2024
Relationship between updated MELD and prognosis in alcohol-associated hepatitis: Opportunities for more efficient trial design
Al-Karaghouli M, Ventura-Cots M, Wong Y, Genesca J, Bosques F, Brown R, Mathurin P, Louvet A, Shawcross D, Vargas V, Verna E, Schnabl B, Caballeria J, Shah V, Kamath P, Lucey M, Garcia-Tsao G, Bataller R, Abraldes J. Relationship between updated MELD and prognosis in alcohol-associated hepatitis: Opportunities for more efficient trial design. Hepatology Communications 2024, 8: e0495. PMID: 39082963, DOI: 10.1097/hc9.0000000000000495.Peer-Reviewed Original ResearchConceptsAlcohol-associated hepatitisTrial designRandomized controlled trialsShort-term mortalityInclusion criteriaPredictive valuePrognostic valueControlled trialsShort-term benefitsEfficient trial designTrial outcomesAssociated with significant mortalityCourse of AHCohort of patientsTreatment decisionsSample sizeOrdinal outcomesMortalityOrdinal scaleMELD valuesLandmark analysisTransplant allocationTrialsOutcomesTransplantation
2022
Prognosis 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
The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study
Morales-Arráez D, Ventura-Cots M, Altamirano J, Abraldes J, Cruz-Lemini M, Thursz M, Atkinson S, Sarin S, Kim W, Chavez-Araujo R, la Tijera M, Singal A, Shah V, Kamath P, Duarte-Rojo A, Charles E, Vargas V, Jager M, Rautou P, Rincon D, Zamarripa F, Restrepo-Gutiérrez J, Torre A, Lucey M, Arab J, Mathurin P, Louvet A, García-Tsao G, González J, Verna E, Brown R, Argemi J, Fernández-Carrillo C, Clemente A, Alvarado-Tapias E, Forrest E, Allison M, Bataller R. The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study. The American Journal Of Gastroenterology 2021, 117: 301-310. PMID: 34962498, PMCID: PMC8999152, DOI: 10.14309/ajg.0000000000001596.Peer-Reviewed Original ResearchConceptsAlcohol-associated hepatitisMaddrey's discriminant functionShort-term mortalityMELD scoreMELD-sodiumEnd-stage liver disease (MELD) scoreGlasgow alcoholic hepatitis scoreMaddrey Discriminant Function scoreAlcohol‐Associated HepatitisMedian MELD scoreLiver Disease scoreInternational normalized ratioCharacteristic curveMDF scoreCause mortalityPrimary outcomeTertiary centerLaboratory variablesCreatinine scoreNormalized ratioFunction scoresDisease scoreMortality predictionMortalityOutcome predictionAdmission 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 severity
2020
Subaortic Membranes in Patients With Hereditary Hemorrhagic Telangiectasia and Liver Vascular Malformations
Kim AS, Henderson KJ, Pawar S, Kim MJ, Punjani S, Pollak JS, Fahey JT, Garcia‐Tsao G, Sugeng L, Young LH. Subaortic Membranes in Patients With Hereditary Hemorrhagic Telangiectasia and Liver Vascular Malformations. Journal Of The American Heart Association 2020, 9: e016197. PMID: 33054561, PMCID: PMC7763373, DOI: 10.1161/jaha.120.016197.Peer-Reviewed Original ResearchMeSH KeywordsActivin Receptors, Type IICardiac Output, HighDiscrete Subaortic StenosisEchocardiographyFemaleHeart Defects, CongenitalHeart FailureHumansLiverMaleMiddle AgedMutationPrognosisRetrospective StudiesSurvival AnalysisTelangiectasia, Hereditary HemorrhagicUnited StatesVascular MalformationsConceptsHigh-output cardiac failureHereditary hemorrhagic telangiectasiaLeft ventricular outflow tractVentricular outflow tractHemorrhagic telangiectasiaMild obstructionSubaortic membraneVascular malformationsOutflow tractActivin receptor-like kinase 1 mutationsHereditary hemorrhagic telangiectasia patientsLiver vascular malformationsMild aortic insufficiencyPulmonary artery pressureRight heart catheterizationCohort of patientsRetrospective observational analysisHigh cardiac outputKinase 1 mutationsArtery pressureHeart catheterizationPulmonary hypertensionAortic insufficiencyBackground PatientsTricuspid regurgitationOrdinal Outcomes Are Superior to Binary Outcomes for Designing and Evaluating Clinical Trials in Compensated Cirrhosis
