2021
Admission Urinary and Serum Metabolites Predict Renal Outcomes in Hospitalized Patients With Cirrhosis
Bajaj JS, Garcia‐Tsao G, Reddy KR, O’Leary J, Vargas HE, Lai JC, Kamath PS, Tandon P, Subramanian RM, Thuluvath P, Fagan A, Sehrawat T, de la Rosa Rodriguez R, Thacker LR, Wong F. Admission Urinary and Serum Metabolites Predict Renal Outcomes in Hospitalized Patients With Cirrhosis. Hepatology 2021, 74: 2699-2713. PMID: 34002868, PMCID: PMC9338693, DOI: 10.1002/hep.31907.Peer-Reviewed Original ResearchConceptsAcute kidney injuryPrediction of AKIClinical variablesSerum/urineSerum metabolitesBranched-chain amino acid metabolitesLiver disease centerNorth American ConsortiumRole of serumAmino acid metabolitesAdmission urinaryAKI developmentAKI subgroupCirrhosis cohortRenal outcomesRenoprotective measuresKidney injuryAKI predictionCirrhosis severityDialysis initiationHospitalized patientsPoor prognosisUrine metabolomicsEarly initiationSpecific admissionThe Level of Alcohol Consumption in the Prior Year Does Not Impact Clinical Outcomes in Patients With Alcohol‐Associated Hepatitis
Musto JA, Eickhoff J, Ventura‐Cots M, Abraldes JG, Bosques‐Padilla F, Verna EC, Brown RS, Vargas V, Altamirano J, Caballería J, Shawcross D, Louvet A, Mathurin P, Garcia‐Tsao G, Schnabl B, Bataller R, Lucey MR. The Level of Alcohol Consumption in the Prior Year Does Not Impact Clinical Outcomes in Patients With Alcohol‐Associated Hepatitis. Liver Transplantation 2021, 27: 1382-1391. PMID: 34109723, PMCID: PMC11075741, DOI: 10.1002/lt.26203.Peer-Reviewed Original ResearchConceptsAlcohol-associated hepatitisAUDIT-C scoresMELD-NaAUDIT-10Recent alcohol consumptionAlcohol consumptionLiver injuryLiver diseaseSurvival statusAUDIT-ConsumptionEnd-stage liver diseaseAUDIT scoresAlcohol‐Associated HepatitisProspective international databaseMELD-Na scoreAlcohol Use Disorders Identification TestShort-term mortalityShort-term outcomesPrior yearDisorders Identification TestSeverity of drinkingPresenting featuresPrimary outcomeClinical outcomesClinical severitySleep Disturbance Is Associated With the Presence of Portosystemic Collaterals in Patients With Compensated Cirrhosis
Balakrishnan M, Falker C, Conley S, Ciarleglio M, Deng Y, Redeker NS, Garcia‐Tsao G. Sleep Disturbance Is Associated With the Presence of Portosystemic Collaterals in Patients With Compensated Cirrhosis. Hepatology Communications 2021, 5: 491-501. PMID: 33681681, PMCID: PMC7917284, DOI: 10.1002/hep4.1636.Peer-Reviewed Original ResearchConceptsPortosystemic collateralsSleep disturbancesCompensated cirrhosisSleep fragmentationSleep characteristicsHigher international normalized ratioPittsburgh Sleep Quality IndexLower total sleep timeMultivariable linear regression analysisSignificant portal hypertensionGroup of patientsInternational normalized ratioEpworth Sleepiness ScaleSleep Quality IndexGreater sleep fragmentationCross-sectional studyMore sleep disturbancesMore sleep fragmentationTotal sleep timeLower sleep efficiencyPresence of collateralsCollateral presencePortal hypertensionLow albuminExcessive daytime
2020
Reduced Clot Stability by Thromboelastography as a Potential Indicator of Procedure‐Related Bleeding in Decompensated Cirrhosis
