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2. Global prevalence and characteristics of infections and clinical outcomes in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium

Author

Kumar, Shiva, Gadano, Adrián, Marciano, Sebastián, Tudehope, Fiona, Prudence, Alexander, Gibson, Robert, Zekry, Amany, Doyle, Adam, Si, Hooi Ling, Kim, Yu Sung, Gofton, Cameron, Riordan, Stephen, MacQuillan, Gerry, Al-Tamimi, Hala, Michalczuk, Matheus, Farias, Alberto, Zitelli, Patricia, Pereira, Gustavo, Victor, Livia, Bera, Chinmay, Faisal, Nabiha, Dahiya, Monica, Tandon, Puneeta, Lohoues, Marie Jeanne, Lah, Ponan Claude Regis, Benítez, Carlos, Arrese, Marco, Guan, Jing, Xian, Yongchao, Zhu, Chuanwu, Wang, Yingling, Su, Man, Su, Minghua, Wang, Xinrui, Gao, Yanhang, Peng, Feng, Jiang, Yongfang, Zhao, Caiyan, Wang, Wei, Yin, Dedong, Wang, Lei, Lu, Mingqin, Cai, Yijing, Guo, Feng, Wang, Xiaozhong, Zhang, Ningping, Zhang, Wanqin, Dong, Fuchen, Li, Hai, Liu, Jing, Zheng, Xin, Tang, Hong, Yan, Libo, Xu, Bin, Wei, Linlin, Xu, Zhen, Gao, Zhiliang, Gao, Haibing, Lin, Minghua, Rao, Qunfang, Wu, Xiaoping, Li, Beiling, Chen, Jinjun, Liu, Chenghai, Zhang, Yanyun, Deng, Huan, Hu, Peng, Wang, Jian, Li, Jie, Bettinger, Dominik, Schultheiß, Michael, Belimi, Hibat Allah, Debzi, Nabil, Mostafa, Alaa, Fouad, Yasser, Fisseha, Henok, Venkatachalapathy, Suresh Vasan, Aravinthan, Aloysious D, Rajoriya, Neil, Faulkes, Rosemary, Leith, Damien, Forrest, Ewan, Danielle, Adebayo, Kennedy, James, Yung, Diana, Alexopoulou, Alexandra, Mani, Iliana, Fung, James, Katchman, Helena, Rabinowich, Liane, Jhaveri, Ajay, Nagral, Aabha, Kulkarni, Anand, Sharma, Mithun, Sarin, Shiv K, Goel, Ashish, Eapen, C E, Duseja, Ajay, Gandotra, Akash, Saraya, Anoop, yegurla, Jatin, Jothimani, Dinesh, Rela, Mohammad, Arora, Anil, Kumar, Ashish, Roy, Akash, Dhiman, R K, Anand, A C, Praharaj, Dibyalochan, Cabrera, Araceli Bravo, Hueso, Sarai Gonzalez, Hérnandez, José Luis Pérez, Gutierrez, Oscar Morales, Ramos-Pineda, Abraham, Zazueta, Godolfino Miranda, Barradas, Mauricio Castillo, Made, Lilian Torres, Velazquez, Rene Male, Félix-Tellez, Francisco, Velasco, José Antonio Velarde-Ruiz, Cordova-Gallardo, Jacqueline, Rajaram, Ruveena, Afendi, Nik Arsyad Nik Muhamad, Nyam, David P, Okeke, Edith N, Allam, Dalia, Patwa, Yashwi Haresh Kumar, Tan, Hiang Keat, Lun, Liou Wei, Ho, Wei Ling Danielle, Wong, Yu Jun, Thanapirom, Kessarin, Teerasarntipan, Tongluk, Haktaniyan, Busra, Gunduz, Feyza, Aslan, Rahmi, Yildirim, Abdullah Emre, Barutcu, Sezgin, Uysal, Alper, Karasu, Zeki, Ucbilek, Enver, Kosay, Tolga, Dinçer, Dinç, Adanır, Haydar, Albhaisi, Somaya, Fallahadeh, Mohammad Amin, Asrani, Sumeet, Reddy, K Rajender, Shaw, Jawaid, Vargas, Hugo, Filipek, Natalia, Biggins, Scott W, Thuluvath, Paul, Sheshadri, Somya, Wegermann, Kara, Kappus, Matthew, Keaveny, Andrew, Rojo, Andres, Negrillo, Ricardo Cabello, Verna, Elizabeth, Cao, Zhujun, Wong, Florence, Choudhury, Ashok K, Kamath, Patrick S, Topazian, Mark, Torre, Aldo, Hayes, Peter C, George, Jacob, Idilman, Ramazan, Seto, Wai-Kay, Desalegn, Hailemichael, Alvares-da-Silva, Mario Reis, Bush, Brian J, Thacker, Leroy R, Xie, Qing, and Bajaj, Jasmohan S

Published
2024
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6. Admission Urinary and Serum Metabolites Predict Renal Outcomes in Hospitalized Patients With Cirrhosis

Author

Bajaj, Jasmohan S, Garcia‐Tsao, Guadalupe, Reddy, K Rajender, O’Leary, Jacqueline G, Vargas, Hugo E, Lai, Jennifer C, Kamath, Patrick S, Tandon, Puneeta, Subramanian, Ram M, Thuluvath, Paul, Fagan, Andrew, Sehrawat, Tejasav, de la Rosa Rodriguez, Randolph, Thacker, Leroy R, and Wong, Florence