D’Amico G, Abraldes JG, Rebora P, Valsecchi MG, Garcia‐Tsao G. Ordinal Outcomes Are Superior to Binary Outcomes for Designing and Evaluating Clinical Trials in Compensated Cirrhosis. Hepatology 2020, 72: 1029-1042. PMID: 31837238, PMCID: PMC11090179, DOI: 10.1002/hep.31070.Peer-Reviewed Original ResearchConceptsClinical trialsGrade 1Prevention of decompensationBaseline platelet countDevelopment of varicesSignificant outcome differencesLow baseline riskPrimary therapeutic targetCirrhosis decompensationCompensated cirrhosisInception cohortComposite endpointEsophageal varicesPlatelet countBinary outcomesDisease progressionSignificant treatment effectBaseline riskGrade 3Sample sizeOutcome differencesTherapeutic targetDecompensationGrade 2Larger sample sizeSerum 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 metabolites
2019
Impact 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 failure
2018
Reply:
O’Leary J, Reddy K, Wong F, Garcia‐Tsao G, Kamath PS, Thacker LR, Bajaj JS. Reply:. Hepatology 2018, 68: 2046-2048. PMID: 30199577, DOI: 10.1002/hep.30264.Commentaries, Editorials and LettersReply
O’Leary J, Reddy K, Wong F, Garcia‐Tsao G, Kamath PS, Bajaj JS. Reply. Hepatology 2018, 68: 791-791. PMID: 29663463, DOI: 10.1002/hep.30032.Commentaries, Editorials and LettersNACSELD acute‐on‐chronic liver failure (NACSELD‐ACLF) score predicts 30‐day survival in hospitalized patients with cirrhosis
O'Leary JG, Reddy KR, Garcia‐Tsao G, Biggins SW, Wong F, Fallon MB, Subramanian RM, Kamath PS, Thuluvath P, Vargas HE, Maliakkal B, Tandon P, Lai J, Thacker LR, Bajaj JS. NACSELD acute‐on‐chronic liver failure (NACSELD‐ACLF) score predicts 30‐day survival in hospitalized patients with cirrhosis. Hepatology 2018, 67: 2367-2374. PMID: 29315693, DOI: 10.1002/hep.29773.Peer-Reviewed Original ResearchConceptsEnd-stage liver disease (MELD) scoreLiver Disease scoreOrgan failureHospitalized patientsBedside toolDisease scoreChronic liver failure scoreTertiary-care hepatology centersWhite blood cell countAlcohol-induced cirrhosisExtrahepatic organ failureMedian Child scoreReliable bedside toolChronic liver failureDiagnosis of cirrhosisBlood cell countRisk of mortalityPresence of infectionSimple bedside toolNorth American ConsortiumHepatology centersNACSELD-ACLFSeparate multicenterUninfected patientsProspective cohortAcute 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
2016
A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis
Tandon P, Reddy KR, O'Leary JG, Garcia‐Tsao G, Abraldes JG, Wong F, Biggins SW, Maliakkal B, Fallon MB, Subramanian RM, Thuluvath P, Kamath PS, Thacker LR, Bajaj JS, Disease N. A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis. Hepatology 2016, 65: 217-224. PMID: 27775842, DOI: 10.1002/hep.28900.Peer-Reviewed Original ResearchConceptsKarnofsky performance statusPerformance statusMELD scoreCirrhosis patientsEnd-stage liver disease (MELD) scoreHigher white blood cell countTertiary-care hepatology centersEnd-stage liver diseaseWhite blood cell countPalliative management strategiesUse prognostic modelLiver Disease scoreMiddle-aged patientsMonths of dischargeLow performance statusIdentification of patientsHigh performance statusBlood cell countNorth American ConsortiumPerformance status groupsHepatology centersPostdischarge mortalityHospital dischargeHepatic encephalopathyIndependent predictors
2012
Prognostic indicators of survival in patients with compensated and decompensated cirrhosis
Zipprich A, Garcia‐Tsao G, Rogowski S, Fleig WE, Seufferlein T, Dollinger MM. Prognostic indicators of survival in patients with compensated and decompensated cirrhosis. Liver International 2012, 32: 1407-1414. PMID: 22679906, PMCID: PMC3713489, DOI: 10.1111/j.1478-3231.2012.02830.x.Peer-Reviewed Original ResearchConceptsHepatic venous pressure gradientPredictors of deathCompensated patientsPortal hypertensionPrognostic valueComplications of cirrhosisSignificant portal hypertensionStage 2 patientsVenous pressure gradientDecompensated patientsSystemic haemodynamicsVariceal hemorrhagePortal pressureIndependent predictorsMultivariable analysisClinical eventsDecompensated stagePrognostic indicatorStaging systemLonger survivalBACKGROUND/CirrhosisPatientsSurvival rateAnalyse survival
2011
Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1*