Zanetto A, Rinder HM, Senzolo M, Simioni P, Garcia‐Tsao G. Reduced Clot Stability by Thromboelastography as a Potential Indicator of Procedure‐Related Bleeding in Decompensated Cirrhosis. Hepatology Communications 2020, 5: 272-282. PMID: 33553974, PMCID: PMC7850311, DOI: 10.1002/hep4.1641.Peer-Reviewed Original ResearchConceptsProcedure-related bleedingTEG maximum amplitudeNonbleeding patientsDecompensated cirrhosisPlatelet countTEG parametersCoagulation testsClot stabilityLife-threatening bleedingConventional coagulation testsInternational normalized ratioRoutine coagulation testsPreprocedural prophylaxisProspective cohortLethal complicationProspective studyNormalized ratioCirrhosisBleedingLarge cohortHigh riskPatientsThromboelastographyΑ angleCohortSGLT2 inhibitors in patients with cirrhosis and diabetes mellitus: A tertiary center cohort study and insights about a potential therapeutic target for portal hypertension
Saffo S, Garcia‐Tsao G, Taddei T. SGLT2 inhibitors in patients with cirrhosis and diabetes mellitus: A tertiary center cohort study and insights about a potential therapeutic target for portal hypertension. Journal Of Diabetes 2020, 13: 265-269. PMID: 33210815, DOI: 10.1111/1753-0407.13136.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overBenzhydryl CompoundsCohort StudiesDiabetes Mellitus, Type 2FemaleGlucosidesGlycated HemoglobinHumansHypertension, PortalLiver CirrhosisMaleMiddle AgedOutcome Assessment, Health CarePolyuriaSodium-Glucose Transporter 2 InhibitorsTertiary Care CentersUrinary Tract InfectionsYoung AdultConceptsSGLT2 inhibitorsPortal hypertensionDiabetes mellitusSodium-glucose cotransporter 2 inhibitorsGlucose cotransporter 2 inhibitorsCenter cohort studyCotransporter 2 inhibitorsCohort of patientsPotential therapeutic targetFavorable pleiotropic effectsCohort studyRenal diseaseClinical trialsClinical dataTherapeutic targetPatientsCirrhosisHypertensionMellitusOngoing evaluationInhibitorsPleiotropic effectsCohortDiseaseTrialsIntestinal Virome in Patients With Alcoholic Hepatitis
Jiang L, Lang S, Duan Y, Zhang X, Gao B, Chopyk J, Schwanemann LK, Ventura‐Cots M, Bataller R, Bosques‐Padilla F, Verna EC, Abraldes JG, Brown RS, Vargas V, Altamirano J, Caballería J, Shawcross DL, Ho SB, Louvet A, Lucey MR, Mathurin P, Garcia‐Tsao G, Kisseleva T, Brenner DA, Tu XM, Stärkel P, Pride D, Fouts DE, Schnabl B. Intestinal Virome in Patients With Alcoholic Hepatitis. Hepatology 2020, 72: 2182-2196. PMID: 32654263, PMCID: PMC8159727, DOI: 10.1002/hep.31459.Peer-Reviewed Original ResearchConceptsAlcohol-associated liver diseaseAlcohol use disorderAlcoholic hepatitisDisease severityEnd-stage liver disease (MELD) scoreFecal samplesLiver Disease scoreMulticenter observational studyVirus-like particlesHigher median ModelIntestinal viromeLiver diseaseSevere manifestationsAntibiotic treatmentObservational studyDisease scoreUse disordersPatientsHigh mortalityViral diversityGut bacteriaViral microbiomeMortalitySeverityHepatitisAcute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo‐coagulable and Hyper‐coagulable Features
Zanetto A, Rinder HM, Campello E, Saggiorato G, Deng Y, Ciarleglio M, Wilson FP, Senzolo M, Gavasso S, Bulato C, Simioni P, Garcia‐Tsao G. Acute Kidney Injury in Decompensated Cirrhosis Is Associated With Both Hypo‐coagulable and Hyper‐coagulable Features. Hepatology 2020, 72: 1327-1340. PMID: 32614088, PMCID: PMC8672302, DOI: 10.1002/hep.31443.Peer-Reviewed Original ResearchConceptsAcute kidney injuryPlasmin-antiplasmin complexDecompensated cirrhosisHemostasis assessmentVon Willebrand factorKidney injuryPlatelet functionThrombin generationPlatelet aggregationSeverity of cirrhosisMedian serum creatinineWillebrand factorLower platelet aggregationAnti-coagulant factorsImpaired platelet functionAKI resolutionHypercoagulable featuresSerum creatinineAspects of hemostasisCirrhosis patientsPlatelet countProspective studyFibrinolytic factorsCirrhosisHyperfibrinolytic stateSerum Levels of Metabolites Produced by Intestinal Microbes and Lipid Moieties Independently Associated With Acute-on-Chronic Liver Failure and Death in Patients With Cirrhosis
