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1. Patterns and predictors of treatment initiation and completion in patients with chronic hepatitis C virus infection

Author

Clark BT, Garcia-Tsao G, and Fraenkel L

Subjects
Medicine (General), R5-920
Abstract

Brian T Clark1,2, Guadalupe Garcia-Tsao1,2, Liana Fraenkel1,21Veterans Administration, Connecticut Healthcare System, West Haven, 2Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USAObjectives: Guidelines for hepatitis C (HCV) strongly recommend antiviral treatment for patients with more severe liver disease given their increased risk of developing cirrhosis and other liver-related complications. Despite the proven benefits of therapy, 70%–88% of patients chronically infected with HCV do not undergo treatment. The goal of this paper is to describe patterns of treatment initiation among patients with both mild and severe disease and to assess the factors that are associated with treatment initiation and completion.Methods: Subjects completed previously validated questionnaires to ascertain sociodemographic characteristics, choice predisposition, and clinical characteristics prior to meeting with the hepatologist to discuss treatment initiation and were followed for 12 months. We examined the association between patient characteristics and treatment patterns controlling for liver disease severity.Results: Of the 148 eligible subjects entered into our study, 55 (37%) initiated treatment during the 12-month follow-up period. Of the 86 subjects with severe liver disease, 43 (50%) initiated treatment. Financial barriers and geographic access to care were the most common reasons for treatment deferral. Of the 55 patients initiating treatment, 24 (44%) discontinued treatment, with intolerance of side effects being the most common reason for discontinuation. After adjusting for liver disease severity, patient choice predisposition (prior to discussion with their provider) was strongly associated with initiation of treatment, while sociodemographic characteristics were not.Conclusion: Treatment initiation did align with current recommendations (patients with severe disease were more likely to initiate treatment), however, rates of treatment initiation and completion were low. Patient choice predisposition is the strongest predictor of treatment initiation, independent of disease severity. Improving individualized treatment outcomes for patients with chronic HCV requires efforts at identifying patients’ choice predisposition, and improving access for those wishing to initiate therapy.Keywords: barriers, access, preferences, utilization, adverse events

Published
2012

3. Early trends in cystatin c and outcomes in patients with cirrhosis and acute kidney injury

Author

Shlipak, Michael, Belcher, JM, Sanyal, AJ, Garcia-Tsao, G, Ansari, N, Coca, SG, Shlipak, MG, and Parikh, CR

Abstract

Background. Acute kidney injury (AKI) is a common and severe complication in patients with cirrhosis. Progression of AKI to a higher stage associates with increased mortality. Intervening early in AKI when renal dysfunction is worsening may improve outcome

Published
2014

6. List of Contributors

Author

Abenavoli, L., primary, Abraldes, J.G., additional, Aguilar-Olivos, N.E., additional, Aguirre-García, J., additional, Almeda-Valdés, P., additional, Arauz, J., additional, Aravalli, R.N., additional, Arellanes-Robledo, J., additional, Ascensão, A., additional, Bardia, A., additional, Beleza, J., additional, Billiar, T.R., additional, Buendía-Montaño, L.D., additional, Camacho, J., additional, Casas-Grajales, S., additional, Casillas-Ramírez, A., additional, Castañeda-Hernández, G., additional, Cederbaum, A.I., additional, Chagoya de Sánchez, V., additional, Chávez, E., additional, Colle, I., additional, Cruz-Antonio, L., additional, Cruz-Baquero, A., additional, Czaja, A.J., additional, Dara, L., additional, del Pilar Cabrales-Romero, M., additional, Dhayal, M., additional, Espinosa-Cantellano, M., additional, Factor, V.M., additional, Ferenci, P., additional, Fernández-Martínez, E., additional, Fernandez, M., additional, Fierro, N.A., additional, Flores-Beltrán, R.E., additional, French, S.W., additional, Fu, P., additional, Fukui, H., additional, Galicia-Moreno, M., additional, Galli, A., additional, García-López, P., additional, Garcia-Tsao, G., additional, García de León, M.C., additional, Ginès, P., additional, Girish, C., additional, Gómez-Quiroz, L.E., additional, Gonçalves, I.O., additional, Gonzalez-Aldaco, K., additional, Gracia-Sancho, J., additional, Grattagliano, I., additional, Graupera, I., additional, Gressner, O.A., additional, Gressner, A.M., additional, Groszmann, R.J., additional, Guízar-Sahagún, G., additional, Gutiérrez-Reyes, D.G., additional, Gutiérrez-Ruiz, M.C., additional, Habeeb, M.A., additional, Hai, H., additional, Hammerich, L., additional, Hernández-Aquino, E., additional, Hernández, C., additional, Jaeschke, H., additional, Jiménez-Castro, M.B., additional, Kaplowitz, N., additional, Katoonizadeh, A., additional, Kawada, N., additional, Kershenobich, D., additional, Khan, A.A., additional, Ki, S.H., additional, Kim, K.M., additional, Lakshman, M.R., additional, Li, W., additional, Liang, X., additional, Liu, X., additional, Liu, Z.-X., additional, Loughran, P.A., additional, Lu, S.C., additional, Maeda, S., additional, Magalhães, J., additional, Mann, J., additional, Marquardt, J.U., additional, Martínez-Castillo, M., additional, Martínez-Chantar, M.L., additional, Martínez-Padrón, H.Y., additional, Martínez-Palomo, A., additional, Martins, M.J., additional, Mato, J.M., additional, Méndez-Sánchez, N., additional, Milic, N., additional, Montes-Páez, G., additional, Montes, S., additional, Muriel, P., additional, Nakamura, T., additional, Noureddin, M., additional, Oliveira, P.J., additional, Pacheco-Rivera, R., additional, Pacheco-Yépez, J., additional, Panduro, A., additional, Peralta, C., additional, Pérez-Carreón, J.I., additional, Portincasa, P., additional, Pradhan, S.C., additional, Raevens, S., additional, Ramachandran, A., additional, Ramos-Tovar, E., additional, Reyes-Gordillo, K., additional, Rivera-Mancía, S., additional, Roberts, M.S., additional, Rocha-Sánchez, A.Y., additional, Roman, S., additional, Serrano-Luna, J., additional, Shah, R., additional, Shibata, W., additional, Shibayama, M., additional, Shimizu, Y., additional, Shiota, G., additional, Solà, E., additional, Tacke, F., additional, Tajiri, K., additional, Takaki, A., additional, Tarocchi, M., additional, Thorgeirsson, S.S., additional, Thuy, T.T.V., additional, Thuy le, T.T., additional, Torimura, T., additional, Tristán-López, L.A., additional, Tsutsumi, V., additional, Tsutsumi, G.R., additional, Uchida, D., additional, Ueno, T., additional, Uribe, M., additional, Vargas-Pozada, E.E., additional, Vázquez-Flores, L.F., additional, Velasco-Loyden, G., additional, Vergani, L., additional, Vishwakarma, S.K., additional, Vorobioff, J.D., additional, Wang, J.-Y., additional, Wang, H., additional, Wu, S.-D., additional, Xia, F., additional, Xu, W., additional, Xu, L., additional, Yamamoto, K., additional, Yao, X.R., additional, Yu, J., additional, Zeng, L., additional, and Zhou, B.J., additional