Subjects
Medical Biochemistry and Metabolomics, Biomedical and Clinical Sciences, Clinical Sciences, Kidney Disease, Clinical Research, Renal and urogenital, Acute Kidney Injury, Aged, Biomarkers, End Stage Liver Disease, Female, Humans, Liver Cirrhosis, Male, Metabolomics, Middle Aged, Patient Admission, Prognosis, Prospective Studies, Renal Dialysis, Risk Assessment, Immunology, Gastroenterology & Hepatology, Clinical sciences
Abstract

Background and aimsAcute kidney injury (AKI) has a poor prognosis in cirrhosis. Given the variability of creatinine, the prediction of AKI and dialysis by other markers is needed. The aim of this study is to determine the role of serum and urine metabolomics in the prediction of AKI and dialysis in an inpatient cirrhosis cohort.Approach and resultsInpatients with cirrhosis from 11 North American Consortium of End-stage Liver Disease centers who provided admission serum/urine when they were AKI and dialysis-free were included. Analysis of covariance adjusted for demographics, infection, and cirrhosis severity was performed to identify metabolites that differed among patients (1) who developed AKI or not; (2) required dialysis or not; and/pr (3) within AKI subgroups who needed dialysis or not. We performed random forest and AUC analyses to identify specific metabolite(s) associated with outcomes. Logistic regression with clinical variables with/without metabolites was performed. A total of 602 patients gave serum (218 developed AKI, 80 needed dialysis) and 435 gave urine (164 developed AKI, 61 needed dialysis). For AKI prediction, clinical factor-adjusted AUC was 0.91 for serum and 0.88 for urine. Major metabolites such as uremic toxins (2,3-dihydroxy-5-methylthio-4-pentenoic acid [DMTPA], N2N2dimethylguanosine, uridine/pseudouridine) and tryptophan/tyrosine metabolites (kynunerate, 8-methoxykyunerate, quinolinate) were higher in patients who developed AKI. For dialysis prediction, clinical factor-adjusted AUC was 0.93 for serum and 0.91 for urine. Similar metabolites as AKI were altered here. For dialysis prediction in those with AKI, the AUC was 0.81 and 0.79 for serum/urine. Lower branched-chain amino-acid (BCAA) metabolites but higher cysteine, tryptophan, glutamate, and DMTPA were seen in patients with AKI needing dialysis. Serum/urine metabolites were additive to clinical variables for all outcomes.ConclusionsSpecific admission urinary and serum metabolites were significantly additive to clinical variables to predict AKI development and dialysis initiation in inpatients with cirrhosis. These observations can potentially facilitate earlier initiation of renoprotective measures.

Published
2021

9. Hospitalized Women With Cirrhosis Have More Nonhepatic Comorbidities and Associated Complications Than Men

Author

Rubin, Jessica B, Srisengfa, Yanin T, Albhaisi, Somaya, Acharya, Chathur, Nangia, Gayatri, Shaikh, Tahira, Thacker, Leroy R, Reddy, K Rajender, Tandon, Puneeta, Bajaj, Jasmohan S, and Lai, Jennifer C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Organ Transplantation, Transplantation, Digestive Diseases, Chronic Liver Disease and Cirrhosis, Liver Disease, Good Health and Well Being, Comorbidity, Creatinine, Female, Humans, Liver Cirrhosis, Liver Transplantation, Male, Waiting Lists, Gastroenterology & Hepatology, Clinical sciences
Abstract

Gender differences in the natural history of chronic liver disease have been well-described. Women have lower rates of chronic liver disease and slower fibrosis progression, yet higher rates of waitlist mortality.1,2 Although previous studies have identified several clinical factors including height and creatinine that explain some of this transplant disparity, most have used data from administrative records, which are limited in their ability to identify clinically relevant differences and opportunities for intervention to reduce disparities.3-5 Additionally, most studies have focused on the period between waitlist and transplant, failing to capture gender differences in access to transplant.3,6 In the present study, we took advantage of a multicenter inpatient cohort with granular clinical data to characterize how women and men with cirrhosis differ, to stimulate future research aimed at reducing the well-established gender disparity in liver transplantation.

Published
2020

10. 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

Author

Bajaj, Jasmohan S, Reddy, K Rajender, O'Leary, Jacqueline G, Vargas, Hugo E, Lai, Jennifer C, Kamath, Patrick S, Tandon, Puneeta, Wong, Florence, Subramanian, Ram M, Thuluvath, Paul, Fagan, Andrew, White, Melanie B, Gavis, Edith A, Sehrawat, Tejasav, de la Rosa Rodriguez, Randolph, Thacker, Leroy R, Sikaroodi, Masoumeh, Garcia-Tsao, Guadalupe, and Gillevet, Patrick M

Subjects
Medical Biochemistry and Metabolomics, Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Clinical Research, Digestive Diseases, Chronic Liver Disease and Cirrhosis, Oral and gastrointestinal, Good Health and Well Being, Acute-On-Chronic Liver Failure, Adult, Aged, Bacteria, Biomarkers, Databases, Factual, Feces, Female, Gastrointestinal Microbiome, Hospital Mortality, Humans, Lipidomics, Lipids, Liver Cirrhosis, Male, Metabolomics, Middle Aged, North America, Patient Admission, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Time Factors, Tryptophan, Estrone, Sepsis, Neurosciences, Paediatrics and Reproductive Medicine, Gastroenterology & Hepatology, Clinical sciences, Nutrition and dietetics
Abstract

