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 UpdateControversies regarding albumin therapy in cirrhosis.
Trebicka J, Garcia-Tsao G. Controversies regarding albumin therapy in cirrhosis. Hepatology 2023 PMID: 37540192, DOI: 10.1097/hep.0000000000000521.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsSpontaneous bacterial peritonitisBacterial peritonitisAcute kidney injuryLarge-volume paracentesisSerum albumin levelChronic liver diseaseUse of albuminHepatorenal syndromeAdvanced cirrhosisAlbumin infusionKidney injuryAlbumin therapyAlbumin levelsAlbumin useProinflammatory stateLiver diseasePatient selectionVolume overloadPoor outcomeHigh oxidative stressCirrhosisPathophysiological relevanceOxidative stressPeritonitisAlbumin
2022
Association 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 samplesCirrhosisPatientsAscites and its complications
Garcia‐Tsao G. Ascites and its complications. 2022, 522-531. DOI: 10.1002/9781119600527.ch59.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsCirrhotic ascitesPresence of ascitesMainstay of therapySevere liver diseaseSpontaneous bacterial peritonitisAccumulation of fluidHepatorenal syndromePeritoneal malignancyUncomplicated ascitesAbdominal ultrasonographySodium restrictionCirrhotic patientsHepatic hydrothoraxBacterial peritonitisHeart failureLiver diseaseDecompensated stageCommon causePeritoneal cavityAscitesPatientsMost cost-effective methodBacterial infectionsCirrhosisCommon type
2021
Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases
Biggins SW, Angeli P, Garcia‐Tsao G, Ginès P, Ling SC, Nadim MK, Wong F, Kim WR. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021, 74: 1014-1048. PMID: 33942342, DOI: 10.1002/hep.31884.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsSpontaneous bacterial peritonitisManagement of ascitesBacterial peritonitisLiver diseaseAmerican AssociationPractice guidancePeritonitisAscitesDiseaseDiagnosis
2016
Su1493 Non-Response to Empirical Treatment for Spontaneous Bacterial Peritonitis (SBP): Incidence, Risk Factors, Clinical Impact, and Antibiotic Choices
To U, Delisle A, Garcia-Tsao G. Su1493 Non-Response to Empirical Treatment for Spontaneous Bacterial Peritonitis (SBP): Incidence, Risk Factors, Clinical Impact, and Antibiotic Choices. Gastroenterology 2016, 150: s1109-s1110. DOI: 10.1016/s0016-5085(16)33749-0.Peer-Reviewed Original ResearchSpontaneous bacterial peritonitisAntibiotic choiceBacterial peritonitisRisk factorsEmpirical treatmentClinical impactNon responsePeritonitisIncidenceApproach to the Patient with Ascites and Its Complications
Garcia‐Tsao G. Approach to the Patient with Ascites and Its Complications. 2016, 447-458. DOI: 10.1002/9781118512104.ch55.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsLarge-volume paracentesisSpontaneous bacterial peritonitisNew-onset ascitesPresence of ascitesAcute renal failureFirst-line therapyMainstay of therapySerial large-volume paracentesisEtiology of ascitesAccumulation of fluidHepatorenal syndromePeritoneal malignancyAbdominal ultrasonographyRefractory ascitesSodium restrictionHepatic hydrothoraxLine therapyRenal failureBacterial peritonitisHeart failureDecompensated stageCirrhotic ascitesCommon causePeritoneal cavityAscites
2014
Survival 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
2012
High Prevalence of Antibiotic-Resistant Bacterial Infections Among Patients With Cirrhosis at a US Liver Center
Tandon P, DeLisle A, Topal JE, Garcia–Tsao G. High Prevalence of Antibiotic-Resistant Bacterial Infections Among Patients With Cirrhosis at a US Liver Center. Clinical Gastroenterology And Hepatology 2012, 10: 1291-1298. PMID: 22902776, PMCID: PMC3891826, DOI: 10.1016/j.cgh.2012.08.017.Peer-Reviewed Original ResearchConceptsSystemic antibioticsBacterial infectionsAntibiotic-resistant bacterial infectionsOdds ratioTertiary care transplant centerCulture-positive infectionsSpontaneous bacterial peritonitisUrinary tract infectionMultivariate logistic regressionPercent of infectionsFirst bacterial infectionInfectious episodesLiver centersLiver unitTract infectionsBacterial peritonitisTransplant centersRisk factorsHigh prevalenceNosocomial infectionsPatientsUS hospitalsCirrhosisAbstractTextInfectionSpontaneous bacterial peritonitis