Boyer TD, Sanyal AJ, Garcia‐Tsao G, Regenstein F, Rossaro L, Appenrodt B, Gülberg V, Sigal S, Bexon AS, Teuber P, Group T. Impact of liver transplantation on the survival of patients treated for hepatorenal syndrome type 1*. Liver Transplantation 2011, 17: 1328-1332. PMID: 21837734, PMCID: PMC3760727, DOI: 10.1002/lt.22395.Peer-Reviewed Original ResearchConceptsHepatorenal syndrome type 1Liver transplantationHepatorenal syndromeSyndrome type 1Nontransplant patientsTransplant patientsSurvival benefitSurvival rateType 1Pretransplant renal functionUse of terlipressinClear survival benefitCohort of patientsSurvival of patientsHRS reversalPosttransplant managementLiver transplantPosttransplant survivalMost patientsPosttransplant outcomesRenal functionPoor prognosisTerlipressinPatientsTransplantation
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 studies
2009
Incidence, Prevalence, and Clinical Significance of Abnormal Hematologic Indices in Compensated Cirrhosis
Qamar AA, Grace ND, Groszmann RJ, Garcia–Tsao G, Bosch J, Burroughs AK, Ripoll C, Maurer R, Planas R, Escorsell A, Garcia–Pagan J, Patch D, Matloff DS, Makuch R, Rendon G, Group P. Incidence, Prevalence, and Clinical Significance of Abnormal Hematologic Indices in Compensated Cirrhosis. Clinical Gastroenterology And Hepatology 2009, 7: 689-695. PMID: 19281860, PMCID: PMC4545534, DOI: 10.1016/j.cgh.2009.02.021.Peer-Reviewed Original ResearchConceptsHepatic venous pressure gradientHematologic indicesCompensated cirrhosisBaseline hepatic venous pressure gradientWhite blood cell countChild-Pugh scorePredictors of deathPrimary end pointVenous pressure gradientDevelopment of varicesKaplan-Meier analysisBlood cell countCombination of leukopeniaBaseline thrombocytopeniaVariceal bleedingClinical decompensationEsophageal varicesPrognostic significanceTransplant surgeryClinical significanceLeukopeniaThrombocytopeniaCirrhosisCell countVarices
2008
Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay
Mayo MJ, Parkes J, Adams‐Huet B, Combes B, Mills AS, Markin RS, Rubin R, Wheeler D, Contos M, West AB, Saldana S, Getachew Y, Butsch R, Luketic V, Peters M, Di Bisceglie A, Bass N, Lake J, Boyer T, Martinez E, Boyer J, Garcia‐Tsao G, Barnes D, Rosenberg WM. Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay. Hepatology 2008, 48: 1549-1557. PMID: 18846542, PMCID: PMC2597274, DOI: 10.1002/hep.22517.Peer-Reviewed Original ResearchConceptsPrimary biliary cirrhosisSerum fibrosis markersBiliary cirrhosisLiver biopsyClinical progressionFibrosis markersLiver fibrosisPrognostic informationPrognostic performanceSerial liver biopsy specimensEnd-stage liver diseaseLong-term prognostic informationLiver-related deathPositive antimitochondrial antibodyMayo risk scoreEvent-free survivalAppropriate clinical settingSerum hyaluronic acidEnhanced liver fibrosisLiver biopsy specimensAccurate noninvasive measureFibrosis algorithmsPBC subjectsVariceal bleedBiopsy complications
2007
Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis
Ripoll C, Groszmann R, Garcia–Tsao G, Grace N, Burroughs A, Planas R, Escorsell A, Garcia–Pagan J, Makuch R, Patch D, Matloff DS, Bosch J, Group P. Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis. Gastroenterology 2007, 133: 481-488. PMID: 17681169, DOI: 10.1053/j.gastro.2007.05.024.Peer-Reviewed Original ResearchMeSH KeywordsAgedAscitesEsophageal and Gastric VaricesFemaleFollow-Up StudiesGastrointestinal HemorrhageHepatic EncephalopathyHumansHypertension, PortalKaplan-Meier EstimateLiver CirrhosisMaleMiddle AgedPortal PressurePredictive Value of TestsPrognosisProportional Hazards ModelsProspective StudiesRisk AssessmentRisk FactorsROC CurveSensitivity and SpecificitySeverity of Illness IndexTime FactorsConceptsHepatic venous pressure gradientVenous pressure gradientClinical decompensationPortal hypertensionMedian hepatic venous pressure gradientEnd-stage liver diseaseDiagnostic capacityBaseline laboratory testsPredictors of decompensationChild-Pugh scoreDevelopment of varicesMedical record reviewEnd of studyMedian followCompensated cirrhosisLiver transplantationLiver diseaseRecord reviewStudy terminationDecompensationPatientsCirrhosisMultivariate analysisVaricesHypertension