Background & aimsInpatients with cirrhosis have high rates of acute-on-chronic failure (ACLF) development and high mortality within 30 days of admission to the hospital. Better biomarkers are needed to predict these outcomes. We performed metabolomic analyses of serum samples from patients with cirrhosis at multiple centers to determine whether metabolite profiles might identify patients at high risk for ACLF and death.MethodsWe performed metabolomic analyses, using liquid chromatography, of serum samples collected at time of admission to 12 North American tertiary hepatology centers from 602 patients in the North American Consortium for the Study of End-Stage Liver Disease sites from 2015 through 2017 (mean age, 56 years; 61% men; mean model for end-stage liver disease score, 19.5). We performed analysis of covariance, adjusted for model for end-stage liver disease at time of hospital admission, serum levels of albumin and sodium, and white blood cell count, to identify metabolites that differed between patients who did vs did not develop ACLF and patients who did vs did not die during hospitalization and within 30 days. We performed random forest analysis to identify specific metabolite(s) that were associated with outcomes and area under the curve (AUC) analyses to analyze them in context of clinical parameters. We analyzed microbiomes of stool samples collected from 133 patients collected at the same time and examined associations with serum metabolites.ResultsOf the 602 patients analyzed, 88 developed ACLF (15%), 43 died in the hospital (7%), and 72 died within 30 days (12%). Increased levels of compounds of microbial origin (aromatic compounds, secondary or sulfated bile acids, and benzoate) and estrogen metabolites, as well as decreased levels of phospholipids, were associated with development of ACLF, inpatient, and 30-day mortality and were also associated with fecal microbiomes. Random forest analysis and logistic regression showed that levels of specific microbially produced metabolites identified patients who developed ACLF with an AUC of 0.84 (95% confidence interval [CI] 0.78-0.88; P = .001), patients who died while in the hospital with an AUC of 0.81 (95% CI 0.74-0.85; P = .002), and patients who died within 30 days with an AUC of 0.77 (95% CI 0.73-0.81; P = .02). The metabolites were significantly additive to clinical parameters for predicting these outcomes. Metabolites associated with outcomes were also correlated with microbiomes of stool samples.ConclusionsIn an analysis of serum metabolites and fecal microbiomes of patients hospitalized with cirrhosis at multiple centers, we associated metabolites of microbial origin and lipid moieties with development of ACLF and death as an inpatient or within 30 days, after controlling for clinical features.

Published
2020

11. Global disparities in mortality and liver transplantation in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium

Author

Sarin, Shiv K, Kumar, Shiva, Marciano, Sebastián, Gadano, Adrián, Tudehope, Fiona, Gibson, Robert, Prudence, Alexander, Doyle, Adam, Si, Hooi Ling, Riordan, Stephen, Farias, Alberto, Zitelli, Patricia, Bera, Chinmay, Faisal, Nabiha, Tandon, Puneeta, Dahiya, Monica, Lohoues, Marie Jeanne, Lah, Ponan Claude Regis, Benítez, Carlos, Arrese, Marco, Xian, Yongchao, Guan, Jin, Zhu, Chuanwu, Wang, Yingling, Su, Minghua, Su, Man, Gao, Yanhang, Wang, Xinrui, Jiang, Yongfang, Peng, Feng, Zhao, Caiyan, Wang, Wei, Wang, Lei, Yin, Dedong, Lu, Mingqin, Cai, Yijing, Zhang, Ningping, Zhang, Wanqin, Li, Hai, Dong, Fuchen, Zheng, Xin, Liu, Jing, Tang, Hong, Yan, Libo, Xu, Bin, Wei, Linlin, Gao, Zhiliang, Xu, Zhen, Lin, Minghua, Gao, Haibin, Chen, Jinjun, Li, Beiling, Liu, Chenghai, Zhang, Yanyun, Hu, Peng, Deng, Huan, Belimi, Hibat Allah, Debzi, Nabil, Fisseha, Henok, Aravinthan, Aloysious D, Venkatachalapathy, Suresh Vasan, Rajoriya, Neil, Faulkes, Rosemary, Leith, Damien, Forrest, Ewan, Adebayo, Danielle, Kennedy, James, Yung, Diana, Seto, Wai-Kay, Fung, James, Katchman, Helena, Rabinowich, Liane, Nagral, Aabha, Jhaveri, Ajay, Kulkarni, Anand, Sharma, Mithun, Eapen, C E, Goel, Ashish, Gandotra, Akash, Duseja, Ajay, Saraya, Anoop, Yegurla, Jatin, Rela, Mohamed, Jothimani, Dinesh, Arora, Anil, Kumar, Ashish, Dhiman, Radha Krishan, Roy, Akash, Anand, Anil C, Praharaj, Dibyalochan, Hueso, Sarai Gonzalez, Cabrera, Araceli Bravo, Pérez Hérnandez, José Luis, Gutierrez, Oscar Morales, Miranda Zazueta, Godolfino, Ramos-Pineda, Abraham, Castillo Barradas, Mauricio, Velazquez, Rene Male, Made, Lilian Torres, Velarde-Ruiz Velasco, José Antonio, Félix-Tellez, Francisco, Cordova-Gallardo, Jacqueline, Rajaram, Ruveena, Nik Muhamad Afendi, Nik Arsyad, Okeke, Edith N, Nyam, David P, Allam, Dalia, Kumar Patwa, Yashwi Haresh, Tan, Hiang Keat, Liou, Wei Lun, Treeprasertsuk, Sombat, Wejnaruemarn, Salisa, Haktaniyan, Busra, Gunduz, Feyza, Aslan, Rahmi, Yildirim, Abdullah Emre, Barutcu, Sezgin, Karasu, Zeki, Uysal, Alper, Ucbilek, Enver, Kosay, Tolga, Adanir, Haydar, Dinçer, Dinç, Albhaisi, Somaya, Asrani, Sumeet, Fallahadeh, Mohammad Amin, Reddy, K Rajender, Rahematpura, Suditi, Shaw, Jawaid, Vargas, Hugo E., Bayne, David, Biggins, Scott W, Filipek, Natalia, Thuluvath, Paul, Sheshadri, Somya, Keaveny, Andrew, Duarte Rojo, Andres, Cabello Negrillo, Ricardo, Bajaj, Jasmohan S, Choudhury, Ashok K, Xie, Qing, Kamath, Patrick S, Topazian, Mark, Hayes, Peter C, Torre, Aldo, Desalegn, Hailemichael, Idilman, Ramazan, Cao, Zhujun, Alvares-da-Silva, Mario R, George, Jacob, Bush, Brian J, Thacker, Leroy R, and Wong, Florence