Published
2017
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7. Effect of rifaximin on infections, acute-on-chronic liver failure and mortality in alcoholic hepatitis : A pilot study (RIFA-AH)

Author

Jiménez, Cesar, Ventura-Cots, Meritxell, Sala Llinas, Margarita, Calafat, Margalida, Garcia-Retortillo, M., Cirera, Isabel, Cañete Hidalgo, Nuria, Soriano, German, Poca Sans, Maria, Simon-Talero, Macarena, Altamirano, José, Lucey, Michael, Garcia-Tsao, G., Brown, R.S., Schwabe, R.F., Verna, Elizabeth, Schnabl, Bernd, Bosques, Francisco, Mathurin, Philippe, Louvet, Alexandre, Shawcross, Debbie, Abraldes, J.G., Genescà, J., Bataller, R., Vargas, V., Universitat Autònoma de Barcelona, Jiménez, Cesar, Ventura-Cots, Meritxell, Sala Llinas, Margarita, Calafat, Margalida, Garcia-Retortillo, M., Cirera, Isabel, Cañete Hidalgo, Nuria, Soriano, German, Poca Sans, Maria, Simon-Talero, Macarena, Altamirano, José, Lucey, Michael, Garcia-Tsao, G., Brown, R.S., Schwabe, R.F., Verna, Elizabeth, Schnabl, Bernd, Bosques, Francisco, Mathurin, Philippe, Louvet, Alexandre, Shawcross, Debbie, Abraldes, J.G., Genescà, J., Bataller, R., Vargas, V., and Universitat Autònoma de Barcelona

Abstract

Background & Aims: Alcoholic hepatitis (AH) is associated with a high incidence of infection and mortality. Rifaximin reduces bacterial overgrowth and translocation. We aimed to study whether the administration of rifaximin as an adjuvant treatment to corticosteroids decreases the number of bacterial infections at 90 days in patients with severe AH compared to a control cohort. Methods: This was a multicentre, open, comparative pilot study of the addition of rifaximin (1200 mg/day/90 days) to the standard treatment for severe AH. The results were compared with a carefully matched historical cohort of patients treated with standard therapy and matching by age and model of end-stage liver disease (MELD). We evaluated bacterial infections, liver-related complications, mortality and liver function tests after 90 days. Results: Twenty-one and 42 patients were included in the rifaximin and control groups respectively. No significant baseline differences were found between groups. The mean number of infections per patient was 0.29 and 0.62 in the rifaximin and control groups, respectively (p =.049), with a lower incidence of acute-on-chronic liver failure (ACLF) linked to infections within the treatment group. Liver-related complications were lower within the rifaximin group (0.43 vs. 1.26 complications/patient respectively) (p =.01). Mortality was lower in the treated versus the control groups (14.2% vs. 30.9, p =.15) without significant differences. No serious adverse events were associated with rifaximin treatment. Conclusions: Rifaximin is safe in severe AH with a significant reduction in clinical complications. A lower number of infections and a trend towards a lower ACLF and mortality favours its use in these patients.

Published
2022

8. Corrigendum to ‘Baveno VII – Renewing consensus in portal hypertension’ [J Hepatol (2022) 959-974, (S0168827821022996), (10.1016/j.jhep.2021.12.022)]

Author

de Franchis, R., Bosch, J., Garcia-Tsao, G., Reiberger, T., Ripoll, C., Abraldes, J. G., Albillos, A., Baiges, A., Bajaj, J., Banares, 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-Pagan, J. C., Genesca, J., Rodrigues, S. G., Gracia-Sanscho, J., Han, G., Hernandez-Gea, V., Jia, J., Kiladjian, J. J., Krag, A., Laleman, W., La Mura, V., Lens, S., Luo, X., Mandorfer, M., Murad, S. D., Paradis, V., Patch, D., Piano, S., Pinzani, M., Plessier, A., Primignani, M., Procopet, B., Rautou, P. E., Rudler, M., Sarin, S. K., 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., and Yoshiji, H.

