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
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 predictionThe 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
SGLT2 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 microbiomeMortalitySeverityHepatitisFactors associated with health‐related quality of life in patients with cirrhosis: a systematic review
Rabiee A, Ximenes R, Nikayin S, Hickner A, Juthani P, Rosen RH, Garcia‐Tsao G. Factors associated with health‐related quality of life in patients with cirrhosis: a systematic review. Liver International 2020, 41: 6-15. PMID: 32998172, DOI: 10.1111/liv.14680.Peer-Reviewed Original ResearchConceptsHealth-related qualityPoor HRQOLMuscle crampsHepatic encephalopathyPoor sleepSystematic reviewPoor health-related qualityPatient-reported outcomesPoor social supportPatient-centered careFull-text screeningAdult patientsPoor HRQoL.Cirrhosis etiologyHRQoLCirrhosisGeneric instrumentsEligibility criteriaCognitive impairmentPatientsMajority of studiesIdentified factorsCrampsDemographic factorsFrailtySerum 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
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 failureOutcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience
O’Leary J, Bajaj JS, Tandon P, Biggins SW, Wong F, Kamath PS, Garcia‐Tsao G, Maliakkal B, Lai J, Fallon M, Vargas HE, Thuluvath P, Subramanian R, Thacker LR, Reddy K. Outcomes After Listing for Liver Transplant in Patients With Acute‐on‐Chronic Liver Failure: The Multicenter North American Consortium for the Study of End‐Stage Liver Disease Experience. Liver Transplantation 2019, 25: 571-579. PMID: 30724010, PMCID: PMC11075742, DOI: 10.1002/lt.25426.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAcute-On-Chronic Liver FailureAdultDisease ProgressionEnd Stage Liver DiseaseFemaleHospital MortalityHospitalizationHumansLiver CirrhosisLiver TransplantationMaleMiddle AgedNorth AmericaProspective StudiesRenal DialysisSeverity of Illness IndexSurvival RateTime-to-TreatmentWaiting ListsConceptsChronic liver failureLiver transplantationNorth American ConsortiumLiver failureEnd-stage liver disease (MELD) scoreEnd-stage liver diseaseAmerican ConsortiumExtrahepatic organ failureAcute kidney injuryLiver Disease scoreOutcomes of patientsPost-LT survivalPerioperative dialysisRenal recoveryKidney injuryLiver transplantOrgan failureLiver diseaseMedian timeMedian MELDACLFSimilar survivalDisease experienceDisease scorePatients
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
Validating, 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
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 biomarkersNovel inflammatory biomarkers of portal pressure in compensated cirrhosis patients
Buck M, Garcia‐Tsao G, Groszmann RJ, Stalling C, Grace ND, Burroughs AK, Patch D, Matloff DS, Clopton P, Chojkier M. Novel inflammatory biomarkers of portal pressure in compensated cirrhosis patients. Hepatology 2014, 59: 1052-1059. PMID: 24115225, DOI: 10.1002/hep.26755.Peer-Reviewed Original ResearchConceptsHepatic vein pressure gradientGastroesophageal varicesCirrhosis patientsUnnecessary esophagogastroduodenoscopyPortal hypertensionInflammatory biomarkersMultivariate logistic regression analysisInflammatory serum biomarkersNovel inflammatory biomarkerSerum VCAM-1Logistic regression analysisAssociated morbidityCohort studyPortal pressureLiver injuryBlood testsClinical parametersInflammatory pathwaysSerum biomarkersClinical trialsVCAM-1IL-1RPatientsDiagnostic testsMmHgSerum B‐type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study
Farias AQ, Silvestre OM, Garcia‐Tsao G, da Costa Seguro L, de Campos Mazo D, Bacal F, Andrade JL, Gonçalves LL, Strunz C, Ramos DS, Polli D, Pugliese V, Rodrigues AC, Furtado MS, Carrilho FJ, D'Albuquerque LA. Serum B‐type natriuretic peptide in the initial workup of patients with new onset ascites: A diagnostic accuracy study. Hepatology 2014, 59: 1043-1051. PMID: 23907731, DOI: 10.1002/hep.26643.Peer-Reviewed Original ResearchConceptsSerum B-type natriuretic peptideB-type natriuretic peptideSerum-ascites albumin gradientNew-onset ascitesDiagnosis of HFHeart failureCause of ascitesConsecutive patientsNatriuretic peptideTotal protein concentrationResult of HFHighest positive likelihood ratioLow negative likelihood ratioWorkup of patientsCross-sectional studyPg/mLPositive likelihood ratioDiagnostic accuracy studiesNegative likelihood ratioDiagnostic paracentesisPeritoneal diseaseInitial workupLikelihood ratioConstrictive pericarditisValidation cohort
2012
Association of AKI With mortality and complications in hospitalized patients with cirrhosis
Belcher JM, Garcia‐Tsao G, Sanyal AJ, Bhogal H, Lim JK, Ansari N, Coca SG, Parikh CR, Consortium F. Association of AKI With mortality and complications in hospitalized patients with cirrhosis. Hepatology 2012, 57: 753-762. PMID: 22454364, PMCID: PMC3390443, DOI: 10.1002/hep.25735.Peer-Reviewed Original ResearchConceptsAcute kidney injuryAcute Kidney Injury Network definitionAssociation of AKIDefinition of AKISeverity of AKIProgression of AKIProspective observational cohort studyAKIN stage 1Baseline renal functionObservational cohort studyIncidence of mortalityAKI criteriaAKI severityAKI stageAKIN criteriaAKIN stageHospital mortalityKidney injuryCohort studyDevastating complicationRenal functionHospitalized patientsImproved outcomesEarly diagnosisTimely treatmentHigh 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 hospitalsCirrhosisAbstractTextInfectionThe Combination of Octreotide and Midodrine Is Not Superior to Albumin in Preventing Recurrence of Ascites After Large-Volume Paracentesis
Bari K, Miñano C, Shea M, Inayat IB, Hashem HJ, Gilles H, Heuman D, Garcia–Tsao G. The Combination of Octreotide and Midodrine Is Not Superior to Albumin in Preventing Recurrence of Ascites After Large-Volume Paracentesis. Clinical Gastroenterology And Hepatology 2012, 10: 1169-1175. PMID: 22801062, PMCID: PMC3678262, DOI: 10.1016/j.cgh.2012.06.027.Peer-Reviewed Original ResearchConceptsPostparacentesis circulatory dysfunctionRecurrence of ascitesVasoconstrictor groupAlbumin groupRefractory ascitesAscites recurrenceCombination of midodrineCombination of octreotidePlacebo-controlled trialLarge-volume paracentesisEffective blood volumeTreatment of choiceSingle intravenous doseOral midodrinePreventing RecurrenceRenal failureCirculatory dysfunctionMedian timeSerum levelsIntravenous doseIntramuscular injectionIntravenous administrationAscitesMidodrineBlood volume