Published
2023
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12. Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis

Author

Bajaj, Jasmohan S., Lai, Jennifer C., Tandon, Puneeta, O’Leary, Jacqueline G., Wong, Florence, Garcia-Tsao, Guadalupe, Vargas, Hugo E., Kamath, Patrick S., Biggins, Scott W., Limon-Miro, Ana, Shaw, Jawaid, Mbachi, Chimezie, Chew, Michael, Golob Deeb, Janina, Thacker, Leroy R., and Reddy, K. Rajender

Published
2023
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15. Workplace Discrimination and Visual Impairment: A Comparison of Equal Employment Opportunity Commission Charges and Resolutions under the Americans with Disabilities Act and Americans with Disabilities Amendments Act

Author

Victor, Callie M., Thacker, Leroy R., Gary, Kelli W., Pawluk, Dianne T. V., and Copolillo, Al

Abstract

To guarantee equal opportunities and treatment in employment for individuals with disabilities, Congress enacted Title I of the Americans with Disabilities Act (ADA) in 1992. This law states, "No covered entity shall discriminate against a qualified individual on the basis of disability in regard to job application procedures, the hiring, advancement, or discharge of employees, employee compensation, job training, and other terms, conditions, and privileges of employment" (Americans with Disabilities Act of 1990). However, disability advocates expressed concern that Americans with disabilities appeared to be less protected in the workplace than was expected under Title I of the ADA. This raised concerns in Congress that the original intent of the ADA was not being upheld. To restore the intended purposes and protections of the ADA, Congress proposed the ADA Amendments Act of 2008 (ADAAA) which was designed to have less emphasis on the evaluation of whether an individual was qualified for coverage and more emphasis on whether or not an employer had unlawfully discriminated against that individual (Vierling, 2009). The purpose of this study was to identify where to focus resources regarding specific aspects of employment based on perceived discrimination and outcome resolutions from individuals with visual impairments. The following research questions guided this study: (1) Are there differences between discrimination charges filed with the U.S. Equal Employment Opportunity Commission (EEOC) before and after the enactment of the ADAAA regarding a visual impairment? and (2) Are there differences between outcome resolutions before and after the enactment of the ADAAA regarding a visual impairment?

Published
2017

17. Nosocomial Infections Are Frequent and Negatively Impact Outcomes in Hospitalized Patients With Cirrhosis.

Author

Bajaj, Jasmohan S, OʼLeary, Jacqueline G, Tandon, Puneeta, Wong, Florence, Garcia-Tsao, Guadalupe, Kamath, Patrick S, Biggins, Scott W, Lai, Jennifer C, Vargas, Hugo E, Maliakkal, Benedict, Fallon, Michael B, Thuluvath, Paul J, Subramanian, Ram M, Thacker, Leroy R, and Reddy, K Rajender

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Chronic Liver Disease and Cirrhosis, Infectious Diseases, Digestive Diseases, Infection, Oral and gastrointestinal, Good Health and Well Being, Adult, Age Distribution, Aged, Cause of Death, Cohort Studies, Cross Infection, End Stage Liver Disease, Female, Hospital Mortality, Hospitalization, Humans, Incidence, Liver Function Tests, Male, Middle Aged, Prognosis, Prospective Studies, Reference Values, Risk Assessment, Sex Distribution, Treatment Outcome, Gastroenterology & Hepatology, Clinical sciences
Abstract

