2023
AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review
Garcia-Tsao G, Abraldes J, Rich N, Wong V. AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review. Gastroenterology 2023, 166: 202-210. PMID: 37978969, DOI: 10.1053/j.gastro.2023.10.016.Peer-Reviewed Original ResearchConceptsSpontaneous bacterial peritonitisAcute kidney injuryLarge-volume paracentesisEffective arterial blood volumeVasoactive drugsVariceal hemorrhageArterial blood volumeHRS-AKIUncomplicated ascitesIntravenous albuminVolume statusPractice UpdateBlood volumeChronic liver failure grade 3Best practice advice statementsClinical Practice Updates CommitteeEnd-stage liver diseaseAGA Clinical Practice UpdateForms of AKIIntensive care unit monitoringAGA Governing BoardCombination of vasoconstrictorsInitial endoscopic hemostasisPatient's volume statusClinical Practice UpdateThe effect of endoscopic gastric plication on portosystemic pressure gradient in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease
Jirapinyo P, Thompson C, Garcia-Tsao G, Zucker S, Ryou M. The effect of endoscopic gastric plication on portosystemic pressure gradient in patients with nonalcoholic fatty liver disease and compensated advanced chronic liver disease. Endoscopy 2023, 56: 56-62. PMID: 37532114, DOI: 10.1055/a-2146-8857.Peer-Reviewed Original ResearchMeSH KeywordsHumansLiverLiver CirrhosisNon-alcoholic Fatty Liver DiseasePilot ProjectsProspective StudiesTreatment OutcomeWeight LossConceptsNonalcoholic fatty liver diseaseEndoscopic gastric plicationAdvanced chronic liver diseaseFatty liver diseasePortosystemic pressure gradientChronic liver diseaseLiver diseaseTotal weight lossGastric plicationNoninvasive testsBaseline median body-mass indexMedian body mass indexPercent total weight lossWeight lossProportion of patientsProspective pilot studyBody mass indexLiver stiffness measurementWeight loss proceduresGoal of therapyHepatic decompensationSecondary outcomesPrimary outcomeMass indexPatientsUpdate in the Treatment of the Complications of Cirrhosis
Abraldes J, Caraceni P, Ghabril M, Garcia-Tsao G. Update in the Treatment of the Complications of Cirrhosis. Clinical Gastroenterology And Hepatology 2023, 21: 2100-2109. PMID: 36972759, PMCID: PMC11097249, DOI: 10.1016/j.cgh.2023.03.019.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsTransjugular intrahepatic portosystemic shuntVariceal hemorrhageHepatic encephalopathyPre-emptive transjugular intrahepatic portosystemic shuntsAcute variceal hemorrhageCombination of terlipressinAcute kidney injuryComplications of cirrhosisSecond-line treatmentSignificant portal hypertensionFirst-line treatmentLeast common causePrognosis of patientsOrnithine L-aspartatePresence of varicesIntrahepatic portosystemic shuntStandard of careQuality of lifeCyanoacrylate injectionHepatorenal syndromeUncomplicated ascitesKidney injuryPortal hypertensionRefractory ascitesAlbumin useMedications for alcohol use disorder improve survival in patients with hazardous drinking and alcohol-associated cirrhosis
Rabiee A, Mahmud N, Falker C, Garcia-Tsao G, Taddei T, Kaplan D. Medications for alcohol use disorder improve survival in patients with hazardous drinking and alcohol-associated cirrhosis. Hepatology Communications 2023, 7: e0093. PMID: 36972386, PMCID: PMC10043587, DOI: 10.1097/hc9.0000000000000093.Peer-Reviewed Original ResearchMeSH KeywordsAcamprosateAlcohol DeterrentsAlcoholismHumansLiver CirrhosisLiver Cirrhosis, AlcoholicNaltrexoneRetrospective StudiesConceptsAlcohol-associated cirrhosisAlcohol use disorderUse disordersCause mortalityImproved survivalPropensity scoreInpatient diagnosis codesRetrospective cohort studyCox regression analysisActive alcohol useCirrhosis decompensationCohort studyConcurrent diagnosisLiver diseasePotential confoundersDiagnosis codesVeteran outcomesCirrhosis diagnosisStrong negative predictorCirrhosisPatientsHazardous drinkingAlcohol use behaviorsCosts AssociatedAlcohol useAcute Kidney Injury in Patients with Cirrhosis
Nadim M, Garcia-Tsao G. Acute Kidney Injury in Patients with Cirrhosis. New England Journal Of Medicine 2023, 388: 733-745. PMID: 36812435, DOI: 10.1056/nejmra2215289.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMachine learning liver histology scores correlate with portal hypertension assessments in nonalcoholic steatohepatitis cirrhosis