Bajaj JS, Reddy KR, O'Leary JG, Vargas HE, Lai JC, Kamath PS, Tandon P, Wong F, Subramanian RM, Thuluvath P, Fagan A, White MB, Gavis EA, Sehrawat T, de la Rosa Rodriguez R, Thacker LR, Sikaroodi M, Garcia-Tsao G, Gillevet PM. Serum Levels of Metabolites Produced by Intestinal Microbes and Lipid Moieties Independently Associated With Acute-on-Chronic Liver Failure and Death in Patients With Cirrhosis. Gastroenterology 2020, 159: 1715-1730.e12. PMID: 32687928, PMCID: PMC7680282, DOI: 10.1053/j.gastro.2020.07.019.Peer-Reviewed Original ResearchMeSH KeywordsAcute-On-Chronic Liver FailureAdultAgedBacteriaBiomarkersDatabases, FactualFecesFemaleGastrointestinal MicrobiomeHospital MortalityHumansLipidomicsLipidsLiver CirrhosisMaleMetabolomicsMiddle AgedNorth AmericaPatient AdmissionPredictive Value of TestsPrognosisProspective StudiesRisk AssessmentRisk FactorsTime FactorsConceptsDevelopment of ACLFSerum levelsClinical parametersStool samplesSerum metabolitesEnd-stage liver diseaseWhite blood cell countSerum samplesFecal microbiomeTertiary hepatology centersChronic liver failureDay of admissionMultiple centersTime of admissionBlood cell countNorth American ConsortiumLevels of phospholipidsMetabolomic analysisHepatology centersHospital admissionLiver failureClinical featuresLiver diseaseACLFEstrogen metabolitesIntestinal Fungal Dysbiosis and Systemic Immune Response to Fungi in Patients With Alcoholic Hepatitis
Lang S, Duan Y, Liu J, Torralba MG, Kuelbs C, Ventura‐Cots M, Abraldes JG, Bosques‐Padilla F, Verna EC, Brown RS, Vargas V, Altamirano J, Caballería J, Shawcross D, Lucey MR, Louvet A, Mathurin P, Garcia‐Tsao G, Ho SB, Tu XM, Bataller R, Stärkel P, Fouts DE, Schnabl B. Intestinal Fungal Dysbiosis and Systemic Immune Response to Fungi in Patients With Alcoholic Hepatitis. Hepatology 2020, 71: 522-538. PMID: 31228214, PMCID: PMC6925657, DOI: 10.1002/hep.30832.Peer-Reviewed Original ResearchConceptsAnti-Saccharomyces cerevisiae antibodiesSerum anti-Saccharomyces cerevisiae antibodiesAlcoholic hepatitisSystemic immune responsesAlcohol use disorderASCA levelsLiver diseaseNonalcoholic controlsImmune responseUse disordersAlcohol-associated liver diseaseAlcohol-related liver diseaseHigher ASCA levelsIntestinal Fungal DysbiosisOvergrowth of CandidaAdjusted hazard ratioCohort of patientsChronic alcohol consumptionIntestinal microbiota compositionIU/mLCerevisiae antibodiesFecal mycobiotaHepatitis cohortHazard ratioSteroid treatment
2019
Platelet count increases after viral elimination in chronic HCV, independent of the presence or absence of cirrhosis
