This Practice Guidance intends to coalesce best practice recommendations for the identification of portal hypertension （PH）， for prevention of initial hepatic decompensation， for the management of acute variceal hemorrhage （AVH）， and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease. The most significant changes in the current Guidance relate to recognition of the concept of compensated advanced chronic liver disease， codification of methodology to use noninvasive assessments to identify clinically significant PH （CSPH）， and endorsement of a change in paradigm with the recommendation of early utilization of nonselective beta-blocker therapy when CSPH is identified. The updated guidance further explores potential future pharmacotherapy options for PH， clarifies the role of preemptive transjugular intrahepatic portosystemic shunt in AVH， discusses more recent data related to the management of cardiofundal varices， and addresses new topics such as portal hypertensive gastropathy and endoscopy prior to transesophageal echocardiography and antineoplastic therapy.

Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy.Whether pregnancy-related or not,liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality.Thus,the European Association for the Study of the Liver invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations,based on the best available evidence,for the management of liver diseases in pregnancy for hepatologists,gastroenter-ologists,obstetric physicians,general physicians,training specialists and other healthcare professionals who provide care for this patient population.

Objective: Depression was common during coronavirus disease-2019 (COVID-19) pandemic, while the association of perceived stress with depression among vaccinated healthcare workers has not been investigated. This study aimed to address this issue. Methods: We included a total of 898 fully vaccinated healthcare workers during the outbreak of severe acute respiratory syndrome coronavirus 2 Delta variant in Nanjing, 2021. Depression was ascertained by Patient Health Questionnaire-9, with a cut-off score of ≥5 indicative of mild-to-severe depression. Perceived stress, resilience, and compassion fatigue were assessed by Perceived Stress Scale-10, Resilience Scale-25, and Professional Quality of Life Scale version-5, respectively. Logistic regression analyses were used to estimate the odds ratio (OR) and 95% confidence interval (CI), along with subgroup and mediation analyses. Results: The prevalence of mild-to-severe depression was 41.1% in vaccinated healthcare workers. The odd of mild-to-severe depression was increased with higher perceived stress. Compared with vaccinated healthcare workers with the lowest tertile of perceived stress, those with the highest tertile had increased odds of mild-to-severe depression by 120% (OR 2.20, 95% CI 1.46 to 3.31) after multivariable-adjustment. However, perceived stress was not associated with mild-to-severe depression in vaccinated healthcare workers with strong resilience, but was in those with weak resilience (pinteraction=0.004). Further analysis showed that compassion fatigue mediated the relationship between perceived stress and mild-to-severe depression, with a mediating effect of 49.7%. Conclusion Perceived stress was related to an increased odd of mild-to-severe depression in vaccinated healthcare workers during COVID-19 pandemic, and this relationship might be explained by compassion fatigue.

Acute-on-chronic liver failure(ACLF),which was first described in 2013,is a severe form of acutely decompensated cirrhosis characterized by the existence of organ system failure(s)and a high risk of short-term mortality.ACLF is caused by an excessive systemic inflammatory response triggered by precipitants that are clinically apparent(e.g.,confirmed microbial infection with sepsis,severe alcohol-related hepatitis)or not.Since the description of ACLF,some important studies have suggested that patients with ACLF may benefit from liver transplantation and should therefore be urgently stabilized for transplantation by receiving appropriate etiological treatment and comprehensive management,including support of organ systems in the intensive care unit(ICU).The goal of the present clinical practice guidelines is to provide the most reliable evidence available to assist the clinical decision-making process in the management of patients with ACLF,to make triage decisions(ICU vs.no ICU),to identify and manage acute precipitants,to identify organ systems that require support or replacement,to define potential criteria for futility of intensive care,and it also provides suggestions for identifying potential indications for liver transplantation.

Acute-on-chronic liver failure (ACLF), which was first described in 2013, is a severe form of acutely decompensated cirrhosis characterised by the existence of organ system failure(s) and a high risk of short-term mortality. ACLF is caused by an excessive systemic inflammatory response triggered by precipitants that are clinically apparent (e.g., comfirmed microbial infection with sepsis, severe alcohol-related hepatitis) or not. Since the description of ACLF, some important studies have suggested that patients with ACLF may benefit from liver transplantation and should therefore be urgently stabilized for transplantation by receiving appropriate etiological treatment and comprehesive management, including support of organ systems in the intensive care unit (ICU). The goal of the present clinical practice guidelines is to provide the most reliable evidence available to assist the clinical decision-making process in the management of patients with ACLF, to make triage decisions (ICU vs. no ICU), to identify and manage acute precipitants, to identify organ systems that require support or replacement, to define potential criteria for futility of intensive care, and it also provides suggestions for identifying potential indications for liver transplantation.

Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether pregnancy-related or not, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, training specialists and other healthcare professionals who provide care for this patient population.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Hemorrhage and thrombosis prevention and treatment in patients with cirrhosis faces certain clinical difficulties. Therefore, this guideline is formulated to provide practical guidance on controversial topics, such as the current perspectives on hemostasis in liver disease, whether invasive procedures need to correct thrombocytopenia and coagulation abnormalities, and the necessity of thromboprophylaxis in hospitalized patients with abnormal coagulation. Many of the recommendations in the guidelines are not useful measures; however, they were stem under the oversight of an expert panel, and are widely used in clinical practice. Here, we compile and summarize the recommendations on the above topics in order to share them with readers.

Objective To discuss the effect of residual renal function on prognosis of maintenance dialysis in patients with end-stage renal disease ( ESRD) .Methods 90 cases of patients of maintenance hemodialysis were selected and divided into group A and group B based on different eGFR levels at the beginning of dialysis, 51 cases in group A of eGFR≤5 mL/( min· 1.73 m2 ) , while 39 cases in group B of eGFR>5 mL/( min· 1.73 m2 ).The renal function of two groups were observed,all patients underwent a five-year clinical follow-up and mortality rates, hemoglobin (Hb), serum albumin ( Alb) , C reactive protein ( CRP) of patients in both groups were observed.Results The renal function of urea nitrogen, serum creatinine, blood uric acid, urinary protein and urine creatinine in group B before dialysis was better than those in group A (all P<0.05).The Hb and Alb levels of group A were significantly lower than those of group B, while the CRP levels was significantly higher than that of group B (all P<0.05).The mortality rate of group A was 43.14%,compared with 20.51% of group B,and there was no significant difference.The two main reasons of death was cardiovascular and pulmonary infection, accounted for 50.00% and 33.33%, respectively.Conclusion Residual renal function of patients with ESRD before dialysis has important clinical significance for prognosis judgment.When eGFR level is lower before dialysis, the mortality rate of patients is higher in five years, prone to cardiovascular and cerebrovascular, with poor nutritional status, which is more vulnerable to infection.