Noureddin M, Goodman Z, Tai D, Chng E, Ren Y, Boudes P, Shlevin H, Garcia‐Tsao G, Harrison S, Chalasani N. Machine learning liver histology scores correlate with portal hypertension assessments in nonalcoholic steatohepatitis cirrhosis. Alimentary Pharmacology & Therapeutics 2023, 57: 409-417. PMID: 36647687, PMCID: PMC10107331, DOI: 10.1111/apt.17363.Peer-Reviewed Original ResearchMeSH KeywordsFibrosisHumansHypertension, PortalLiverLiver CirrhosisNon-alcoholic Fatty Liver DiseasePortal PressureVaricose VeinsConceptsHepatic venous pressure gradientPresence of varicesEnd of treatmentValidation cohortLiver histology scoresPhase 2b trialPrimary efficacy endpointVenous pressure gradientDevelopment of varicesNonalcoholic steatohepatitis cirrhosisImportant histologic featuresImportant clinical relevanceHVPG changesEfficacy endpointHVPG measurementLiver histologyUpper endoscopyLiver biopsyLiver outcomesHistologic variablesNASH cirrhosisHistologic featuresHypertension assessmentCirrhosis (HALT-C) TrialClinical trials
2022
Endovascular Assessment of Liver Hemodynamics in Patients with Cirrhosis Complicated by Portal Hypertension
Ferral H, Schepis F, Gaba R, Garcia-Tsao G, Zanetto A, Perez-Campuzano V, Haskal Z, Garcia-Pagan J. Endovascular Assessment of Liver Hemodynamics in Patients with Cirrhosis Complicated by Portal Hypertension. Journal Of Vascular And Interventional Radiology 2022, 34: 327-336. PMID: 36516940, DOI: 10.1016/j.jvir.2022.12.014.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsHemodynamicsHumansHypertension, PortalLiver CirrhosisPortal PressurePortasystemic Shunt, Transjugular IntrahepaticConceptsHepatic venous pressure gradientPortal hypertensionPortosystemic pressure gradientTransjugular intrahepatic portosystemic shuntVenous pressure gradientIntrahepatic portosystemic shuntSurgical patientsRisk stratificationHemodynamic measurementsPortosystemic shuntLiver hemodynamicsTreatment optionsShunt diameterMeticulous techniquePatientsClinical practiceGold standardHypertensionManagement optionsPressure gradientCirrhosisComplicatedHemodynamicsOptionsShuntAssociation of serum metabolites and gut microbiota at hospital admission with nosocomial infection development in patients with cirrhosis
Bajaj JS, Reddy KR, Tandon P, Garcia‐Tsao G, Kamath PS, O'Leary JG, Wong F, Lai J, Vargas H, Thuluvath PJ, Subramanian RM, Pena‐Rodriguez M, Sikaroodi M, Thacker LR, Gillevet PM. Association of serum metabolites and gut microbiota at hospital admission with nosocomial infection development in patients with cirrhosis. Liver Transplantation 2022, 28: 1831-1840. PMID: 36017804, PMCID: PMC11097235, DOI: 10.1002/lt.26552.Peer-Reviewed Original ResearchConceptsNosocomial infectionsGut microbiotaAnalysis of covariancePoor outcomeClinical variablesSerum metabolitesCommensal microbiotaNI developmentIntensive care unit transferHigh MELD scoreLiquid chromatography-mass spectrometry metabolomicsSpontaneous bacterial peritonitisCommon nosocomial infectionAdmission WBCHospital courseInpatient outcomesMELD scoreBacterial peritonitisHospital admissionOrgan failureStool microbiotaSerum metabolomicsStool samplesCirrhosisPatientsNoninvasive predictors of clinically significant portal hypertension in NASH cirrhosis: Validation of ANTICIPATE models and development of a lab‐based model
Rabiee A, Deng Y, Ciarleglio M, Chan JL, Pons M, Genesca J, Garcia‐Tsao G. Noninvasive predictors of clinically significant portal hypertension in NASH cirrhosis: Validation of ANTICIPATE models and development of a lab‐based model. Hepatology Communications 2022, 6: 3324-3334. PMID: 36214066, PMCID: PMC9701481, DOI: 10.1002/hep4.2091.Peer-Reviewed Original ResearchMeSH KeywordsElasticity Imaging TechniquesHumansHypertension, PortalLiver CirrhosisNon-alcoholic Fatty Liver DiseasePortal PressureConceptsHepatic venous pressure gradientSignificant portal hypertensionTransient elastographyNASH cirrhosisPortal hypertensionFibrosis-4 indexPresence of CSPHVenous pressure gradientNonalcoholic steatohepatitis cirrhosisBody mass indexLiver stiffness measurementGood calibrationCompensated cirrhosisFIB-4Mass indexPlatelet countValidation cohortNoninvasive predictorTraining cohortBaseline riskLaboratory valuesCirrhosisHigh riskSeparate cohortNoninvasive surrogateRole of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis
