Editorial: Treatment and Prognostic Assessment of Liver Cirrhosis and Its Complications Volume II

Wei Zhang¹Yufu Tang¹Hao Wu²Andrea Mancuso, MD.³Thierry Thévenot⁴Xingshun Qi^5*

• ¹General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
• ²West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
• ³ARNAS Ospedali Civico Di Cristina Benfratelli, Palermo, Sicily, Italy
• ⁴University Hospital of Besançon, Besançon, Burgundy, France
• ⁵Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China

Since the first discussion with the in-house editors of the Frontiers on November 23, 2023, the research topic entitled as “Treatment and Prognostic Assessment of Liver Cirrhosis and Its Complications, Volume II” was launched in our journal Frontiers in Medicine on December 12, 2023. We have received a large number of submissions until the deadline on August 4, 2024. Finally, a total of 21 papers were published by 157 authors after internal editorial assessment, external peer review, and editorial decision processes (https://www.frontiersin.org/research-topics/61170/treatment-and-prognostic-assessment-of-liver-cirrhosis-and-its-complications-volume-ii/articles). Interestingly, at the time of writing this editorial on March 27, 2025, they have been viewed or downloaded for more than 10 thousand times. Herein, their contents have been briefly summarized in the following sections.Symptoms in liver cirrhosis.Philips et al. from the Rajagiri Hospital, India, comprehensively reviewed several common symptoms, including malaise, fatigue, lethargy, appetite disorders, restrictive diet, malnutrition, non-cholestatic pruritus, muscle cramps, sleep disorders, mental health disorders, gastrointestinal symptoms, sexual dysfunction, pain, peripheral neurological symptoms, hair loss, and skin changes, in patients with liver cirrhosis, and summarized their management (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1442525/full). Xie et al. from the Hebei Clinical Research Center for Digestive Diseases, China, performed a meta-analysis of 16 observational studies, and demonstrated that the overall estimated prevalence of frailty was 27% in cirrhosis and that its occurrence was positively associated with male, older, lower BMI, and worse liver function (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1353406/full).Pathogenesis of liver fibrosis.There are three papers regarding the pathogenesis of liver fibrosis. Hu et al. from the Shengjing Hospital of China Medical University, China, reviewed the role of Chitinase-3-like protein 1 in the pathogenesis and diagnosis of liver fibrosis (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1372434/full). Shamsan et al. from the Qinghai University, China, comprehensively reviewed the role of PI3k/AKT signaling pathway in attenuating liver fibrosis (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1389329/full). Guo et al. from the Shandong University, China, performed a Mendelian randomization study to confirm the causal effects of cigarette smoking on liver fibrosis and cirrhosis (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1390049/full).Assessment of liver cancer.There are three papers regarding the assessment of risk factors and prognostic factors of liver cancer. Dong et al. from the General Hospital of Northern Theater Command, China, retrospectively analyzed the association of ABO blood groups and rhesus factor with primary liver cancer in liver cirrhosis (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1432137/full). The researchers did not show any significant association between them in cirrhotic patients. Qiao et al. from the Beijing You’an Hospital of Capital Medical University, China, developed a nomogram by combining gamma-glutamyl transpeptidase-to-platelet ratio, age, and hemoglobin for predicting the overall survival of patients with compensated cirrhosis and hepatocellular carcinoma who were treated with local ablation (https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2024.1406764/full). They demonstrated good predictive performance of this nomogram in such patients. Luo et al. from the Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, China, evaluated the role of γ-glutamyl transferase to serum albumin ratio in assessing the survival of patients with hepatocellular carcinoma who underwent liver transplantation (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1380750/full). They demonstrated that the γ-glutamyl transferase to serum albumin ratio ≥2.04 was independently associated with recurrence-free survival and overall survival.Assessment of portal hypertension.There are five papers regarding the assessment of portal hypertension. Shanka et al. from the I.M. Sechenov First Moscow State Medical University, Russia, systematically reviewed the evidence regarding non-invasive methods for diagnosis of portal hypertension in liver cirrhosis secondary to nonalcoholic fatty liver diseases or metabolic dysfunction associated steatotic liver diseases (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1459569/full). They suggested that liver and spleen stiffness measurement had good diagnostic performance of clinically significant and severe portal hypertension. Mao et al. from the First Affiliated Hospital of Anhui Medical University, China, explored