Published
2022

12. Under-dilated TIPS Associate With Efficacy and Reduced Encephalopathy in a Prospective, Non-randomized Study of Patients With Cirrhosis

Author

Schepis, F, Vizzutti, F, Garcia-Tsao, G, Marzocchi, G, Rega, L, De Maria, N, Di Maira, T, Gitto, S, Caporali, C, Colopi, S, De Santis, M, Arena, U, Rampoldi, A, Airoldi, A, Cannavale, A, Fanelli, F, Mosconi, C, Renzulli, M, Agazzi, R, Nani, R, Quaretti, P, Fiorina, I, Moramarco, L, Miraglia, R, Luca, A, Bruno, R, Fagiuoli, S, Golfieri, R, Torricelli, P, Di Benedetto, F, Belli, L, Banchelli, F, Laffi, G, Marra, F, Villa, E, Schepis F., Vizzutti F., Garcia-Tsao G., Marzocchi G., Rega L., De Maria N., Di Maira T., Gitto S., Caporali C., Colopi S., De Santis M., Arena U., Rampoldi A., Airoldi A., Cannavale A., Fanelli F., Mosconi C., Renzulli M., Agazzi R., Nani R., Quaretti P., Fiorina I., Moramarco L., Miraglia R., Luca A., Bruno R., Fagiuoli S., Golfieri R., Torricelli P., Di Benedetto F., Belli L. S., Banchelli F., Laffi G., Marra F., Villa E., Schepis, F, Vizzutti, F, Garcia-Tsao, G, Marzocchi, G, Rega, L, De Maria, N, Di Maira, T, Gitto, S, Caporali, C, Colopi, S, De Santis, M, Arena, U, Rampoldi, A, Airoldi, A, Cannavale, A, Fanelli, F, Mosconi, C, Renzulli, M, Agazzi, R, Nani, R, Quaretti, P, Fiorina, I, Moramarco, L, Miraglia, R, Luca, A, Bruno, R, Fagiuoli, S, Golfieri, R, Torricelli, P, Di Benedetto, F, Belli, L, Banchelli, F, Laffi, G, Marra, F, Villa, E, Schepis F., Vizzutti F., Garcia-Tsao G., Marzocchi G., Rega L., De Maria N., Di Maira T., Gitto S., Caporali C., Colopi S., De Santis M., Arena U., Rampoldi A., Airoldi A., Cannavale A., Fanelli F., Mosconi C., Renzulli M., Agazzi R., Nani R., Quaretti P., Fiorina I., Moramarco L., Miraglia R., Luca A., Bruno R., Fagiuoli S., Golfieri R., Torricelli P., Di Benedetto F., Belli L. S., Banchelli F., Laffi G., Marra F., and Villa E.

Abstract

Background & Aims: Portosystemic encephalopathy (PSE) is a major complication of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement. Most devices are self-expandable polytetrafluoroethylene-covered stent grafts (PTFE-SGs) that are dilated to their nominal diameter (8 or 10 mm). We investigated whether PTFE-SGs dilated to a smaller caliber (under-dilated TIPS) reduce PSE yet maintain clinical and hemodynamic efficacy. We also studied whether under-dilated TIPS self-expand to nominal diameter over time. Methods: We performed a prospective, non-randomized study of 42 unselected patients with cirrhosis who received under-dilated TIPS (7 and 6 mm) and 53 patients who received PTFE-SGs of 8 mm or more (controls) at referral centers in Italy. After completion of this study, dilation to 6 mm became the standard and 47 patients were included in a validation study. All patients were followed for 6 months; Doppler ultrasonography was performed 2 weeks and 3 months after TIPS placement and every 6 months thereafter. Stability of PTFE-SG diameter was evaluated by computed tomography analysis of 226 patients with cirrhosis whose stent grafts increased to 6, 7, 8, 9, or 10 mm. The primary outcomes were incidence of at least 1 episode of PSE grade 2 or higher during follow up, incidence of recurrent variceal hemorrhage or ascites, incidence of shunt dysfunction requiring TIPS recanalization, and reduction in porto-caval pressure gradient. Results: PSE developed in a significantly lower proportion of patients with under-dilated TIPS (27%) than controls (54%) during the first year after the procedure (P =.015), but the proportions of patients with recurrent variceal hemorrhage or ascites did not differ significantly between groups. No TIPS occlusions were observed. These results were confirmed in the validation cohort. In an analysis of self-expansion of stent grafts, during a mean follow-up period of 252 days after placement, none of the PTFE-SGs self-expanded to t

Published
2018

13. Impatto dei farmaci anti virali ad azione diretta sulla cura dei pazienti con epatite C: un approccio di value-based medicine

Author

Conti, S, Cortesi, P, Okolicsanyi, S, Rota, M, Ciaccio, A, Gemma, M, Scalone, L, Cesana, G, Cozzolino, P, Fabris, L, Colledan, M, Fagiuoli, S, Ideo, G, Garcia-Tsao, G, Belli, L, Munari, L, Mantovani, L, Strazzabosco, M, Conti S, Cortesi PA, Okolicsanyi S, Rota M, Ciaccio A, Gemma M, Scalone L, Cesana G, Cozzolino P, Fabris L, Colledan M, Fagiuoli S, Ideo G, Garcia-Tsao G, Belli LS, Munari LM, Mantovani LG, Strazzabosco M, Conti, S, Cortesi, P, Okolicsanyi, S, Rota, M, Ciaccio, A, Gemma, M, Scalone, L, Cesana, G, Cozzolino, P, Fabris, L, Colledan, M, Fagiuoli, S, Ideo, G, Garcia-Tsao, G, Belli, L, Munari, L, Mantovani, L, Strazzabosco, M, Conti S, Cortesi PA, Okolicsanyi S, Rota M, Ciaccio A, Gemma M, Scalone L, Cesana G, Cozzolino P, Fabris L, Colledan M, Fagiuoli S, Ideo G, Garcia-Tsao G, Belli LS, Munari LM, Mantovani LG, and Strazzabosco M