ObjectivesNosocomial infections (NIs) can be a major cause of morbidity and mortality in cirrhosis. This study aims to define the determinants of NI development and its impact on 30-day outcomes among hospitalized patients with cirrhosis.MethodsNorth American Consortium for the Study of End-Stage Liver Disease enrolled patients with cirrhosis who were admitted nonelectively. Admission variables and 30-day outcomes were compared between patients with and without NI. These were also compared based on whether there was an isolated admission infection, NI, or both. Models were created for NI development using admission variables and for 30-day mortality.ResultsThe study included 2,864 patients; of which, 15% (n = 436) developed NI. When comparing NI vs no NI, 1,866 patients were found to be infection free, whereas 562 had admission infections only, 228 had only NI, and 208 had both infections. At admission, patients with NI were more likely to be infected and have advanced cirrhosis. NIs were associated with higher rates of acute-on-chronic liver failure, death, and transplant regardless of admission infections. Patients with NI had higher respiratory infection, urinary tract infection, Clostridium difficile infection, fungal infections, and infection with vancomycin-resistant enterococci compared with patients without NI. Risk factors for NIs were admission infections, model for end-stage liver disease (MELD) > 20, systemic inflammatory response syndrome criteria, proton pump inhibitor, rifaximin, and lactulose use, but the regression model (sensitivity, 0.67; specificity, 0.63) was not robust. Age, alcohol etiology, admission MELD score, lactulose use, acute-on-chronic liver failure, acute kidney injury, intensive care unit, and NI increased the risk of death, whereas rifaximin decreased the risk of death.DiscussionNIs are prevalent in hospitalized patients with cirrhosis and are associated with poor outcomes. Although higher MELD scores and systemic inflammatory response syndrome are associated with NI, all hospitalized patients with cirrhosis require vigilance and preventive strategies.

Published
2019

18. Targets to improve quality of care for patients with hepatic encephalopathy: data from a multi‐centre cohort

Author

Bajaj, Jasmohan S, O’Leary, Jacqueline G, Tandon, Puneeta, Wong, Florence, Kamath, Patrick S, Biggins, Scott W, Garcia‐Tsao, Guadalupe, Lai, Jennifer, Fallon, Michael B, Thuluvath, Paul J, Vargas, Hugo E, Maliakkal, Benedict, Subramanian, Ram M, Thacker, Leroy R, and Reddy, K Rajender

Subjects
Digestive Diseases, Liver Disease, Clinical Research, Aged, Cohort Studies, Drug Therapy, Combination, End Stage Liver Disease, Female, Gastrointestinal Agents, Hepatic Encephalopathy, Humans, Lactulose, Liver Cirrhosis, Male, Middle Aged, Quality of Health Care, Recurrence, Rifaximin, Clinical Sciences, Pharmacology and Pharmaceutical Sciences, Gastroenterology & Hepatology
Abstract

BackgroundHepatic encephalopathy (HE) can adversely affect outcomes in both in-patients and out-patients with cirrhosis.AimTo define targets for improving quality of care in HE management in the multi-centre North American Consortium for End-Stage Liver Disease (NACSELD) cohort.MethodNACSELD in-patient cohort was analysed for (a) medication-associated precipitants, (b) aspiration pneumonia development, (c) HE medication changes, and (d) 90-day HE recurrence/readmissions. Comparisons were made between patients on no-therapy, lactulose only, rifaximin only or both. Ninety-day HE-readmission analysis was adjusted for MELD score.ResultsTwo thousand eight hundred and ten patients (1102 no-therapy, 659 lactulose, 154 rifaximin, 859 both) were included. HE on admission, and HE rates during hospitalisation were highest in those on lactulose only or dual therapy compared to no-therapy or rifaximin only (P

Published
2019

19. Outcomes in Patients With Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis.

Author

Bajaj, Jasmohan S, Tandon, Puneeta, OʼLeary, Jacqueline G, Wong, Florence, Biggins, Scott W, Garcia-Tsao, Guadalupe, Kamath, Patrick S, Maliakkal, Benedict, Fallon, Michael B, Lai, Jennifer C, Thuluvath, Paul J, Vargas, Hugo E, Subramanian, Ram M, Thacker, Leroy R, and Reddy, K Rajender

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Digestive Diseases, Clinical Research, Chronic Liver Disease and Cirrhosis, Liver Disease, Prevention, Patient Safety, Good Health and Well Being, Antibiotic Prophylaxis, Bacterial Infections, Biomarkers, Female, Humans, Liver Cirrhosis, Male, Middle Aged, North America, Peritonitis, Primary Prevention, Registries, Retrospective Studies, Secondary Prevention, Gastroenterology & Hepatology, Clinical sciences
Abstract

ObjectivesAntibiotic prophylaxis is recommended for prevention of the first episode of spontaneous bacterial peritonitis (SBP; primary prophylaxis 1°) and subsequent episodes (secondary prophylaxis 2°). We aimed to compare outcomes in cirrhotic inpatients on 1° vs 2° SBP prophylaxis.MethodsData from North American Consortium for the Study of End-Stage Liver Disease were evaluated for cirrhosis details, reasons for admission/medications, inpatient course recorded, and outcomes over 90 days. Outcomes (intensive care units, acute kidney injury, inpatient/90-day mortality) were compared between the 2 groups after propensity-matching on admission model for end-stage liver disease (MELD) score and serum albumin.ResultsAmong the 2,731 patients enrolled, 305 were on 1° and 187 on 2° SBP prophylaxis. After propensity-matching, 154 patients remained in each group. Patients on 1° prophylaxis were more likely to have admission systemic inflammatory response syndrome (P = 0.02), with higher intensive care unit admissions (31% vs 21%; P = 0.05) and inpatient mortality (19% vs 9%; P = 0.01) than the 2° prophylaxis group. Patients on 2° prophylaxis had higher total (22% vs 10%; P = 0004), readmission (16% vs 9%; P = 0.03), and nosocomial (6% vs 0.5%; P = 0.01) SBP rates with predominant Gram-negative organisms compared to 1° prophylaxis patients. At 90 days, 1° prophylaxis patients had a higher mortality (35% vs 22%; P = 0.02) and acute kidney injury incidence (48% vs 30%; P = 0.04) compared to 2° prophylaxis patients.DiscussionIn this inpatient cirrhosis study, despite prophylaxis, a high proportion of patients developed SBP, which was associated with mortality. Cirrhotic inpatients on 1° prophylaxis had worse outcomes than those on 2° prophylaxis when propensity-matched for the MELD score and serum albumin during the index admission and 90-day follow-up.