the diagnostic performance of esophageal varices diameter, which was measured using a virtual ruler under endoscopy, for assessing portal pressure gradient, which was measured using interventional radiology (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1443581/full). Cao et al. from the same study group also performed a multicenter study to evaluate the diagnostic performance of esophageal varices diameter, which was also measured using a virtual ruler under endoscopy, for predicting the risk of early rebleeding within 6 weeks after endoscopic variceal ligation. The novelty of the two studies is the use of virtual ruler-based measurement of esophageal varices. The researchers found that an esophageal varices diameter of >1.1cm and ≥1.4cm by virtual ruler had good diagnostic performance of a significantly increased portal pressure gradient level of 20mmHg and early rebleeding in cirrhosis, respectively. Li et al. from the Women and Children’s Hospital of Chongqing Medical University, China, developed and internally validated a clinical-radiomics nomogram, by combining prothrombin time, sarcopenia, and radiomics score, for predicting the occurrence of upper gastrointestinal bleeding in liver cirrhosis (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1308435/full). Notably, the radiomics score is established by extracting 11 different features on CT images. Ye et al. from the West China Hospital of Sichuan University, China, evaluated the association of metabolites with severe portal hypertension indicated by a hepatic venous pressure gradient of >16mmHg in Tibetan patients with liver cirrhosis (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1404442/full). Notably, by using metabolomics, the researchers identified pisumionoside and N-decanoylglycine as promising biomarkers for severe portal hypertension.Assessment of prognosis in other aspects.Gulcicegi et al. from the University Hospital Cologne, Germany, evaluated the role of dynamic changes in spleen stiffness after starting the treatment of acute decompensation in hospitalized cirrhotic patients (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1475997/full). They found a gradual decrease in spleen stiffness after effective treatment. Que et al. from the Daping Hospital of Army Medical University, China, developed a novel prognostic model by combining age, ascites, albumin, prothrombin time, total bilirubin, and sodium in patients with viral hepatitis-related cirrhosis who were treated by transjugular intrahepatic portosystemic shunt (TIPS) (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1456758/full). They found that the novel post-TIPS prognostic model had good predictive performance. Wang et al. from the Peking University People's Hospital, China, retrospectively evaluated the risk factors of the first liver-related readmission within 30-90 days after the index hospitalization (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1417222/full). They found that hepatic encephalopathy, ascites, and spontaneous bacterial peritonitis caused a higher risk of rehospitalization.Treatment of liver cirrhosis related complications.There are three case reports, one retrospective study, and one meta-analysis regarding treatment of liver cirrhosis related complications. Liu et al. from the Beijing Xiaotangshan Hospital, China, reported a case of hepatic myelopathy that was successfully treated by liver transplantation and comprehensive rehabilitation training (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1467611/full). Sun et al. from the Gansu Provincial Hospital, China, reported a case of gastric variceal bleeding who was successfully treated by TIPS via the mesenteric venous pathway (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1388584/full). Wang et al. from the General Hospital of Northern Theater Command, China, reported a case of liver cirrhosis with acute symptomatic portal vein system thrombosis who developed after endoscopic variceal therapy and was successfully treated by immediate anticoagulation (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1382181/full). Tie et al. from the Xijing Hospital of Digestive Diseases of Air Force Medical University, China, evaluated the efficacy of variceal embolization for primary prophylaxis of variceal bleeding in cirrhotic patients who are not suitable candidates for nonselective beta blockers or endoscopic treatments (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1401900/full). They demonstrated that variceal embolization achieved a high rate of technical success and low rates of recurrence and severe complications. Yang et al. from the People’s Hospital of Guangxi Zhuang Autonomous Region and Guangxi Academy of Medical Sciences, China, conducted a meta-analysis and showed the benefits of probiotics for hepatic encephalopathy reversal, liver function and quality of life improvement, and gut dysbiosis regulation in cirrhosis (https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1379333/full).While all papers in this research topic are successfully published, we wish that their findings can really impact the real-world clinical practice. Meanwhile, we also except to initiate the Volume III of the research topic in the near future and receive more interesting and valuable papers.