OS compared to other nutritional indices, such as CONUT(0.724), GNRI(0.755), PNI(0.776), and UK-PBC(0.660)(P < 0.05). CPNI is superior to other nutritional scores in the prognostic assessment of PBC patients.

BACKGROUND Liver failure, particularly acute-on-chronic liver failure, is associated with high mortality (50%-90%). The plasma exchange (PE) mode of the artificial liver support system has been shown to improve clinical outcomes, although its efficacy may vary depending on the regenerative capacity of the liver. Alpha-fetoprotein (AFP), an oncofetal glycoprotein, is reactivated during liver regeneration and may serve as a prognostic biomarker. Previous studies have reported significantly higher post-PE AFP levels in survivors than in non-survivors (286.5 ng/mL vs 82.3 ng/mL at day 7). However, the predictive value of baseline AFP stratification and serial AFP kinetics during PE therapy remains unestablished. This study investigated whether serial AFP measurements predict clinical outcomes in liver failure patients receiving PE. AIM To evaluate the predictive value of serial AFP measurements in liver failure patients receiving PE. METHODS This retrospective study included 194 liver failure patients with complete AFP data, excluding those with tumors, bleeding disorders, allergies, or unstable conditions. Patients were stratified by baseline AFP into low-AFP (< 100 ng/mL, n = 60), medium-AFP (100-200 ng/mL, n = 70), and high-AFP (> 200 ng/mL, n = 64) groups. AFP was measured before PE and on days 1, 10, 20, and 25. RESULTS Stratification by baseline AFP revealed significant gradients. The high-AFP group required fewer PE sessions than the low-AFP group (2.8 ± 1.0 vs 4.2 ± 1.5) but exhibited greater post-PE AFP elevation (75.1 ± 20.3 ng/mL vs 33.1 ± 10.2 ng/mL; P < 0.001). The high-AFP group demonstrated optimal values, including the lowest ammonia, bilirubin, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, and the highest albumin and prothrombin activity (all post hoc P < 0.05 vs low-AFP). The medium-AFP group showed intermediate values except for prothrombin activity (35.2% ± 8.6%), which was significantly lower than in both other groups (P < 0.001). The high-AFP group had a reduced incidence of spontaneous bacterial peritonitis (9.4% vs 25.0%; P = 0.003), superior three-month survival (90.6% vs 56.7%; P < 0.001), and a higher post-treatment three-month receiver operating characteristic area under the curve (0.8851 vs 0.7051). CONCLUSION AFP dynamics correlate with regenerative capacity and clinical outcomes in liver failure. Serial AFP monitoring may enhance risk stratification and support personalized therapeutic strategies.