Bajaj J, Lai J, Tandon P, O'Leary J, Wong F, Garcia-Tsao G, Vargas H, Kamath P, Biggins S, Limon-Miro A, Shaw J, Mbachi C, Chew M, Golob Deeb J, Thacker L, Reddy K. Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis. Clinical Gastroenterology And Hepatology 2022, 21: 1864-1872.e2. PMID: 36328307, PMCID: PMC11057906, DOI: 10.1016/j.cgh.2022.10.023.Peer-Reviewed Original ResearchConceptsPoor oral healthOral healthMulti-center cohortCirrhosis detailsComorbid conditionsLiver diseaseEnd-stage liver diseaseMulti-center cohort studyRisk of hospitalizationPortal hypertensive complicationsMinimal hepatic encephalopathyNew study cohortMulti-variable analysisCirrhosis complicationsNonelective hospitalizationPeriodontitis historyPrior HEFrailty assessmentFrailty scoreHypertensive complicationsCohort studyHepatic encephalopathyStudy cohortRisk factorsCirrhosis“Periprocedural management of abnormal coagulation parameters and thrombocytopenia in patients with cirrhosis: Guidance from the SSC of the ISTH”: Comment from Hartmann et al.
Hartmann J, Dias JD, Garcia‐Tsao G, Pivalizza EG. “Periprocedural management of abnormal coagulation parameters and thrombocytopenia in patients with cirrhosis: Guidance from the SSC of the ISTH”: Comment from Hartmann et al. Journal Of Thrombosis And Haemostasis 2022, 20: 2711-2712. PMID: 36271460, DOI: 10.1111/jth.15861.Peer-Reviewed Original ResearchPrognosis of hospitalized patients with cirrhosis and acute kidney disease
Wong F, Garcia‐Tsao G, Reddy KR, O'Leary JG, Kamath PS, Tandon P, Lai JC, Vargas HE, Biggins SW, Fallon MB, Thuluvath PJ, Maliakkal BJ, Subramanian R, Thacker L, Bajaj JS. Prognosis of hospitalized patients with cirrhosis and acute kidney disease. Liver International 2022, 42: 896-904. PMID: 35023264, PMCID: PMC11075740, DOI: 10.1111/liv.15154.Peer-Reviewed Original ResearchConceptsAcute kidney diseaseStage 1 AKIAKD patientsPeak ScrAKI patientsCirrhotic patientsKidney diseaseSecond infectionEnd-stage liver diseaseDecompensated cirrhotic patientsHigher hospital admissionsWorse renal dysfunctionNormal renal functionGlomerular filtration rateNorth American ConsortiumBaseline SCrRenal dysfunctionPrompt treatmentRenal functionSerum creatinineHospital admissionClinical outcomesLiver diseasePredictive factorsFiltration rate
2021
Baveno VII – Renewing consensus in portal hypertension
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Faculty B, Abraldes J, Albillos A, Baiges A, Bajaj J, Bañares R, Barrufet M, Benajiba L, Berzigotti A, Bureau C, Calvaruso V, Cardenas A, D’Amico G, De Gottardi A, Dell’Era A, Escorsell A, Fallowfield J, Ferral H, Francque S, Gaba R, Garcia-Pagàn J, Genescà J, Rodrigues S, Gracia-Sancho J, Han G, Hernandez-Gea V, Jia J, Kiladjian J, Krag A, Laleman W, La Mura V, Lens S, Luo X, Mandorfer M, Murad S, Paradis V, Patch D, Piano S, Pinzani M, Plessier A, Primignani M, Procopet B, Rautou P, Rudler M, Sarin S, Schepis F, Senzolo M, Shah V, Shukla A, Tandon P, Tellez L, Thabut D, Thiele M, Trebicka J, Tripathi D, Tsochatzis E, Turco L, Turon F, Valla D, Villanueva C, Wanless I, Yoshiji H. Baveno VII – Renewing consensus in portal hypertension. Journal Of Hepatology 2021, 76: 959-974. PMID: 35120736, PMCID: PMC11090185, DOI: 10.1016/j.jhep.2021.12.022.Peer-Reviewed Original ResearchMeSH KeywordsElasticity Imaging TechniquesEsophageal and Gastric VaricesHumansHypertension, PortalLiver CirrhosisPortal PressureConceptsPortal hypertensionAdvanced chronic liver diseaseHepatic venous pressure gradientAcute bleeding episodeSignificant portal hypertensionVenous pressure gradientChronic liver diseaseSplanchnic vein thrombosisCourse of cirrhosisRisk of deathNon-invasive toolBleeding episodesCompensated cirrhosisFurther decompensationVein thrombosisLiver diseaseBaveno VIVascular disordersFirst episodeHypertensionPersonalized careMedical literatureTherapeutic needsGold standardCirrhosisAdmission 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 admissionCan We Rely on Changes in HVPG in Patients with Cirrhosis?