Sayyar M, Saidi M, Zapatka S, Deng Y, Ciarleglio M, Garcia‐Tsao G. Platelet count increases after viral elimination in chronic HCV, independent of the presence or absence of cirrhosis. Liver International 2019, 39: 2061-2065. PMID: 31365178, PMCID: PMC11340272, DOI: 10.1111/liv.14203.Peer-Reviewed Original ResearchConceptsChronic hepatitis C virusHepatitis C virusPresence of cirrhosisViral eliminationTreatment completionPlatelet countLiver fibrosisNegative HCV RNAAbsence of cirrhosisChronic HCV infectionNon-invasive scoresPlatelet count increaseChronic liver diseaseHCV infectionPortal hypertensionHCV RNAAntiviral treatmentFibrosis scoreLiver diseaseC virusFibrosis stageRetrospective analysisCirrhosisPatientsFibrosisImpact of Chronic Kidney Disease on Outcomes in Cirrhosis
Wong F, Reddy K, O’Leary J, Tandon P, Biggins SW, Garcia‐Tsao G, Maliakkal BJ, Lai JC, Fallon MB, Vargas HE, Subramanian R, Thuluvath PJ, Kamath PS, Thacker L, Bajaj JS. Impact of Chronic Kidney Disease on Outcomes in Cirrhosis. Liver Transplantation 2019, 25: 870-880. PMID: 30908855, PMCID: PMC11075743, DOI: 10.1002/lt.25454.Peer-Reviewed Original ResearchConceptsChronic kidney diseaseKidney diseasePrevalence of CKDEnd-stage liver diseaseHospital clinical courseAcute kidney injuryChild-Pugh scoreChronic liver failureHigher serum creatinineGlomerular filtration rateHigh-risk groupNorth American ConsortiumCKD groupHospital courseKidney injuryRefractory ascitesNegative patientsOverall survivalPositive patientsSerum creatinineCirrhosis etiologyClinical courseHospital admissionHospitalized patientsLiver failureTargets to improve quality of care for patients with hepatic encephalopathy: data from a multi‐centre cohort
Bajaj JS, O’Leary J, Tandon P, Wong F, Kamath PS, Biggins SW, Garcia‐Tsao G, Lai J, Fallon MB, Thuluvath PJ, Vargas HE, Maliakkal B, Subramanian RM, Thacker LR, Reddy KR. Targets to improve quality of care for patients with hepatic encephalopathy: data from a multi‐centre cohort. Alimentary Pharmacology & Therapeutics 2019, 49: 1518-1527. PMID: 31032966, PMCID: PMC6538445, DOI: 10.1111/apt.15265.Peer-Reviewed Original ResearchConceptsQuality of careAspiration pneumoniaEnd-stage Liver Disease cohortLiver disease cohortMulti-center cohortNorth American ConsortiumLiver transplantMELD scoreCirrhotic patientsDual therapyHepatic encephalopathyPneumonia developmentReadmission analysisBetter prognosisPatient cohortTherapy patientsDisease cohortLarge cohortPatientsMedicationsCohortAmerican ConsortiumTherapyReadmissionPneumoniaEmricasan (IDN‐6556) Lowers Portal Pressure in Patients With Compensated Cirrhosis and Severe Portal Hypertension
Garcia‐Tsao G, Fuchs M, Shiffman M, Borg BB, Pyrsopoulos N, Shetty K, Gallegos‐Orozco J, Reddy KR, Feyssa E, Chan JL, Yamashita M, Robinson JM, Spada AP, Hagerty DT, Bosch J. Emricasan (IDN‐6556) Lowers Portal Pressure in Patients With Compensated Cirrhosis and Severe Portal Hypertension. Hepatology 2019, 69: 717-728. PMID: 30063802, PMCID: PMC6587783, DOI: 10.1002/hep.30199.Peer-Reviewed Original ResearchConceptsSevere portal hypertensionPortal hypertensionAlanine aminotransferaseCompensated cirrhosisEnd-stage liver disease (MELD) scoreAspartate aminotransferaseAST/alanine aminotransferaseChild class ALiver Disease scoreOpen-label studyNonserious adverse eventsPortal venous inflowAnti-inflammatory effectsHepatitis C virusSplanchnic vasodilationAdverse eventsHVPG measurementIntrahepatic inflammationPortal pressureBlood pressureCirrhosis etiologyMedian ageNonalcoholic steatohepatitisVenous inflowSignificant changes
2018
Acute kidney injury, but not sepsis, is associated with higher procedure‐related bleeding in patients with decompensated cirrhosis
