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Aim: Myostatin is a myokine involved in muscle mass regulation. The associations between circulating myostatin levels and clinical characteristics in patients with acute liver failure (ALF) and late‐onset hepatic failure (LOHF) are unclear. Methods: In this retrospective study, 51 patients with ALF or LOHF were included. Serum myostatin was measured using an enzyme‐linked immunosorbent assay. Results: Myostatin levels were significantly lower in patients with ALF and LOHF than in controls (ALF/LOHF: 2522 pg/mL, controls: 3853 pg/mL, p = 0.003). The prevalence of low myostatin in deceased patients was significantly higher than that in spontaneous survivors and patients who underwent liver transplantation. Patients with low myostatin levels had a high incidence of complications. There was a positive correlation between the psoas muscle index and serum myostatin levels. Patients with low myostatin levels had shorter 1‐year transplant‐free survival and shorter 1‐year overall survival than patients with high myostatin levels. Low serum myostatin levels were associated with poor prognosis independent of the Japanese scoring system for ALF ≥3, King's College criteria, or model for end‐stage liver disease score >30.5. The combination of serum myostatin levels and prognostic models for ALF significantly stratified patients according to 1‐year prognosis. Conclusions: Low serum myostatin levels were associated with a low psoas muscle index, complication rate, and poor prognosis in patients with ALF and LOHF. Assessment of circulating myostatin levels may improve the prediction of outcomes in patients with ALF and LOHF. [ABSTRACT FROM AUTHOR]

With the widespread use of immune checkpoint inhibitors (ICIs), liver injury (ICI‐induced liver injury) as an immune‐related adverse event has become a major concern in clinical practice. Because severe cases of liver injury require administration of corticosteroids, a comprehensive evaluation is crucial, including clinical course, blood and imaging tests, and if necessary, pathological examination through liver biopsy. As with liver injury induced by other drugs, classification of injury type by R‐value is useful in deciding treatment strategies for ICI‐induced liver injury. Histologically, the most representative feature is an acute hepatitis‐like hepatocellular injury, characterized by diffuse lobular inflammation accompanied by CD8‐positive T lymphocytes. Another condition that can cause liver injury during ICI treatment is cholangitis accompanied by non‐obstructive bile duct dilatation and bile duct wall thickening. Many cases of ICI‐induced cholangitis are classified as non‐hepatocellular injury type, and they have been reported to respond poorly to corticosteroids. It is essential that gastroenterologists/hepatologists and doctors in various departments work in cooperation to develop a system that achieves early diagnosis and appropriate treatment of ICI‐induced liver injury. [ABSTRACT FROM AUTHOR]