Published
2018

14. Ordinal Outcomes Are Superior to Binary Outcomes for Designing and Evaluating Clinical Trials in Compensated Cirrhosis

Author

D’Amico, G, Abraldes, J, Rebora, P, Valsecchi, M, Garcia‐tsao, G, D’Amico, Gennaro, Abraldes, Juan G., Rebora, Paola, Valsecchi, Maria Grazia, Garcia‐Tsao, Guadalupe, D’Amico, G, Abraldes, J, Rebora, P, Valsecchi, M, Garcia‐tsao, G, D’Amico, Gennaro, Abraldes, Juan G., Rebora, Paola, Valsecchi, Maria Grazia, and Garcia‐Tsao, Guadalupe

Abstract

Background and Aims: Prevention of decompensation is a primary therapeutic target in patients with compensated cirrhosis (CC). However, a major problem is the large sample size and long follow-up required to demonstrate a significant treatment effect because of the relatively low baseline risk. For this reason, it has been recently suggested that ordinal outcomes may be used in this area to gain power and reduce sample size. The aim of this study was to assess the applicability of ordinal outcomes in cirrhosis. Approach and Results: An inception cohort of 202 patients with CC (no ascites, gastrointestinal bleeding, encephalopathy, or jaundice) without esophageal varices was included, and 5-year outcome is reported. Etiology was mostly viral and alcoholic, and there were no dropouts. Ordinal outcome was set according to six grades with a previously established prognostic ordinality: grade 1 = no disease progression; grade 2 = development of varices; grade 3 = bleeding alone; grade 4 = nonbleeding single decompensation; grade 5 = more than one decompensating event; and grade 6 = death. At the 60-month time point, patients were distributed in grades 1 through 6 as follows: 129, 43, 2, 7, 5, and 16, respectively. Emulation of a clinical trial performed by dividing patients based on baseline platelet count into two groups (cutoff, 150 × 109/L) demonstrated a statistically significant outcome difference between groups when using ordinal outcomes not detectable by binary logistic or chi-square or time-to-event analyses. Additionally, using ordinal outcomes in a hypothetical study to prevent decompensation resulted in sample-size estimates 3-to 4-fold lower than using a binary composite endpoint. Conclusions: Compared to traditional binary outcomes, the use of ordinal outcomes in trials of cirrhosis decompensation may provide more power and thus may require a smaller sample size.

Published
2020

15. Sepsis in cirrhosis: report on the 7th meeting of the international ascites club

Author

Wong, F., Bernardi, M., Balk, R., Christman, B., Moreau, R., Garcia-Tsao, G., Patch, D., Soriano, G., Hoefs, J., and Navasa, M.

Subjects
Sepsis -- Risk factors, Sepsis -- Physiological aspects, Sepsis -- Care and treatment, Sepsis -- Diagnosis, Liver cirrhosis -- Complications and side effects, Health
Published
2005

18. Expert opinion on bleeding risk from invasive procedures in cirrhosis

Author

Alix Riescher-Tuczkiewicz, Stephen H. Caldwell, Patrick S. Kamath, Erica Villa, Pierre-Emmanuel Rautou, Afdhal Nezam H, Ageno Walter, Bianchini Marcello, Blasi Annabel, Caldwell Stephen H, Callaway Mark, Cardenas Andres, Darwish Murad Sarwa, De Gottardi Andrea, De Pietri Lesley, De Raucourt Emmanuelle, Dell'Era Alessandra, Denys Alban, Elkrief Laure, Garcia-Pagan Juan-Carlos, Garcia-Tsao Guadalupe, Gatt Alexander, Giannini Edoardo G, Golfieri Rita, Greenberg Charles S, Hernández-Gea Virginia, Heydtmann Mathis, Intagliata Nicolas M, Kamath Patrick S, Lester Will, Magnusson Maria, Neuberger James, Northup Patrick G, O'Leary Jacqueline G, Patton Heather, Peck-Radosavljevic Markus, Pillai Anjana, Plessier Aurélie, Rautou Pierre-Emmanuel, Ripoll Cristina, Roberts Lara N, Sarwar Ammar, Senzolo Marco, Shukla Akash, Simioni Paolo, Simonetto Douglas A, Singal Ashwani K, Soto Robin, Stine Jonathan G, Tapper Elliot B, Thabut Dominique, Thachil Jecko, Tomescu Dana, Tripathi Dhiraj, Tsochatzis Emmanuel A, Villa Erica, and Valla Dominique