Garcia‐Tsao G. Spontaneous bacterial peritonitis. 2012, 745-750. DOI: 10.1002/9781118321386.ch100.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsSpontaneous bacterial peritonitisBacterial peritonitisPoor liver synthetic functionShort-term antibiotic prophylaxisCompatible clinical pictureHospitalized cirrhotic patientsLiver synthetic functionPolymorphonuclear cell countAntibiotic prophylaxisDiagnostic paracentesisIntravenous antibioticsOral norfloxacinSecondary prophylaxisGastrointestinal bleedGastrointestinal hemorrhageLiver transplantationRenal dysfunctionAlbumin therapyCirrhotic patientsAcute infectionImportant complicationClinical pictureCommon infectionsActive infectionPatientsParacentesis
De Gottardi A, Yeo C, Garcia‐Tsao G. Paracentesis. 2012, 1158-1162. DOI: 10.1002/9781118321386.ch154.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsDiagnostic paracentesisTherapeutic paracentesisAscitic fluidNew-onset ascitesAdministration of albuminSpontaneous bacterial peritonitisSite of paracentesisFormal contraindicationBowel perforationAbdominal ultrasoundBacterial peritonitisMajor complicationsSpecific etiologyAbdominal cavityParacentesisAscitesCell countBlood culture bottlesPatient consentSingle procedureFrequent technical problemsLeakage of fluidTherapeutic purposesPatientsMedical proceduresAscites
Garcia‐Tsao G. Ascites. 2012, 103-106. DOI: 10.1002/9781118321386.ch17.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsRight heart failurePeritoneal malignancyHeart failureHepatic sinusoidal pressureLow-protein ascitesNew-onset ascitesSpontaneous bacterial peritonitisEtiology of ascitesRoutine laboratory testsRisk of infectionAccumulation of fluidDiagnostic paracentesisBacterial peritonitisCareful historyPhysical examinationCirrhotic ascitesLiver architecturePeritoneal cavityHepatic sinusoidsAscitesPeritoneal lymphaticsCell countCirrhosisProtein levelsSinusoidal pressure
2011
Ascites
Garcia‐Tsao G. Ascites. 2011, 210-233. DOI: 10.1002/9781444341294.ch10.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsHepatorenal syndromeBacterial infectionsBaseline renal dysfunctionPeripheral arterial vasodilatationAcute kidney injurySecond-line treatmentMainstay of treatmentSpontaneous bacterial peritonitisSympathetic nervous systemEffective blood volumeSpontaneous bacterial infectionsCommon bacterial infectionsSigns of infectionLong-term safetyDiagnostic paracentesisIntravenous albuminPrerenal typeSinusoidal hypertensionAldosterone systemArterial vasodilatationKidney injuryLiver transplantationRefractory ascitesRenal dysfunctionSodium restrictionSpontaneous Bacterial Peritonitis – Prophylaxis and Treatment
Wiest R, Garcia-Tsao G. Spontaneous Bacterial Peritonitis – Prophylaxis and Treatment. Frontiers Of Gastrointestinal Research 2011, 28: 65-82. DOI: 10.1159/000318963.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsSpontaneous bacterial peritonitisAntibiotic prophylaxisHistory of SBPSpontaneous bacterial peritonitis prophylaxisLong-term antibiotic treatmentPrompt effective therapyPrognosis of patientsIdentification of patientsSevere bacterial infectionsLife-threatening infectionsSpontaneous bacteremiaGastrointestinal hemorrhageCirrhotic patientsBacterial peritonitisTreatment failureAntibiotic treatmentClinical trialsCurrent guidelinesEffective therapyFirst episodeHigh riskProphylaxisPatientsBacterial infectionsSpontaneous infection
2010
Renal Dysfunction Is the Most Important Independent Predictor of Mortality in Cirrhotic Patients With Spontaneous Bacterial Peritonitis
