Malnutrition in critically ill patients with cirrhosis is a frequent but often overlooked complication with high prognostic relevance. The Nutrition Risk in Critically ill (NUTRIC) score and its modified variant (mNUTRIC) were established to assess the nutrition risk of intensive care unit patients. Considering the high mortality of cirrhosis in critically ill patients, this study aims to evaluate the discriminative ability of NUTRIC and mNUTRIC to predict outcome. We performed a retro-prospective evaluation in 150 Caucasian cirrhotic patients admitted to our ICU. Comparative prognostic analyses between NUTRIC and mNUTRIC were assessed in 114 patients. On ICU admission, a large proportion of 65% were classified as high NUTRIC (6–10) and 75% were categorized as high mNUTRIC (5–9). High nutritional risk was linked to disease severity and poor outcome. NUTRIC was moderately superior to mNUTRIC in prediction of 28-day mortality (area under curve 0.806 vs. 0.788) as well as 3-month mortality (area under curve 0.839 vs. 0.819). We found a significant association of NUTRIC and mNUTRIC with MELD, CHILD, renal function, interleukin 6 and albumin, but not with body mass index. NUTRIC and mNUTRIC are characterized by high prognostic accuracy in critically ill patients with cirrhosis. NUTRIC revealed a moderate advantage in prognostic ability compared to mNUTRIC.

Decompensated cirrhosis predisposes to infectious diseases and acute-on-chronic liver failure (ACLF) in critically ill patients. Infections like spontaneous bacterial peritonitis (SBP) are frequently associated with multi-organ failure and increased mortality. Consequently, reliable predictors of outcome and early diagnostic markers of infection are needed to improve individualized therapy. This study evaluates the prognostic role of ascitic interleukin 6 in 64 patients with cirrhosis admitted to our intensive care unit (ICU). In addition, we analysed the diagnostic ability of ascitic interleukin 6 in a subgroup of 19 patients with SBP. Baseline ascitic interleukin 6 performed well in predicting 3-month mortality in patients with decompensated cirrhosis (area under curve (AUC) = 0.802), as well as in patients fulfilling ACLF-criteria (AUC = 0.807). Ascitic interleukin 6 showed a moderate prognostic advantage compared with common clinical scores and proinflammatory parameters. Moreover, ascitic interleukin 6 had a sufficient diagnostic ability to detect SBP (AUC = 0.901) and was well correlated with ascitic polymorphonuclear neutrophils in SBP (p = 0.002). Interestingly, ascitic interleukin 6 revealed a high predictive value to rule out apparent infections on admission to ICU (AUC = 0.904) and to identify patients with “culture-positive SBP” (AUC = 0.856). Ascitic interleukin 6 is an easily-applicable proinflammatory biomarker with high prognostic and diagnostic relevance in critically ill patients with liver cirrhosis.

Background/Objectives: Systemic treatment for unresectable hepatocellular carcinoma (HCC) has rapidly advanced, with immune checkpoint inhibitors now the preferred first-line option. However, with multiple agents available and no established treatment sequence, selecting the most suitable second-line (2L) therapy remains challenging. While sorafenib is frequently chosen for 2L treatment, comprehensive data supporting its use is limited. This study evaluates the effectiveness of sorafenib as 2L therapy and factors influencing outcomes following first-line treatment failure in advanced HCC patients. Methods: This is a retrospective, multicenter study, including 81 patients with unresectable HCC from 12 European centers who received sorafenib as 2L treatment. Median overall survival (mOS), median progression-free survival (mPFS), radiological response to treatment, and toxicity were evaluated. Univariable and multivariable analyses were performed to identify potential predictors of clinical benefit. Results: In this cohort, some patients were treated with 2L sorafenib mOS for 7.4 months (95% CI: 6.6–13.6) and other patients were treated with mPFS for 3.7 months (95% CI: 3.0–4.8). Multivariable analysis revealed the best median OS for patients with CP A and AFP levels < 400 ng/mL (15.5 months). Adverse events (AE) of grade ≥ 3 were reported in 59.4% of patients. Conclusions: In this real-world cohort of European patients with unresectable HCC, the outcome of sorafenib treatment in the 2L setting was comparable to that of the other established 2L treatment options in patients with preserved liver function and good performance status. This study contributes to the understanding of the role of sorafenib in the 2L setting and underscores the need for further research to identify predictive factors for response and survival in order to optimize treatment algorithms for advanced HCC.

Evidence supporting the safety and efficacy of immune checkpoint inhibitors (ICI) before liver transplantation (LTx) in hepatocellular carcinoma (HCC) is increasing, but risks of graft rejection and tumour recurrence remain major concerns. We evaluated post‐transplant outcomes across 10 European centres using data from the multinational LITCHI ( Li ver t ransplantation after i mmune c heckpoint i nhibition) registry. Clinical and tumour characteristics, ICI regimens and post‐transplant immunosuppression were assessed, and overall and rejection‐free survival were estimated using the log‐rank test. Among 18 patients who underwent LTx following ICI, 15 were treated with atezolizumab plus bevacizumab. One‐year survival was 77% (95% CI 67.3–87.8) and four rejection episodes occurred, with one fatal case after a 13‐day wash‐out and three non‐fatal episodes, each responsive to escalation of immunosuppression. Overall, however, no intensified immunosuppression was required in our cohort. Despite tumour burden beyond Milan criteria in most patients before ICI initiation, HCC recurrence occurred in only one patient.

Background: The coronavirus disease-2019 (COVID-19) pandemic had a profound influence on screening, diagnosis and treatment of cancer patients worldwide. Due to overloaded health care facilities, screening and surveillance visits for early cancer detection were postponed or completely omitted. This included surveillance of patients with liver cirrhosis who are at risk for development of hepatocellular carcinoma (HCC) and resulted in a decrease in HCC diagnoses. We therefore aimed to analyze the impact of the COVID-19 pandemic on HCC diagnoses and survival of HCC patients in our tertiary care center in Germany. Methods: We conducted a monocentric retrospective study in which we analyzed data of 175 patients diagnosed with HCC before (March 2018 through February 2020) or during the COVID-19 pandemic (March 2020 through February 2022). Results: Compared to patients diagnosed with HCC prior to the COVID-19 pandemic, a significantly higher percentage of patients was diagnosed with HCC in more advanced stages during the COVID-19 pandemic. This was associated with a significantly lower overall survival (OS) in patients diagnosed with HCC during the first year of the pandemic. Importantly, stage-dependent survival was not different between patients diagnosed before and during the COVID-19 pandemic, strongly indicating that diagnostic delay during the pandemic did not play a major role at our center. Conclusions: Taken together, our data indicate that the COVID-19 pandemic significantly impacted on HCC patient care. Specifically, our data suggests that HCC diagnosis was delayed during the pandemic in a relevant percentage of patients translating into reduced survival in our patient cohort.