Beyond the Tipping Point: Advances in the Diagnosis and Management of Acute-on-Chronic Liver Failure and End-Stage Liver Disease

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 31 January 2027 | Viewed by 1252

Special Issue Editor


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Guest Editor
Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, UK
Interests: liver

Special Issue Information

Dear Colleagues,

Acute-on-chronic liver failure (ACLF) represents a unique and evolving entity within the spectrum of end-stage liver disease (ESLD), characterized by rapid decompensation and high short-term mortality. Its complex pathophysiology—driven by systemic inflammation, immune dysregulation, and organ failure—presents significant diagnostic and prognostic challenges. This Special Issue aims to bring together recent advances in the diagnostic landscape of ACLF and ESLD, including novel biomarkers, imaging modalities, AI-assisted stratification tools, and integrated scoring systems. Contributions addressing early recognition, risk prediction, and translational insights from bench to bedside are particularly welcome. By fostering a multidisciplinary dialogue, we hope that this collection will lead to a more precise and responsive approach to managing one of the most critical complications in modern hepatology.

Dr. Jonathan Soldera
Guest Editor

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Keywords

  • liver cirrhosis
  • hepatorenal syndrome
  • acute-on-chronic liver failure
  • liver transplan-tation
  • biomarkers
  • diagnostic imaging
  • artificial intelligence
  • inflammation media-tors
  • prognosis
  • end-stage liver disease

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Published Papers (1 paper)

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Research

23 pages, 329 KB  
Article
Clinical Evaluation of Oxidative Stress Biomarkers in Cirrhosis: Associations with Child–Pugh Class and Hepatic Encephalopathy
by Vlad Pădureanu, Virginia Maria Rădulescu, Cristiana Gianina Moise, Marius Cristian Marinaș, Rodica Pădureanu, Denisa Marilena Săbiescu, Denisa Floriana Vasilica Pîrșcoveanu, Dragoș Forțofoiu and Lidia Boldeanu
Diagnostics 2025, 15(22), 2853; https://doi.org/10.3390/diagnostics15222853 - 11 Nov 2025
Cited by 1 | Viewed by 955
Abstract
Background/Objectives: Oxidative stress contributes to the pathogenesis of cirrhosis, but its value as a clinical biomarker remains uncertain. Methods: We retrospectively analysed 90 patients with decompensated cirrhosis. Serum malondialdehyde (MDA) and 8-epi-prostaglandin F2α (8-iso-PGF2α) were measured at admission. Biomarker levels were [...] Read more.
Background/Objectives: Oxidative stress contributes to the pathogenesis of cirrhosis, but its value as a clinical biomarker remains uncertain. Methods: We retrospectively analysed 90 patients with decompensated cirrhosis. Serum malondialdehyde (MDA) and 8-epi-prostaglandin F2α (8-iso-PGF2α) were measured at admission. Biomarker levels were compared between Child–Pugh classes B and C, across hepatic encephalopathy grades, and ascites severity, using Mann–Whitney, Kruskal–Wallis, and Spearman correlation tests. Results: Median MDA did not differ significantly between Child–Pugh classes B and C (2.67 [2.10–3.20] vs. 2.45 [1.98–3.05] μmol/L; p = 0.331), nor across ascites categories (p = 0.453). Similarly, 8-iso-PGF2α values did not vary between Child–Pugh classes (255.8 [220.0–310.0] vs. 250.1 [210.0–295.0] pg/mL; p = 0.784) or ascites groups (p = 0.828). Spearman analysis showed no significant correlations with albumin, INR, bilirubin, creatinine, or age, except for a non-significant trend with bilirubin (ρ = −0.18, p = 0.09). Importantly, MDA levels increased significantly across encephalopathy grades (p = 0.021), suggesting a link between systemic oxidative stress and neuropsychiatric impairment. Conclusions: In this clinical cohort, oxidative stress biomarkers did not provide discriminatory value for staging by Child–Pugh or ascites, but MDA was associated with encephalopathy severity. These findings highlight both the limitations and potential clinical relevance of oxidative stress markers in cirrhosis management. Full article
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