Sepsis represents a major cause of mortality, especially among patients with liver cirrhosis, who are at increased risk due to immune dysfunction, gut-derived bacterial translocation, and altered hepatic metabolism. Traditional biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) often have reduced diagnostic reliability in this subgroup, due to impaired liver and renal function. Presepsin, a soluble fragment of CD14 released during phagocytic activation, has emerged as a promising biomarker for early sepsis detection. This systematic review explores the diagnostic and prognostic utility of presepsin in cirrhotic and non-cirrhotic patients with suspected infection. Data from multiple clinical studies indicate that presepsin levels correlate with infection severity and clinical scores such as SOFA and APACHE II. In cirrhotic patients, presepsin demonstrates superior sensitivity and specificity compared to conventional biomarkers, maintaining diagnostic value despite hepatic dysfunction. Its utility extends to differentiating bacterial infections from fungal infections and monitoring treatment response. While preliminary evidence is compelling, further prospective, multicenter studies are required to validate its integration into standard care algorithms. Presepsin may become a valuable addition to clinical decision-making tools, particularly in hepatology-focused sepsis management.

Background Fatty pancreas (FP) is emerging as a concerning focus in pancreatology, though its impact on pancreatic neoplastic cystic lesions (PNCL) risk remains unclear. Objective The study aims to evaluate the prevalence of FP in patients with PNCL and to determine if FP is significantly increased in the subgroup of PNCL with significant risk of malignancy. Methods We conducted a retrospective, single-center, matched case–control study on patients diagnosed with PNCL between 2019–2024. We included patients with endosonographic (EUS) and computerized tomography (CT) evaluation. FP was defined by pancreas-to-spleen attenuation ratio (P/S) under 0.7 on CT. Ethical approval was granted by the local ethics committee (346,833/19.05.2023), registered in Clinical Trials (ID: NCT06867172). Results The study enrolled 22 cases with PNCL and 44 matched controls, adjusted by age, sex, nutritional status and lack of hepato-bilio-pancreatic diseases or major comorbidities. 14 of the 22 patients had lesions with risk of malignancy. No significant differences in P/S ratio (p = 0.496) or in FP prevalence (P/S > 0.7, p = 0.573) were observed between these groups. We could observe that P/S ratio were lower in the tail in patients with premalignant PNCL (p = 0.059). There were no significant differences between pancreatic fat ratio in head, body and tail (p = 0.399). Conclusions Although pancreatic fat content did not significantly differ between patients with PNCL and the general population, an observed non-significant increase in steatosis in the pancreatic tail could warrant further investigation. Additional studies are necessary to clarify the role of FP in the progression and risk of pancreatic neoplastic cystic lesions.

Objectives: Esophagogastroduodenoscopy (EGD) performed with topical pharyngeal anesthesia presents less adverse events and post-procedural impairment associated with sedation. The aim of this study was to evaluate if by combining Flurbiprofen and Lidocaine sprays for topical pharyngeal anesthesia there is an improvement in patient tolerance and endoscopist satisfaction in comparison to using Lidocaine spray alone. Methods: We conducted a single center, double blind, randomized controlled trial designed to compare unsedated EGD using topical Flurbiprofen spray (Strepsils Intensive^®) plus Lidocaine spray versus Lidocaine spray alone. We assessed patients’ tolerance and endoscopist satisfaction through a 0 to 10 points visual numerical rating scale. Results: A total of 36 patients were included and randomized in two equal groups: Lidocaine and Flurbiprofen spray group (FL) and Lidocaine spray group (L). No significant differences were found amongst groups for patient discomfort score (FL 5.33 ± 2.42, L 5.56 ± 2.12, p = 0.708), pain score (FL 1.77 ± 2.17, L 1.89 ± 0.74, p = 0.119), gag reflex intensity score (FL 1.61 ± 0.82, L 1.83 ± 0.68, p = 0.418), patient satisfaction score (FL 7.78 ± 2.46, L 7.22 ± 1.78, p = 0.428), and endoscopist satisfaction score (FL 7.5 ± 2.87, L 7.58 ± 1.45, p = 0.312). Conclusions: During unsedated EGD, both Lidocaine plus Strepsils spray and Lidocaine spray alone were safe and well tolerated. The combination of Flurbiprofen and Lidocaine did not significantly improve patients’ level of discomfort, pain, gag reflex, and satisfaction and endoscopist satisfaction.