Published
2019

21. Serum and urinary metabolomics and outcomes in cirrhosis

Author

Bajaj, Jasmohan S, Fan, Sili, Thacker, Leroy R, Fagan, Andrew, Gavis, Edith, White, Melanie B, Heuman, Douglas M, Fuchs, Michael, and Fiehn, Oliver

Subjects
Medical Biochemistry and Metabolomics, Analytical Chemistry, Biomedical and Clinical Sciences, Chemical Sciences, Transplantation, Good Health and Well Being, Adult, Aged, Biomarkers, Female, Hepatic Encephalopathy, Hospitalization, Humans, Liver Cirrhosis, Liver Transplantation, Male, Metabolomics, Middle Aged, Prognosis, Prospective Studies, Severity of Illness Index, General Science & Technology
Abstract

BackgroundCirrhosis can alter several metabolic pathways. Metabolomics could prognosticate outcomes like hepatic encephalopathy (HE), transplant, hospitalization and death.AimDetermine changes in serum and urine metabolomics in cirrhotics who develop outcomes.MethodsCirrhotic outpatients underwent data, serum/urine collection and were followed for 90 days. Demographics, cirrhosis details and medications were collected. Metabolomics was performed on urine/serum using GC/MS with subsequent bioinformatics analyses (ChemRICH, MetaMAPP and PLS-DA). Logistic regression adjusting for covariates (demographics, alcohol etiology, prior HE, PPI, SBP prophylaxis, rifaximin/lactulose) were performed and ROC curves comparing MELD to adjusted serum & urine metabolites were created.Results211 patients gave serum, of which 64 were hospitalized, 19 developed HE, 13 were transplanted and 11 died. 164 patients gave urine of which 56 were hospitalized, 18 developed HE, 12 were transplanted and 11 died. Metabolomics: Saturated fatty acids, amino acids and bioenergetics-related metabolites differentiated patients with/without outcomes. After regression, 232, 228, 284 and 229 serum metabolites were significant for hospitalization, HE, death and transplant. In urine 290, 284, 227 & 285 metabolites were significant for hospitalization, HE, death and transplant respectively. AUC was higher for serum metabolites vs MELD for HE (0.85 vs.0.76), death (0.99 vs.0.88), transplant (0.975 vs.0.94) and hospitalizations (0.84 vs.0.83). Similarly, urinary metabolite AUC was also higher than MELD for HE (0.87 vs.0.72), death (0.92 vs 0.86), transplant (0.99 vs.0.90) and hospitalizations (0.89 vs.0.84).ConclusionsIn this exploratory study, serum and metabolites focused on lipid, bioenergetics and amino acid metabolism are altered in cirrhotics who develop negative outcomes.

Published
2019

31. Global prevalence and characteristics of infections and clinical outcomes in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium

Author

Cao, Zhujun, Wong, Florence, Choudhury, Ashok K, Kamath, Patrick S, Topazian, Mark, Torre, Aldo, Hayes, Peter C, George, Jacob, Idilman, Ramazan, Seto, Wai-Kay, Desalegn, Hailemichael, Alvares-da-Silva, Mario Reis, Bush, Brian J, Thacker, Leroy R, Xie, Qing, Bajaj, Jasmohan S, Kumar, Shiva, Gadano, Adrián, Marciano, Sebastián, Tudehope, Fiona, Prudence, Alexander, Gibson, Robert, Zekry, Amany, Doyle, Adam, Si, Hooi Ling, Kim, Yu Sung, Gofton, Cameron, Riordan, Stephen, MacQuillan, Gerry, Al-Tamimi, Hala, Michalczuk, Matheus, Farias, Alberto, Zitelli, Patricia, Pereira, Gustavo, Victor, Livia, Bera, Chinmay, Faisal, Nabiha, Dahiya, Monica, Tandon, Puneeta, Lohoues, Marie Jeanne, Lah, Ponan Claude Regis, Benítez, Carlos, Arrese, Marco, Guan, Jing, Xian, Yongchao, Zhu, Chuanwu, Wang, Yingling, Su, Man, Su, Minghua, Wang, Xinrui, Gao, Yanhang, Peng, Feng, Jiang, Yongfang, Zhao, Caiyan, Wang, Wei, Yin, Dedong, Wang, Lei, Lu, Mingqin, Cai, Yijing, Guo, Feng, Wang, Xiaozhong, Zhang, Ningping, Zhang, Wanqin, Dong, Fuchen, Li, Hai, Liu, Jing, Zheng, Xin, Tang, Hong, Yan, Libo, Xu, Bin, Wei, Linlin, Xu, Zhen, Gao, Zhiliang, Gao, Haibing, Lin, Minghua, Rao, Qunfang, Wu, Xiaoping, Li, Beiling, Chen, Jinjun, Liu, Chenghai, Zhang, Yanyun, Deng, Huan, Hu, Peng, Wang, Jian, Li, Jie, Bettinger, Dominik, Schultheiß, Michael, Belimi, Hibat Allah, Debzi, Nabil, Mostafa, Alaa, Fouad, Yasser, Fisseha, Henok, Venkatachalapathy, Suresh Vasan, Aravinthan, Aloysious D, Rajoriya, Neil, Faulkes, Rosemary, Leith, Damien, Forrest, Ewan, Danielle, Adebayo, Kennedy, James, Yung, Diana, Alexopoulou, Alexandra, Mani, Iliana, Fung, James, Katchman, Helena, Rabinowich, Liane, Jhaveri, Ajay, Nagral, Aabha, Kulkarni, Anand, Sharma, Mithun, Sarin, Shiv K, Goel, Ashish, Eapen, C E, Duseja, Ajay, Gandotra, Akash, Saraya, Anoop, yegurla, Jatin, Jothimani, Dinesh, Rela, Mohammad, Arora, Anil, Kumar, Ashish, Roy, Akash, Dhiman, R K, Anand, A C, Praharaj, Dibyalochan, Cabrera, Araceli Bravo, Hueso, Sarai Gonzalez, Hérnandez, José Luis Pérez, Gutierrez, Oscar Morales, Ramos-Pineda, Abraham, Zazueta, Godolfino Miranda, Barradas, Mauricio Castillo, Made, Lilian Torres, Velazquez, Rene Male, Félix-Tellez, Francisco, Velasco, José Antonio Velarde-Ruiz, Cordova-Gallardo, Jacqueline, Rajaram, Ruveena, Afendi, Nik Arsyad Nik Muhamad, Nyam, David P, Okeke, Edith N, Allam, Dalia, Patwa, Yashwi Haresh Kumar, Tan, Hiang Keat, Lun, Liou Wei, Ho, Wei Ling Danielle, Wong, Yu Jun, Thanapirom, Kessarin, Teerasarntipan, Tongluk, Haktaniyan, Busra, Gunduz, Feyza, Aslan, Rahmi, Yildirim, Abdullah Emre, Barutcu, Sezgin, Uysal, Alper, Karasu, Zeki, Ucbilek, Enver, Kosay, Tolga, Dinçer, Dinç, Adanır, Haydar, Albhaisi, Somaya, Fallahadeh, Mohammad Amin, Asrani, Sumeet, Reddy, K Rajender, Shaw, Jawaid, Vargas, Hugo, Filipek, Natalia, Biggins, Scott W, Thuluvath, Paul, Sheshadri, Somya, Wegermann, Kara, Kappus, Matthew, Keaveny, Andrew, Rojo, Andres, Negrillo, Ricardo Cabello, and Verna, Elizabeth

Abstract

Infections have a poor prognosis in inpatients with cirrhosis. We aimed to determine regional variations in infections and their association with clinical outcomes in a global cohort of inpatients with cirrhosis.

Published
2024
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34. Efficacy of Supporting Play Exploration and Early Development Intervention in the First Months of Life for Infants Born Very Preterm: 3-Arm Randomized Clinical Trial Protocol

Author

Dusing, Stacey C., Burnsed, Jennifer C., Brown, Shaaron E., Harper, Amy D., D. Hendricks-Munoz, Karen, Stevenson, Richard D., Thacker, Leroy R., II, and Molinini, Rebecca M.

Subjects
Diseases, Clinical trials, Premature infants, Child development, Medical centers, Medical schools
Abstract

More than 275,000 infants are born very preterm ( The mandate under the Individuals with Disabilities Education Improvement Act (7,8 )is to provide early intervention (EI) to infants with disabilities. [...], Objective. The aim of this project is to study the effect of a physical therapist intervention provided in the first months of life on developmental outcomes of infants born very preterm. Secondary aims are to investigate the impact of intervention timing on the efficacy and impact of the intervention on infants with and without cerebral palsy. Methods. This study is a multisite longitudinal controlled trial comparing developmental outcomes from infants in the Supporting Play, Exploration, and Early Development Intervention (SPEEDI)_Late or SPEEDI_Early group to a usual care group. Settings are urban. Urban and rural areas surrounding 2 academic medical centers. There will be 90 preterm infants enrolled in this study born at Impact. More than 270,000 infants are born very preterm in the United States each year, 50% of whom will have neurological dysfunction that limits their ability to keep pace with peers who are typically developing. This study is a step toward understanding the impact that intensive developmental intervention could have in this population in the first months of life.

Published
2020
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36. Predictors of Respiratory Failure Development in A Multi-Center Cohort of Inpatients with Cirrhosis

Author

Bajaj, Jasmohan S, primary, Kamath, Patrick S, additional, Reddy, K Rajender, additional, Asrani, Sumeet K, additional, Keaveny, Andrew P., additional, Tandon, Puneeta, additional, Duarte-Rojo, Andres, additional, Kappus, Matthew, additional, Verna, Elizabeth, additional, Biggins, Scott W, additional, Vargas, Hugo E., additional, Albhaisi, Somaya, additional, Shaw, Jawaid, additional, Dahiya, Monica, additional, Filipek, Natalia, additional, Fallahzadeh, Mohammad Amin, additional, Wegermann, Kara, additional, Cabello, Ricardo, additional, Bera, Chinmay, additional, Thuluvath, Paul, additional, Bush, Brian, additional, Thacker, Leroy R, additional, and Wong, Florence, additional

Published
2023
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41. Factors Influencing Receipt and Type of Therapy Services in the NICU