Subjects
haemorrhage, coagulation, haemostasis, biopsy, anticoagulant, procedural related bleeding, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background & Aims: Despite several recent international guidelines, no consensus exists on the bleeding risk nor haemostatic parameter thresholds that define the safety of invasive procedures in patients with cirrhosis. The aim of this study was to establish a position paper on the bleeding risk associated with invasive procedures in patients with cirrhosis among the experts involved in various guidelines. Methods: All experts involved in recent guidelines on the management of invasive procedures in patients with cirrhosis were invited to classify 80 procedures as ''high risk'' or ''low risk'' with respect to bleeding. Procedures were considered high risk when the estimated risk of major bleeding was 1.5% or more, or when even minor bleeding might lead to significant morbidity or death. The experts were also asked to choose safety thresholds for laboratory test values at which elective invasive procedures could be safely performed. The predetermined threshold considered as “consensus” was ≥75% agreement. Results: Fifty-two experts participated in the study. Out of 80 procedures, a consensus opinion was reached for 52 procedures (65%): 17 procedures were classified as “high risk”, primarily interventional endoscopic procedures, percutaneous organ biopsies, or procedures involving the central nervous system; and 35 as “low risk”, primarily “diagnostic” procedures. The lowest platelet counts at which performance of a low-risk procedure or a high-risk procedure/surgery were deemed acceptable were 30 × 109/L and 50 × 109/L, respectively. Experts did not believe that international normalised ratio should be considered before performing low-risk procedures; 71% also indicated that it should not be considered before performing high-risk procedures. Conclusions: This experience-based classification may be helpful to refine future study designs and to guide clinical decision making regarding invasive procedures in patients with cirrhosis. Impact and implications: Several risk classifications and management guidelines for invasive procedures in patients with cirrhosis have been proposed, but with conflicting recommendations. By providing a position paper, based on the opinion of a broad panel of experts, on the bleeding risk associated with 52 invasive procedures in patients with cirrhosis, this survey will help to provide a framework for future study design. The consensus on platelet count, international normalised ratio, fibrinogen and activated partial thromboplastin time identified in this survey will inform physicians regarding the laboratory test values considered acceptable by the experts prior to the performance of an elective invasive procedure in patients with cirrhosis.

Published
2024
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19. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia

Author

Faughnan, M E, Palda, V A, Garcia-Tsao, G, Geisthoff, U W, McDonald, J, Proctor, D D, Spears, J, Brown, D H, Buscarini, E, Chesnutt, M S, Cottin, V, Ganguly, A, Gossage, J R, Guttmacher, A E, Hyland, R H, Kennedy, S J, Korzenik, J, Mager, J J, Ozanne, A P, Piccirillo, J F, Picus, D, Plauchu, H, Porteous, M E M, Pyeritz, R E, Ross, D A, Sabba, C, Swanson, K, Terry, P, Wallace, M C, Westermann, C J J, White, R I, Young, L H, and Zarrabeitia, R

Published
2011
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21. Impatto dei farmaci anti virali ad azione diretta sulla cura dei pazienti con epatite C: un approccio di value-based medicine

Author

Conti S, Cortesi PA, Okolicsanyi S, Rota M, Ciaccio A, Gemma M, Scalone L, Cesana G, Cozzolino P, Fabris L, Colledan M, Fagiuoli S, Ideo G, Garcia-Tsao G, Belli LS, Munari LM, Mantovani LG, Strazzabosco M, Conti, S, Cortesi, P, Okolicsanyi, S, Rota, M, Ciaccio, A, Gemma, M, Scalone, L, Cesana, G, Cozzolino, P, Fabris, L, Colledan, M, Fagiuoli, S, Ideo, G, Garcia-Tsao, G, Belli, L, Munari, L, Mantovani, L, and Strazzabosco, M

Subjects
MED/42 - IGIENE GENERALE E APPLICATA, MED/12 - GASTROENTEROLOGIA, epatite C, farmaci antivirali, value-based medicine, MED/01 - STATISTICA MEDICA
Published
2018

22. Applicazione della value-based medicine nella valutazione della cura dei pazienti affetti da epatite

Author

Fornari, C, Cortesi, PA, Conti, S, Okolicsanyi, S, Rota, M, Ciaccio, A, Gemma, M, Scalone, L, Cesana, G, Cozzolino, P, Fabris, L, Colledan, M, Fagiuoli, S, Ideo, G, Garcia-Tsao, G, Belli, LS, Munari, LM, Mantovani, LG, Strazzabosco, M, Fornari, C, Cortesi, P, Conti, S, Okolicsanyi, S, Rota, M, Ciaccio, A, Gemma, M, Scalone, L, Cesana, G, Cozzolino, P, Fabris, L, Colledan, M, Fagiuoli, S, Ideo, G, Garcia-Tsao, G, Belli, L, Munari, L, Mantovani, L, and Strazzabosco, M

Subjects
Value- based medicine, epatite B, epatite C
Published
2018

24. AISF position paper on liver transplantation and pregnancy: Women in Hepatology Group, Italian Association for the Study of the Liver (AISF)