Tandon P, Garcia–Tsao G. Renal Dysfunction Is the Most Important Independent Predictor of Mortality in Cirrhotic Patients With Spontaneous Bacterial Peritonitis. Clinical Gastroenterology And Hepatology 2010, 9: 260-265. PMID: 21145427, PMCID: PMC3713475, DOI: 10.1016/j.cgh.2010.11.038.Peer-Reviewed Original ResearchConceptsRenal dysfunctionCirrhotic patientsBacterial peritonitisAscitic fluid cell countHigh-risk patientsMain prognostic factorsNormal renal functionSpontaneous bacterial peritonitisHigh-risk groupImportant independent predictorBlood urea nitrogenGood quality studiesSBP resolutionVasoconstrictor therapyMELD scoreAdult patientsRenal functionIndependent predictorsMedian agePrognostic factorsRisk stratificationCommon infectionsImmunosuppressive factorsPrognostic valuePrognostic studiesAntibiotic Prophylaxis and Management of Bacterial Infections
Lim J, Tandon P, Garcia-Tsao G. Antibiotic Prophylaxis and Management of Bacterial Infections. Clinical Gastroenterology 2010, 395-410. DOI: 10.1007/978-1-60761-866-9_20.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsSpontaneous bacterial peritonitisBacterial infectionsAntibiotic prophylaxisAcute kidney injuryRecurrent variceal hemorrhageHigh-risk patientsRole of antibioticsAcute decompensationKidney injuryVariceal hemorrhageBacterial peritonitisImportant complicationLiver failureClinical featuresCommon infectionsRisk factorsRole of albuminCirrhosisCommon precipitantsProphylaxisInfectionCommon typePatientsDecompensationPeritonitis
2008
Acute kidney injury in cirrhosis
Garcia‐Tsao G, Parikh CR, Viola A. Acute kidney injury in cirrhosis. Hepatology 2008, 48: 2064-2077. PMID: 19003880, DOI: 10.1002/hep.22605.Peer-Reviewed Original ResearchConceptsAcute kidney injuryAcute renal failureHepatorenal syndromeKidney injurySerum creatinineSpecific therapyEffective arterial blood volumeUseful bridging therapyAcute tubular necrosisRenal blood flowSpontaneous bacterial peritonitisArterial blood volumeBridging therapyLiver transplantationPrerenal azotemiaRenal dysfunctionRenal failureTubular necrosisBacterial peritonitisVasodilatory stateRelative hypovolemiaVolume repletionCommon causeCirrhosisBlood flowApproach to the Patient with Ascites and Its Complications
Garcia‐Tsao G. Approach to the Patient with Ascites and Its Complications. 2008, 442-466. DOI: 10.1002/9781444300758.ch23.ChaptersBacterial Infections, Sepsis, and Multiorgan Failure in Cirrhosis
Tandon P, Garcia-Tsao G. Bacterial Infections, Sepsis, and Multiorgan Failure in Cirrhosis. Seminars In Liver Disease 2008, 28: 026-042. PMID: 18293275, DOI: 10.1055/s-2008-1040319.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsSpontaneous bacterial peritonitisBacterial infectionsMultiorgan failureBacterial translocationSystemic inflammatory response syndromeHigh-risk patientsInflammatory response syndromeHyperdynamic circulatory stateRole of antibioticsAdrenal insufficiencyBacterial peritonitisImportant complicationResponse syndromeBacterial overgrowthCirculatory stateClinical featuresCommon infectionsRisk factorsRole of albuminCirrhosisPrognostic modelInfectionSepsisComplicationsPatients
2006
Portal hypertension
Garcia-Tsao G. Portal hypertension. Current Opinion In Internal Medicine 2006, 5: 399-407. DOI: 10.1097/01.mog.0000218962.93806.9a.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsPortal hypertensionVariceal bleedingTransjugular intrahepatic portosystemic shuntRecurrent variceal bleedingLarge-volume paracentesisSpontaneous bacterial peritonitisEndoscopic variceal ligationIntrahepatic portosystemic shuntHepatorenal syndromeRefractory ascitesBacterial peritonitisVariceal ligationSpecific complicationsPortosystemic shuntHypertensionΒ-blockersComplicationsTrialsBleedingVaricesAscitesDiagnosisRecent findingsRecent studiesCirrhosis