Exercise interventions to improve sleep quality in university students: a systematic review and meta-analysis of randomized controlled trials.

Cirrhosis reflects a more advanced stage of chronic liver disease, defined by extensive fibrosis, architectural distortion and regenerative nodule formation, impairing hepatic capacity and portal blood flow []. It is responsible for over 1 million deaths annually, ranking among the leading causes of mortality and imposing a significant burden on health systems worldwide []. Its clinical burden varies by region—cirrhosis is the 9 leading cause of mortality in Southeast Asia and Europe []. The most common etiologies of cirrhosis in the world include excessive alcohol consumption, metabolic dysfunction-associated steatotic liver disease, and chronic hepatitis B and C infections [,]. Alcohol-related liver disease is the principal cause of cirrhosis in Europe, accounting for significant morbidity and economic loss []. The clinical course of cirrhosis is divided into 2 main stages, compensated and decompensated, with the latter manifesting as complications such as ascites, variceal bleeding and hepatic encephalopathy (HE) []. In the decompensated stage, splanchnic arterial vasodilation stimulates endogenous vasoconstrictor pathways, leading to renal fluid retention that causes the development of ascites []. Nitric oxide-mediated circulatory derangements reduce mitochondrial ATP production, causing systemic inflammation that leads to immune-mediated tissue injury and metabolic alterations, culminating in multiorgan dysfunction []. Progressive fibrosis disrupts the sinusoidal architecture, increasing intrahepatic vascular resistance and reducing nitric oxide within the liver, while enhanced splanchnic vasodilation further elevates portal pressure, leading to the major complications of the disease []. Prognosis is based on scoring systems, such as the Child-Pugh score, which evaluates encephalopathy, ascites, bilirubin, albumin and prothrombin time, offering semi-quantitative risk stratification []. The model for end-stage liver disease (MELD) score, initially measuring serum bilirubin, creatinine and international normalized ratio, is recognized as the main tool for assessing short-term mortality and prioritizing transplant allocation, whereas the updated version, MELD-Na, which incorporates serum sodium, has proven even more accurate in prognostic assessments [,]. Biomarkers based on albumin have recently emerged as valuable tools for stratifying disease severity and prognosis compared to traditional markers [], while imaging methods such as transient elastography also contribute to noninvasive detection and staging []. Newly recognized prognostic systems enhance risk prediction by integrating organ failure metrics, inflammatory markers, and early decompensation predictors []. Artificial intelligence-based models have also gained prominence in cirrhosis prognosis, enabling a dynamic multimodal risk assessment challenging the static capabilities of conventional scoring systems [].