Author

Burra, P, Rodríguez-Castro, K, Guarino, M, Morisco, F, Villa, E, Mazzella, G, Women in Hepatology Group, Italian Association for the Study of the Liver (AISF) (Alisi, A, Balsano, C, Bernabucci, V, Berzigotti, A, Brunetto, M, Bugianesi, E, Calvaruso, V, Cariani, E, Coco, B, Colle, I, Critelli, R, De Martin, E, Del Buono, M, Fabregat, I, Faillaci, F, Fattovich, G, Floreani, A, Garcia-Tsao, G, Housset, C, Karampatou, A, Lei, B, Mangia, A, Martinez-Chantar, Ml, Milosa, F, Nasta, P, Ozben, T, Pollicino, T, Ponti, Ml, Pontisso, P, Reeves, H, Rendina, M, Rodríguez-Castro, Ki, Sagnelli, C, Sebastiani, Giulia, Smedile, A, Taliani, G, Vandelli, C, Vanni, E, Vukotic, R, Zignego, Al), Alisi A, Balsano C, Bernabucci V, Berzigotti A, Brunetto M, Bugianesi E, Burra P, Calvaruso V, Cariani E, Coco B, Colle I, Critelli R, De Martin E, Del Buono M, Fabregat I, Faillaci F, Fattovich G, Floreani A, Garcia-Tsao G, Housset C, Karampatou A, Lei B, Mangia A, Martinez-Chantar ML, Milosa F, Morisco F, Nasta P, Ozben T, Pollicino T, Ponti ML, Pontisso P, Reeves H, Rendina M, Rodríguez-Castro KI, Sagnelli C, Sebastiani G, Smedile A, Taliani G, Vandelli C, Vanni E, Villa E, Vukotic R, Zignego AL, Burra P, Rodríguez-Castro K, Guarino M, Morisco F, Villa E, Mazzella G., Alisi, A, Balsano, C, Bernabucci, V, Berzigotti, A, Brunetto, M, Bugianesi, E, Burra, P, Calvaruso, V, Cariani, E, Coco, B, Colle, I, Critelli, R, De Martin, E, Del Buono, M, Fabregat, I, Faillaci, F, Fattovich, G, Floreani, A, Garcia-Tsao, G, Housset, C, Karampatou, A, Lei, B, Mangia, A, Martinez-Chantar, Ml, Milosa, F, Morisco, F, Nasta, P, Ozben, T, Pollicino, T, Ponti, Ml, Pontisso, P, Reeves, H, Rendina, M, Rodríguez-Castro, Ki, Sagnelli, C, Sebastiani, G, Smedile, A, Taliani, G, Vandelli, C, Vanni, E, Vukotic, R, Zignego, Al, Rodríguez-Castro, K, Guarino, M, Villa, E, Mazzella, G., Garcia Tsao, G, Martinez Chantar, Ml, Morisco, Filomena, Rodríguez Castro, Ki, Rodríguez Castro, K, Guarino, Maria, Alisi, Anna, Balsano, Clara, Bernabucci, Veronica, Berzigotti, Annalisa, Brunetto, Maurizia, Bugianesi, Elisabetta, Burra, Patrizia, Calvaruso, Vincenza, Cariani, Elisabetta, Coco, Barbara, Colle, Isabelle, Critelli, Rosina, De Martin, Eleonora, Del Buono, Mariagrazia, Fabregat, Isabel, Faillaci, Francesca, Fattovich, Giovanna, Floreani, Annarosa, Garcia-tsao, Guadalupe, Housset, Chantal, Karampatou, Aimilia, Lei, Barbara, Mangia, Alessandra, Martinez-chantar, Maria Luz, Milosa, Fabiola, Nasta, Paola, Ozben, Tomri, Pollicino, Teresa, Ponti, Maria Laura, Pontisso, Patrizia, Reeves, Helen, Rendina, Maria, Rodrã­guez-castro, Kryssia Isabel, Sagnelli, Caterina, Sebastiani, Giada, Smedile, Antonella, Taliani, Gloria, Vandelli, Carmen, Vanni, Ester, Villa, Erica, Vukotic, Ranka, Zignego, Anna Linda, Rodrã­guez-castro, Kryssia, and Mazzella, Giuseppe

Subjects
Risk Assessment, Fertility, Immunosuppression, Liver transplantation, Pregnancy, Immunosuppressive Agent, Medical, Hepatology, Gastroenterology, Humans, Obstetric Labor Complication, Societies, Medical, Postpartum Period, Pregnancy Outcome, Contraception, Female, Italy, Obstetric Labor Complications, Practice Guidelines as Topic, Pregnancy Complications, Immunosuppressive Agents, Liver Transplantation, Pregnancy Complication, surgical procedures, operative, Societies, Human
Abstract

After the first successful pregnancy in a liver transplant recipient in 1978, much evidence has accumulated on the course, outcomes and management strategies of pregnancy following liver transplantation. Generally, liver transplantation restores sexual function and fertility as early as a few months after transplant. Considering that one third of all liver transplant recipients are women, that approximately one-third of them are of reproductive age (18-49 years), and that 15% of female liver transplant recipients are paediatric patients who have a >70% probability of reaching reproductive age, the issue of pregnancy after liver transplantation is rather relevant, and obstetricians, paediatricians, and transplant hepatologists ever more frequently encounter such patients. Pregnancy outcomes for both the mother and infant in liver transplant recipients are generally good, but there is an increased incidence of preterm delivery, hypertension/preeclampsia, foetal growth restriction, and gestational diabetes, which, by definition, render pregnancy in liver transplant recipients a high-risk one. In contrast, the risk of congenital anomalies and the live birth rate are comparable to those of the general population. Currently there are still no robust guidelines on the management of pregnancies after liver transplantation. The aim of this position paper is to review the available evidence on pregnancy in liver transplant recipients and to provide national Italian recommendations for clinicians caring for these patients. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Published
2016

28. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis

Author

Ginès P, Angeli P, Lenz K, Möller S, Moore K, Moreau R, Merkel C, Ring Larsen H, Garcia Tsao G, Hayes P., BERNARDI, MAURO, Ginès P, Angeli P, Lenz K, Möller S, Moore K, Moreau R, Merkel C, Ring-Larsen H, Bernardi M, Garcia-Tsao G, and Hayes P.

