The coexistence of chronic hepatitis B (CHB) and metabolic dysfunction–associated liver disease (MASLD) gained recognition, but the diagnostic performance of non‐invasive markers regarding it remains underexplored. This study aimed to evaluate the utility of the FIB‐4 index for fibrosis prediction in CHB patients and investigate its performance in the distinct subgroup of CHB‐MASLD. A prospective study from 2021 to 2022 included 109 CHB and 64 CHB‐MASLD patients. All underwent liver stiffness measurement via elastography and FIB‐4 calculation. MASLD criteria were defined, creating CHB‐alone and CHB‐MASLD groups. FIB‐4 values were compared to the liver stiffness measurements. Statistical analyses included t‐tests, ROC curves, and correlation assessments. No significant age, gender, or ethnicity differences were observed between the CHB and CHB‐MASLD groups. CHB‐MASLD patients exhibited higher BMI, dysglycemia, and dyslipidemia. HBeAg negativity and nucleoside/tide treatment rates were comparable. FIB‐4 and APRI scores were elevated in CHB‐MASLD. ROC analysis revealed an AUC of 0.86 for FIB‐4 in the CHB group, with an optimal cutoff of 1.95. Subgroup analysis by BMI showed consistent FIB‐4 performance. In the CHB‐MASLD group, the ROC curve showed an AUC of 0.61 (p = 0.12), indicating non‐significance. Our study affirms FIB‐4's robust performance in predicting fibrosis in CHB patients across varied BMI profiles. Yet, challenges surface when applying FIB‐4 to those with concurrent CHB and MASLD. These limitations stress the urgency of refined fibrosis prediction tools, essential for navigating the complex interplay of viral and metabolic factors in the CHB–MASLD population.

Background: Proton pump inhibitors (PPIs), although relatively safe drugs for reduction of gastric acid production, continue to raise concerns (i.e. potential infectious complications, electrolyte disturbances). PPIs are frequently administered to hemato-oncological patients receiving chemotherapy. The study main objective is to investigate whether PPI use by hemato-oncological patients receiving chemotherapy raises the risk of febrile neutropenia. Methods: This is a retrospective database study of patients under hemato-oncological follow up between January 2007 and December 2015, treated with different chemotherapy regimens. Comparative analysis assessed frequencies and types of febrile neutropenia among patients with or without PPI treatment. Multivariate analyses were performed adjusting for age, sub-type of malignancy and specific PPI administered. Results: 247 patients were included, 18–91 years of age (mean 61.6 ± 16), 120 (48.58%) female; amongst 66 (26%) how were hospitalized for febrile neutropenia, 50 (75.8%) received PPIs. Multivariate analysis found three risk factors associated with the development of febrile neutropenia in hematological patients: age, diffuse large B-cell lymphoma and treatment with PPIs. Conclusion: A statistically significant association was demonstrated between PPI treatment and the development of febrile neutropenia among hemato-oncological patients. The clinical implications necessitate further caution in administering PPIs to patients with hematological malignancy receiving chemotherapy.

The long-term clinical significance of anti-mitochondrial antibody (AMA)-positive patients with normal liver enzymes remains unclear. Despite increasing detection of AMA positivity in asymptomatic individuals, clinicians lack evidence-based protocols for long-term surveillance, and guidelines offer no clear recommendations. This study, the largest of its kind, investigates the natural history, prognostic implications, and risk factors for disease progression in this population. We conducted a retrospective cohort study using a national healthcare database to identify adults (aged 18 years or older) with a positive AMA and normal alkaline phosphatase (ALP) levels between 2002 and 2023. Demographics, laboratory data, and liver-related outcomes were assessed. Multivariate logistic and Cox regression models were used to evaluate predictors of primary biliary cholangitis (PBC), cirrhosis, and hepatic complications. Among 1018 patients (median follow-up 6.3 years (IQR 2.5-11.5), 76 (7.5 %) developed PBC and 30 (2.9 %) progressed to cirrhosis. Liver-related complications were infrequent: esophageal varices (1.1 %), ascites (1.8 %), hepatocellular carcinoma (0.2 %), and liver transplantation (0.1 %). Higher AMA titers were strongly associated with increased risk of PBC, cirrhosis, and complications, showing a clear titer-dependent gradient. Longitudinal analysis also demonstrated titer-associated increases in ALP and bilirubin over time. AMA-positive individuals with normal liver enzymes typically experience a benign clinical course. However, high AMA titers identify a subgroup at increased risk for progression to PBC and advanced liver disease. These findings underscore the importance of risk-stratified surveillance strategies in clinical practice, guiding healthcare professionals in the management of their patients.

Background/Objectives: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease caused by an autoimmune attack on hepatocytes. The first-line treatment for AIH comprises two core components: glucocorticoids and thiopurine analog inhibitors and mycophenolate mofetil (MMF). Numerous studies have suggested an increased risk for lymphoma among patients with either rheumatoid arthritis or inflammatory bowel disease (IBD) who are treated with azathioprine/6-mercaptopurine (6-MP). The relative risk of non-Hodgkin lymphoma (NHL) among autoimmune hepatitis patients treated with these immunosuppressive drugs remains unclear. We aimed at investigating the risk of NHL across a large retrospective AIH cohort after a long-term follow-up. Methods: This retrospective, population-based study comprised approximately 2.7 million adults over two decades. It included adult patients aged 20 years or older at the time of autoimmune hepatitis diagnosis who had initiated treatment with azathioprine, 6-MP, or MMF. The primary outcome was the development of non-Hodgkin lymphoma. Results: The study initially included 834 patients diagnosed with AIH. A total of 685 patients remained in the research cohort after matching the data to the local cancer registry. Compared to the predicted NHL rate in the general population, NHL incidence was considerably higher in AIH patients (Standardized Incidence Ratio, SIR = 36.5). Subgroup studies showed that lymphoma mainly affected patients 45 years of age and over and was detected primarily during the first seven years following the AIH diagnosis. No correlation was found between the incidence of NHL and the treatment drug used. Conclusions: Patients with AIH exhibit a markedly higher risk of NHL compared to the general population.