Garcia‐Tsao G. Can We Rely on Changes in HVPG in Patients with Cirrhosis? Hepatology 2021, 74: 2945-2947. PMID: 34569630, DOI: 10.1002/hep.32159.Peer-Reviewed Original ResearchCirrhosis Is Associated With High Mortality and Readmissions Over 90 Days Regardless of COVID‐19: A Multicenter Cohort
Bajaj JS, Garcia‐Tsao G, Wong F, Biggins SW, Kamath PS, McGeorge S, Chew M, Pearson M, Shaw J, Kalluri A, Fagan A, Olofson A, Moini M, de la Rosa Rodriguez R, Reddy KR. Cirrhosis Is Associated With High Mortality and Readmissions Over 90 Days Regardless of COVID‐19: A Multicenter Cohort. Liver Transplantation 2021, 27: 1343-1347. PMID: 33427401, PMCID: PMC8014819, DOI: 10.1002/lt.25981.Peer-Reviewed Original ResearchDeterminants of increased thrombotic tendency in NASH cirrhosis: not there yet!
Zanetto A, Senzolo M, Campello E, Bulato C, Gavasso S, Saggiorato G, Feltracco P, Farinati F, Russo FP, Burra P, Garcia‐Tsao G, Simioni P. Determinants of increased thrombotic tendency in NASH cirrhosis: not there yet! Transplant International 2021, 34: 1325-1327. PMID: 33932057, DOI: 10.1111/tri.13895.Peer-Reviewed Original ResearchSACRED: Effect of simvastatin on hepatic decompensation and death in subjects with high-risk compensated cirrhosis: Statins and Cirrhosis: Reducing Events of Decompensation
Kaplan D, Mehta R, Garcia-Tsao G, Albrecht J, Aytaman A, Baffy G, Bajaj J, Hernaez R, Hunt K, Ioannou G, Johnson K, Kanwal F, Lee T, Monto A, Pandya P, Schaubel D, Taddei T. SACRED: Effect of simvastatin on hepatic decompensation and death in subjects with high-risk compensated cirrhosis: Statins and Cirrhosis: Reducing Events of Decompensation. Contemporary Clinical Trials 2021, 104: 106367. PMID: 33771685, PMCID: PMC8422958, DOI: 10.1016/j.cct.2021.106367.Peer-Reviewed Original ResearchConceptsHepatic decompensationPortal hypertensionEvents of decompensationHepatic decompensation eventsLiver-related deathSignificant portal hypertensionAcceptable safety profileProspective human studiesRole of statinsChronic liver diseaseClasses of medicationsPatient-reported outcomesDevelopment of decompensationEffect of simvastatinVA Medical CenterCompensated cirrhosisDecompensation eventsStatin therapyVariceal hemorrhageCirrhotic patientsStandard therapyVascular reactivityExert pleiotropic effectsLiver diseaseRetrospective studySleep 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 daytimeVascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases
Northup PG, Garcia‐Pagan J, Garcia‐Tsao G, Intagliata NM, Superina RA, Roberts LN, Lisman T, Valla DC. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021, 73: 366-413. PMID: 33219529, DOI: 10.1002/hep.31646.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements