{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T23:32:09Z","timestamp":1781220729164,"version":"3.54.1"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,12]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background and Aims<\/jats:title>\n \n Hypogonadism is frequent in\n AdvCLD<\/jats:styled-content>\n and associated with frailty and poor outcomes. This study aimed to evaluate the association between free testosterone (\n FT<\/jats:styled-content>\n ) levels and all\u2010cause mortality in male patients with\n AdvCLD<\/jats:styled-content>\n awaiting liver transplantation (\n LT<\/jats:styled-content>\n ), and to compare the prognostic value of\n FT<\/jats:styled-content>\n with total testosterone (\n TT<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this prospective cohort study, 191 male patients with\n AdvCLD<\/jats:styled-content>\n awaiting\n LT<\/jats:styled-content>\n underwent\n FT<\/jats:styled-content>\n and\n TT<\/jats:styled-content>\n evaluation. The primary outcome was all\u2010cause mortality, assessed using a competing\u2010risk model with\n LT<\/jats:styled-content>\n as the competing event.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 191 patients, 41 (21.5%) had low\n FT<\/jats:styled-content>\n levels. This group was more likely to have a higher Child\u2010Turcotte\u2010Pugh class and\n MELD<\/jats:styled-content>\n \u2010Na score, as well as higher proportion of individuals with a history of hepatic encephalopathy (\n HE<\/jats:styled-content>\n ) compared to those with normal\n FT<\/jats:styled-content>\n levels (\n p<\/jats:italic>\n \u2009<\u20090.05). Patients with low\n FT<\/jats:styled-content>\n also exhibited greater frailty (liver frailty index: 4.2\u2009\u00b1\u20090.8 vs. 3.6\u2009\u00b1\u20090.9,\n p<\/jats:italic>\n \u2009<\u20090.001, respectively). After adjustment for\n MELD<\/jats:styled-content>\n \u2010Na, low\n FT<\/jats:styled-content>\n was significantly associated with increased mortality risk (adjusted subdistribution hazard ratio [\n aSHR<\/jats:styled-content>\n ] 1.97; 95%\n CI<\/jats:styled-content>\n : 1.07\u20133.61). Additionally, patients with low\n FT<\/jats:styled-content>\n had a lower cumulative probability of undergoing\n LT<\/jats:styled-content>\n compared to those with normal\n FT<\/jats:styled-content>\n levels (43.4% vs. 74.3%). In contrast, low\n TT<\/jats:styled-content>\n was not associated with mortality (\n aSHR<\/jats:styled-content>\n : 1.65; 95%\n CI<\/jats:styled-content>\n : 0.90\u20133.02).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Low\n FT<\/jats:styled-content>\n levels are independently associated with higher mortality and lower\n LT<\/jats:styled-content>\n probability in men with\n AdvCLD<\/jats:styled-content>\n and outperform\n TT<\/jats:styled-content>\n as a prognostic marker. These findings support\n FT<\/jats:styled-content>\n as a valuable biomarker to identify high\u2010risk patients and guide future interventional strategies.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/liv.70393","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T04:16:21Z","timestamp":1764130581000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Free Testosterone Is Associated With Worse Survival in Patients With Advanced Chronic Liver Disease Awaiting Liver Transplantation"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2846-7812","authenticated-orcid":false,"given":"Miguel","family":"Sogbe","sequence":"first","affiliation":[{"name":"Liver Unit Clinica Universidad de Navarra Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4544-9664","authenticated-orcid":false,"given":"Brittany","family":"Bromfield","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Tellez","sequence":"additional","affiliation":[{"name":"Starzl Transplantation Institute University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela M.","family":"Bloomer","sequence":"additional","affiliation":[{"name":"Starzl Transplantation Institute University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Bennett","sequence":"additional","affiliation":[{"name":"Department of Urology Northwestern Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher B.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Starzl Transplantation Institute University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Starzl Transplantation Institute University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Ruiz\u2010Marg\u00e1in","sequence":"additional","affiliation":[{"name":"Division of Hepatology Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubir\u00e1n M\u00e9xico City M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5377-9295","authenticated-orcid":false,"given":"Andres","family":"Duarte\u2010Rojo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Northwestern Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/J.1530\u20100277.1990.TB00507.X"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.meg.0000059115.41030.e0"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/LIV.13122"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14938"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JCEH.2021.11.012"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ECI.14108"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/JGH.12695"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.5604\/01.3001.0012.0930"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/HEPR.13253"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep35539"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1515\/CCLM.2006.186"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/JC.2018\u201000229"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1210\/JCEM.84.10.6079"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JHEP.2016.06.007"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/LT.25449"},{"key":"e_1_2_12_17_1","volume-title":"Williams Textbook of Endocrinology","author":"Melmed S.","year":"2015"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.08.010"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1043\u20104666(05)80001\u20108"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004\u20102190"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medcle.2015.06.002"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.BIOCEL.2005.04.018"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JHEP.2016.07.040"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0B013E318237C5C0"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.2001.281.6.E1128"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.01.025"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/CTG.2016.33"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1073\/PNAS.1317049110"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000002192"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/CTR.15412"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/HEP4.1688"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/AJG.2017.443"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.24607"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102265.2012.04347.x"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840060502"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.CLINRE.2011.09.005"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000001146"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2025.02.004"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/LT.25950"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70393","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.70393","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70393","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T11:21:14Z","timestamp":1770117674000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70393"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":38,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/liv.70393"],"URL":"https:\/\/doi.org\/10.1111\/liv.70393","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]},"assertion":[{"value":"2025-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70393"}}