Subjects
medicine.medical_specialty, Cirrhosis, Hepatology, SPONTANEOUS BACTERIAL PERITONITIS, business.industry, medicine.disease, Gastroenterology, Clinical Practice, Large volume paracentesis, Spontaneous bacterial peritonitis, Hepatorenal syndrome, Internal medicine, Ascites, REFRACTORY ASCITES, HEPATORENAL SYNDROME, Medicine, ASCITES, medicine.symptom, business, CIRRHOSIS
Published
2010

29. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis

Author

Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V, Di Bona G, Lee S, Henriksen JH, Ruiz del Arbol L, Angeli P, Garcia Tsao G, Gülberg V, Guevara M, Moreau R, Ortega R, Kamath P, Moore K, Mullen K, Sanyal A, Blendis L, Terg R., BERNARDI, MAURO, Universitat de Barcelona, Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V, Di Bona G, Lee S, Henriksen JH, Ruiz del Arbol L, Angeli P, Garcia-Tsao G, Gülberg V, Guevara M, Moreau R, Ortega R, Kamath P, Moore K, Mullen K, Sanyal A, Bernardi M, Blendis L, and Terg R.

Subjects
medicine.medical_specialty, Cirrosi hepàtica, Hepatorenal Syndrome, Cirrhosis, LIVER CIRRHOSIS, medicine.medical_treatment, education, MEDLINE, Lypressin, Therapeutics, Liver transplantation, DIAGNOSIS, Malalties dels ronyons, Liver disease, Medicina preventiva, Diagnòstic, Hepatorenal syndrome, Renal Dialysis, Albumins, Diagnosis, Ascites, Humans, Vasoconstrictor Agents, Medicine, Infusions, Parenteral, Intensive care medicine, Preventive medicine, Kidney diseases, business.industry, TREATMENT, General Medicine, Terapèutica, medicine.disease, PREVENTION, Liver Transplantation, Surgery, Transplantation, Hepatic cirrhosis, Portasystemic Shunt, Transjugular Intrahepatic, medicine.symptom, Refractory ascites, business, Terlipressin
Abstract

Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease, occurring mainly in patients with advanced cirrhosis and ascites, who have marked circulatory dysfunction,1 as well as in patients with acute liver failure.2 In spite of its functional nature, HRS is associated with a poor prognosis,3 4 and the only effective treatment is liver transplantation. During the 56th Meeting of the American Association for the Study of Liver Diseases, the International Ascites Club held a Focused Study Group (FSG) on HRS for the purpose of reporting the results of an international workshop and to reach a consensus on a new definition, criteria for diagnosis and recommendations on HRS treatment. A similar workshop was held in Chicago in 1994 in which standardised nomenclature and diagnostic criteria for refractory ascites and HRS were established.5 The introduction of innovative treatments and improvements in our understanding of the pathogenesis of HRS during the previous decade led to an increasing need to undertake a new consensus meeting. This paper reports the scientific rationale behind the new definitions and recommendations. The international workshop included four issues debated by four panels of experts (see Acknowledgements). The issues were: (1) evidence-based HRS pathogenesis; (2) treatment of HRS using vasoconstrictors; (3) other HRS treatments using transjugular intrahepatic portosystemic stent-shunt (TIPS) and extracorporeal albumin dialysis (ECAD); and (4) new definitions and diagnostic criteria for HRS and recommendations for its treatment.

Published
2008

30. 13C-methacetin breath test is a highly accurate non-invasive point of care test for detecting CSPH in patients with NASH

Author

Bosch, J., primary, Bureau, C., additional, Chalasani, N., additional, Lawitz, E., additional, Abdelmalek, M., additional, Rinella, M., additional, Harrison, S., additional, Berzigotti, A., additional, Sanyal, A., additional, Noureddin, M., additional, Rockey, D., additional, Ber, T.I., additional, Ilan, Y., additional, and Garcia-Tsao, G., additional

Published
2018
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31. Primary spontaneous bacterial peritonitis prophylaxis is associated with greater ICU admission and 30-day mortality compared to secondary spontaneous bacterial peritonitis prophylaxis

Author

Bajaj, J.S., primary, Tandon, P., additional, O’leary, J., additional, Wong, F., additional, Biggins, S., additional, Garcia-Tsao, G., additional, Kamath, P., additional, Maliakkal, B., additional, Fallon, M., additional, Thuluvath, P.J., additional, Lai, J., additional, Subramanian, R., additional, Vargas, H.E., additional, Thacker, L., additional, and Reddy, R., additional

Published
2018
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32. A multicenter, randomized, double-blind, PLB-controlled trial of Galectin-3 inhibitor (GR-MD-02) in patients with NASH cirrhosis and portal hypertension

Author

Chalasani, N., primary, Garcia-Tsao, G., additional, Goodman, Z., additional, Lawitz, E., additional, Abdelmalek, M., additional, Rinella, M., additional, Ryan, M., additional, Noureddin, M., additional, Jue, C., additional, Pyko, M., additional, Allgood, A., additional, Shlevin, H., additional, Horton, R., additional, Zomer, E., additional, Traber, P., additional, Loomba, R., additional, Tetri, B., additional, Sanyal, A., additional, and Harrison, S., additional

Published
2018
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33. Thrombelastography-Guided Blood Product Use Before Invasive Procedures in Cirrhosis With Severe Coagulopathy: A Randomized, Controlled Trial

Author

De Pietri L, Bianchini M, Montalti R, De Maria N, Di Maira T, Begliomini B, Gerunda GE, di Benedetto F, Garcia-Tsao G, and Villa E

Abstract

Bleeding is a feared complication of invasive procedures in patients with cirrhosis and significant coagulopathy (as defined by routine coagulation tests) and is used to justify preprocedure use of fresh frozen plasma (FFP) and/or platelets (PLT). Thromboelastography (TEG) provides a more comprehensive global coagulation assessment than routine tests (international normalized ratio [INR] and platelet count), and its use may avoid unnecessary blood product transfusion in patients with cirrhosis and significant coagulopathy (defined in this study as INR >1.8 and/or platelet count 40 min and/or PLT if maximum amplitude (MA) was

