Clinical characteristics and risk factors of 27 liver failure patients complicated by invasive fungal infections

To investigate the clinical feature, risk factors and outcome of treatment in patients with liver failure complicated by invasive fungal infections. Retro-spective analysis of the clinical data and related factors of 27 patients with liver failure com-plicated by invasive fungal infections was per-formed. These patients were admitted from January 2007 to August 2009 in our department. Among them, Candida albicans accounted for 17cases (54.84%), albicans tropicals for 4 cases (12.90%). Fungal infection in respiratory tract and alimentary tract accounted for 58.06% and 11% respectively. 81.25% of them had fever fluctuating from 37.4oC to 40oC. 81.25% had elevated white blood cell counts .All had the usage of broad-spectrum of antibiotics, whereas some of them used corticosteroids and had invasive medical manipulation for the treatment. Most patients deteriorated after invasive fungal infections. 21 cases accepted with the treatment of antifungal drugs and mortality rate was 63.00%. It was found that the invasive fungal infection possibility of patients with liver failure significantly increased. To prevent the occurrence of invasive fungal infection, promptly early treatment of liver failure, proper use of antibiotics, cautious use or disuse of corticosteroids, reduction of invasive medical manipulation should be well done. Early detection and treatment of fungal infection are vital to decrease in mortality rate.

Association of Mosaic Chromosomal Alterations and Genetic Factors with the Risk of Cirrhosis

Background and Aims:Age-related mosaic chromosomal alterations(mCAs)detected from genotyping of blood-de-rived DNA are structural somatic variants that indicate clonal hematopoiesis.This study aimed to investigate whether mCAs contribute to the risk of cirrhosis and modify the effect of a polygenic risk score(PRS)on cirrhosis risk prediction.Methods:mCA call sets of individuals with European ancestry were obtained from the UK Biobank.The PRS was constructed based on 12 susceptible single-nucleotide poly-morphisms for cirrhosis.Cox proportional hazard models were applied to evaluate the associations between mCAs and cirrhosis risk.Results:Among 448,645 individuals with a median follow-up of 12.5 years,we identified 2,681 cas-es of cirrhosis,1,775 cases of compensated cirrhosis,and 1,706 cases of decompensated cirrhosis.Compared to non-carriers,individuals with copy-neutral loss of heterozygosity mCAs had a significantly increased risk of cirrhosis(hazard ratio(HR)1.42,95%confidence interval(CI)1.12-1.81).This risk was higher in patients with expanded cell fractions of mCAs(cell fractions≥10%vs.cell fractions<10%),especially for the risk of decompensated cirrhosis(HR 2.03[95%CI 1.09-3.78]vs.1.14[0.80-1.64]).In comparison to non-carriers of mCAs with low genetic risk,individuals with expanded copy-neutral loss of heterozygosity and high genetic risk showed the highest cirrhosis risk(HR5.39[95%CI 2.41-12.07]).Conclusions:The presence of mCAs is associated with increased susceptibility to cirrhosis risk and could be combined with PRS for personalized cirrhosis risk stratification.

Comparison of Clinical Characteristics and Outcomes of MAFLD and NAFLD in Chinese Health Examination Populations

Background and Aims:The recently proposed concept of metabolic dysfunction-associated fatty liver disease(MAFLD)has remained controversial.We aimed to describe the features and associated outcomes to examine the diagnostic ability of MAFLD for identifying high-risk individuals.Methods:In this retrospective cohort study,we enrolled 72,392 Chinese participants between 2014 and 2015.Participants were classified as MAFLD,nonalcoholic fatty liver disease(NAFLD),non-MAFLD-NAFLD,and a normal control group.The primary outcomes were liver-related and cardiovascular disease(CVD)events.Person-years of follow-up were calculated from enrolment to the diagnosis of the event,or the last date of data(June,2020).Results:Of the 72,392 participants,31.54%(22,835)and 28.33%(20,507)qualified the criteria for NAFLD or MAFLD,respectively.Compared with NAFLD,MAFLD patients were more likely to be male,overweight,and have higher biochemical indices including liver enzyme levels.Lean MAFLD diagnosed with≥2 or≥3 metabolic abnormalities presented similar clinical manifestations.During the median follow-up of 5.22 years,919 incident cases of severe liver disease and 2,073 CVD cases were recorded.Compared with the normal control group,the NAFLD and MAFLD groups had a higher cumulative risk of liver failure and cardiac-cerebral vascular diseases.There were no significant differences in risk between the non-MAFLD-NAFLD and normal group.Diabetes-MAFLD group had the highest incidence of liver-related and cardiac-cerebral vascular diseases,lean MAFLD came second,and obese-MAFLD had the lowest incidence.Conclusions:This real-world study provided evidence for rationally assessing the benefit and practicability of the change in terminology from NAFLD to MAFLD.MAFLD may be better than NAFLD in identifying fatty liver with worse clinical features and risk profile.