Hung A, Garcia‐Tsao G. Acute kidney injury, but not sepsis, is associated with higher procedure‐related bleeding in patients with decompensated cirrhosis. Liver International 2018, 38: 1437-1441. PMID: 29393567, PMCID: PMC6072624, DOI: 10.1111/liv.13712.Peer-Reviewed Original ResearchConceptsAcute kidney injuryProcedure-related bleedingKidney injuryPost-procedure bleedingRisk factorsCT scanEnd-stage renal diseaseInfection/sepsisAbnormal coagulation parametersBlood product transfusionLarge-volume paracentesisNon-cirrhotic patientsRetrospective chart reviewOnly independent predictorUnstratified cohortsMELD scoreProduct transfusionAdverse eventsChart reviewPatient characteristicsCirrhosis patientsIndependent predictorsRenal diseaseHemoglobin levelsCoagulation parameters
2017
Beta‐blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation
Bhutta A, Garcia‐Tsao G, Reddy K, Tandon P, Wong F, O'Leary J, Acharya C, Banerjee D, Abraldes J, Jones T, Shaw J, Deng Y, Ciarleglio M, Bajaj J. Beta‐blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation. Alimentary Pharmacology & Therapeutics 2017, 47: 78-85. PMID: 28994122, PMCID: PMC6016372, DOI: 10.1111/apt.14366.Peer-Reviewed Original ResearchConceptsMean arterial pressureBeta-blocker useLower mean arterial pressureBeta-blocker discontinuationRefractory ascitesHigh mortalityLower white blood cell countBeneficial anti-inflammatory effectsWhite blood cell countAcute kidney injuryAnti-inflammatory effectsTime of discontinuationBlood cell countEffect of BBBB discontinuationKidney injuryChart reviewHospital dischargeArterial pressureDiscontinuationAscitesCirrhosisPatientsCell countMortalityValidating, deconstructing and refining Baveno criteria for ruling out high‐risk varices in patients with compensated cirrhosis
Jangouk P, Turco L, De Oliveira A, Schepis F, Villa E, Garcia‐Tsao G. Validating, deconstructing and refining Baveno criteria for ruling out high‐risk varices in patients with compensated cirrhosis. Liver International 2017, 37: 1177-1183. PMID: 28160373, PMCID: PMC5511584, DOI: 10.1111/liv.13379.Peer-Reviewed Original ResearchConceptsHigh-risk varicesNegative predictive valueBaveno VI criteriaLiver stiffnessBaveno criteriaPredictive valueItalian cohortPlatelet countNon-invasive criteriaCohort of patientsNumber of endoscopiesUnnecessary endoscopiesCompensated cirrhosisPrimary prophylaxisRetrospective studyUS cohortVariceal screeningTransient elastographyVaricesHigh riskLow prevalenceCirrhosisPatientsEndoscopyClinical diagnosis
2016
The 3‐month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis
Bajaj JS, Reddy KR, Tandon P, Wong F, Kamath PS, Garcia‐Tsao G, Maliakkal B, Biggins SW, Thuluvath PJ, Fallon MB, Subramanian RM, Vargas H, Thacker LR, O'Leary JG, Disease N. The 3‐month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis. Hepatology 2016, 64: 200-208. PMID: 26690389, PMCID: PMC4700508, DOI: 10.1002/hep.28414.Peer-Reviewed Original ResearchConceptsEnd-stage liver diseaseNosocomial infectionsLiver diseaseEnd-stage Liver Disease cohortEnd-stage liver disease (MELD) scoreSmall single-center studiesLarge North American cohortHigher readmission riskInfection-related readmissionLiver disease cohortPercent of readmissionsLiver Disease scoreSingle-center studyMultivariable logistic regressionNorth American cohortNorth American ConsortiumIndex admissionNonelective indicationsAdvanced cirrhosisProphylactic antibioticsCirrhosis severityInhibitor useReadmission ratesMonths postdischargeReadmission risk