Published
2016

34. Beta‐blockers in hospitalised patients with cirrhosis and ascites: mortality and factors determining discontinuation and reinitiation

Author

Bhutta, A. Q., primary, Garcia‐Tsao, G., additional, Reddy, K. R., additional, Tandon, P., additional, Wong, F., additional, O'Leary, J. G., additional, Acharya, C., additional, Banerjee, D., additional, Abraldes, J. G., additional, Jones, T. M., additional, Shaw, J., additional, Deng, Y., additional, Ciarleglio, M., additional, and Bajaj, J. S., additional

Published
2017
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35. Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes

Author

Wong, F, primary, O'Leary, J G, additional, Reddy, K R, additional, Garcia-Tsao, G, additional, Fallon, M B, additional, Biggins, S W, additional, Subramanian, R M, additional, Thuluvath, P J, additional, Kamath, P S, additional, Patton, H, additional, Maliakkal, B, additional, Tandon, P, additional, Vargas, H, additional, Thacker, L, additional, and Bajaj, J S, additional

Published
2017
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37. In hepatitis C virus-related advanced fibrosis and cirrhosis, early decline of liver stiffness following antiviral therapy with DAAs is related to decline in liver inflammation

Author

Winters, A., primary, Luedtke, S., additional, Moreland, A., additional, Jangouk, P., additional, Weng, G., additional, Silveira, M., additional, Davitkov, P., additional, Duarte-Rojo, A., additional, Cheung, R., additional, Garcia-Tsao, G., additional, Falck-Ytter, Y., additional, Branch, A., additional, and Bräu, N., additional

Published
2017
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38. A reduction in the hepatic venous pressure gradient (HVPG) prevents clinical outcomes in compensated and decompensated cirrhosis: a meta-analysis

Author

Turco, L., primary, Villanueva, C., additional, La Mura, V., additional, Garcia-Pagan, J.C., additional, Reiberger, T., additional, Genesca, J., additional, Groszmann, R.J., additional, Sharma, B.C., additional, Merkel, C., additional, Bureau, C., additional, Alvarado, E., additional, Abraldes, J.G., additional, Albillos, A., additional, Banares, R., additional, Peck-Radosavljevic, M., additional, Augustin, S., additional, Sarin, S., additional, Bosch, J., additional, and Garcia-Tsao, G., additional

Published
2017
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39. Albumin use and acute kidney injury in a large real-world analysis of cirrhotic inpatients

Author

Bajaj, J.S.S., primary, O’leary, J., additional, Wong, F., additional, Garcia-Tsao, G., additional, Tandon, P., additional, Biggins, S., additional, Kamath, P.S., additional, Lai, J., additional, Fallon, M., additional, Subramanian, R., additional, Maliakkal, B., additional, Thuluvath, P., additional, Vargas, H., additional, Thacker, L., additional, and Reddy, R., additional

Published
2017
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40. NACSELD acute-on-chronic liver failure (NACSELD-ACLF) predicts 30-day mortality in admitted cirrhotic patients

Author

O’leary, J.G., primary, Reddy, K.R., additional, Tanson, P., additional, Kamath, P.S., additional, Wong, F., additional, Garcia-Tsao, G., additional, Lai, J., additional, Biggins, S., additional, Fallon, M.B., additional, Subramanian, R., additional, Thuluvath, P., additional, Maliakkal, B., additional, Thacker, L., additional, and Bajaj, J.S., additional

Published
2017
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41. Hyponatremia and Hepatorenal Syndrome

Author

Arpan Mohanty and Garcia-Tsao, G.

Subjects
Column, nutritional and metabolic diseases
Abstract

Hyponatremia and hepatorenal syndrome are severe complications in patients with cirrhosis and ascites resulting from circulatory abnormalities (splanchnic and systemic vasodilatation) that develop with portal hypertension. Both conditions are associated with an increased risk of death. Hyponatremia and renal failure may develop in patients with cirrhosis due to causes other than portal hypertension. Making an accurate differential diagnosis is important both therapeutically and prognostically. In this article, we discuss the pathophysiology, diagnosis, differential diagnosis, and management of hyponatremia and hepatorenal syndrome in patients with cirrhosis.

Published
2015

43. In-Hospital Mortality Related to Hepatic Encephalopathy is Independent of Acute-On-Chronic Liver Failure and Varies Significantly across North America: Nacseld Experience

Author

Bajaj, J.S., primary, Reddy, K., additional, Tandon, P., additional, Garcia-Tsao, G., additional, Wong, F., additional, Kamath, P., additional, Biggins, S., additional, Fallon, M., additional, Maliakkal, B., additional, Thuluvath, P., additional, Subramanian, R., additional, Vargas, H., additional, Lai, J., additional, Thacker, L., additional, and O’leary, J., additional

Published
2016
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44. Beta-Blocker Use in Hospitalized Cirrhotic Patients with Ascites is Associated with a Lower Meld, less Inflammation and an Improved Survival

Author

Bhutta, A.Q., primary, Garcia-Tsao, G., additional, Reddy, R., additional, Tandon, P., additional, Wong, F., additional, O’Leary, J.G., additional, Acharya, C., additional, Banerjee, D., additional, Abraldes, J.G., additional, Plener, I., additional, Jones, T.M., additional, Shaw, J., additional, Deng, Y., additional, Ciarleglio, M., additional, and Bajaj, J.S., additional

Published
2016
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