2015
High risk of delisting or death in liver transplant candidates following infections: Results from the North American consortium for the study of end‐stage liver disease
Reddy KR, O'Leary JG, Kamath PS, Fallon MB, Biggins SW, Wong F, Patton HM, Garcia‐Tsao G, Subramanian RM, Thacker LR, Bajaj JS, Disease F. High risk of delisting or death in liver transplant candidates following infections: Results from the North American consortium for the study of end‐stage liver disease. Liver Transplantation 2015, 21: 881-888. PMID: 25845966, DOI: 10.1002/lt.24139.Peer-Reviewed Original ResearchConceptsEnd-stage liver diseaseLiver transplantationOrgan failureNorth American ConsortiumLiver diseaseUnderwent transplantationMELD scoreMedian ageEnd-stage liver disease (MELD) scoreTertiary-care hepatology centersAmerican ConsortiumExtrahepatic organ failureMean MELD scoreLiver Disease scoreLiver transplant candidatesPatients' median ageHepatitis C virusType of infectionPrevention of infectionHepatology centersTransplant candidatesCirculatory failureC virusInfected patientsHigh risk
2014
Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury
Belcher JM, Sanyal AJ, Peixoto AJ, Perazella MA, Lim J, Thiessen‐Philbrook H, Ansari N, Coca SG, Garcia‐Tsao G, Parikh CR, Consortium F. Kidney biomarkers and differential diagnosis of patients with cirrhosis and acute kidney injury. Hepatology 2014, 60: 622-632. PMID: 24375576, PMCID: PMC4065642, DOI: 10.1002/hep.26980.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAcute-Phase ProteinsAdultAgedAlbuminuriaBiomarkersCreatinineDiagnosis, DifferentialFatty Acid-Binding ProteinsFemaleGlomerular Filtration RateHepatitis A Virus Cellular Receptor 1HumansInterleukin-18KidneyLipocalin-2LipocalinsLiver CirrhosisMaleMembrane GlycoproteinsMiddle AgedProspective StudiesProto-Oncogene ProteinsReceptors, VirusSodiumConceptsAcute kidney injuryAcute tubular necrosisKidney injury molecule-1Neutrophil gelatinase-associated lipocalinHepatorenal syndromePrerenal azotemiaKidney injuryDifferential diagnosisUrinary biomarkersEtiology of AKIProgressive acute kidney injuryLiver-type fatty acidOptimal diagnostic cutoffInjury molecule-1Prospective cohort studyGelatinase-associated lipocalinAccurate differential diagnosisClinical decision makingNumber of biomarkersCohort studyTubular necrosisFractional excretionCommon etiologyInterleukin-18Kidney biomarkersSurvival in infection‐related acute‐on‐chronic liver failure is defined by extrahepatic organ failures
Bajaj JS, O'Leary JG, Reddy KR, Wong F, Biggins SW, Patton H, Fallon MB, Garcia‐Tsao G, Maliakkal B, Malik R, Subramanian RM, Thacker LR, Kamath PS, Disease T. Survival in infection‐related acute‐on‐chronic liver failure is defined by extrahepatic organ failures. Hepatology 2014, 60: 250-256. PMID: 24677131, PMCID: PMC4077926, DOI: 10.1002/hep.27077.Peer-Reviewed Original ResearchConceptsMean arterial pressureLower mean arterial pressureExtrahepatic organ failureChronic liver failureSpontaneous bacterial peritonitisUrinary tract infectionOrgan failureCirrhosis patientsHepatic encephalopathyIndependent predictorsLiver failureSecond infectionEndstage Liver Disease (MELD) scoreHigher white blood countBaseline independent predictorsDevelopment of ACLFNon-SBP infectionsLiver Disease scoreMore organ failuresWhite blood countNorth American ConsortiumDeterminants of survivalRenal replacementTract infectionsArterial pressure