Author

Butera, Christiana D., primary, Brown, Shaaron E., additional, Burnsed, Jennifer, additional, Darring, Jodi, additional, Harper, Amy D., additional, Hendricks-Muñoz, Karen D., additional, Hyde, Megan, additional, Kane, Audrey E., additional, Miller, Meagan R., additional, Stevenson, Richard D., additional, Spence, Christine M., additional, Thacker, Leroy R., additional, and Dusing, Stacey C., additional

Published
2023
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46. Global disparities in mortality and liver transplantation in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium

Author

Bajaj, Jasmohan S, primary, Choudhury, Ashok K, additional, Xie, Qing, additional, Kamath, Patrick S, additional, Topazian, Mark, additional, Hayes, Peter C, additional, Torre, Aldo, additional, Desalegn, Hailemichael, additional, Idilman, Ramazan, additional, Cao, Zhujun, additional, Alvares-da-Silva, Mario R, additional, George, Jacob, additional, Bush, Brian J, additional, Thacker, Leroy R, additional, Wong, Florence, additional, Sarin, Shiv K, additional, Kumar, Shiva, additional, Marciano, Sebastián, additional, Gadano, Adrián, additional, Tudehope, Fiona, additional, Gibson, Robert, additional, Prudence, Alexander, additional, Doyle, Adam, additional, Si, Hooi Ling, additional, Riordan, Stephen, additional, Farias, Alberto, additional, Zitelli, Patricia, additional, Bera, Chinmay, additional, Faisal, Nabiha, additional, Tandon, Puneeta, additional, Dahiya, Monica, additional, Lohoues, Marie Jeanne, additional, Lah, Ponan Claude Regis, additional, Benítez, Carlos, additional, Arrese, Marco, additional, Xian, Yongchao, additional, Guan, Jin, additional, Zhu, Chuanwu, additional, Wang, Yingling, additional, Su, Minghua, additional, Su, Man, additional, Gao, Yanhang, additional, Wang, Xinrui, additional, Jiang, Yongfang, additional, Peng, Feng, additional, Zhao, Caiyan, additional, Wang, Wei, additional, Wang, Lei, additional, Yin, Dedong, additional, Lu, Mingqin, additional, Cai, Yijing, additional, Zhang, Ningping, additional, Zhang, Wanqin, additional, Li, Hai, additional, Dong, Fuchen, additional, Zheng, Xin, additional, Liu, Jing, additional, Tang, Hong, additional, Yan, Libo, additional, Xu, Bin, additional, Wei, Linlin, additional, Gao, Zhiliang, additional, Xu, Zhen, additional, Lin, Minghua, additional, Gao, Haibin, additional, Chen, Jinjun, additional, Li, Beiling, additional, Liu, Chenghai, additional, Zhang, Yanyun, additional, Hu, Peng, additional, Deng, Huan, additional, Belimi, Hibat Allah, additional, Debzi, Nabil, additional, Fisseha, Henok, additional, Aravinthan, Aloysious D, additional, Venkatachalapathy, Suresh Vasan, additional, Rajoriya, Neil, additional, Faulkes, Rosemary, additional, Leith, Damien, additional, Forrest, Ewan, additional, Adebayo, Danielle, additional, Kennedy, James, additional, Yung, Diana, additional, Seto, Wai-Kay, additional, Fung, James, additional, Katchman, Helena, additional, Rabinowich, Liane, additional, Nagral, Aabha, additional, Jhaveri, Ajay, additional, Kulkarni, Anand, additional, Sharma, Mithun, additional, Eapen, C E, additional, Goel, Ashish, additional, Gandotra, Akash, additional, Duseja, Ajay, additional, Saraya, Anoop, additional, Yegurla, Jatin, additional, Rela, Mohamed, additional, Jothimani, Dinesh, additional, Arora, Anil, additional, Kumar, Ashish, additional, Dhiman, Radha Krishan, additional, Roy, Akash, additional, Anand, Anil C, additional, Praharaj, Dibyalochan, additional, Hueso, Sarai Gonzalez, additional, Cabrera, Araceli Bravo, additional, Pérez Hérnandez, José Luis, additional, Gutierrez, Oscar Morales, additional, Miranda Zazueta, Godolfino, additional, Ramos-Pineda, Abraham, additional, Castillo Barradas, Mauricio, additional, Velazquez, Rene Male, additional, Made, Lilian Torres, additional, Velarde-Ruiz Velasco, José Antonio, additional, Félix-Tellez, Francisco, additional, Cordova-Gallardo, Jacqueline, additional, Rajaram, Ruveena, additional, Nik Muhamad Afendi, Nik Arsyad, additional, Okeke, Edith N, additional, Nyam, David P, additional, Allam, Dalia, additional, Kumar Patwa, Yashwi Haresh, additional, Tan, Hiang Keat, additional, Liou, Wei Lun, additional, Treeprasertsuk, Sombat, additional, Wejnaruemarn, Salisa, additional, Haktaniyan, Busra, additional, Gunduz, Feyza, additional, Aslan, Rahmi, additional, Yildirim, Abdullah Emre, additional, Barutcu, Sezgin, additional, Karasu, Zeki, additional, Uysal, Alper, additional, Ucbilek, Enver, additional, Kosay, Tolga, additional, Adanir, Haydar, additional, Dinçer, Dinç, additional, Albhaisi, Somaya, additional, Asrani, Sumeet, additional, Fallahadeh, Mohammad Amin, additional, Reddy, K Rajender, additional, Rahematpura, Suditi, additional, Shaw, Jawaid, additional, Vargas, Hugo E., additional, Bayne, David, additional, Biggins, Scott W, additional, Filipek, Natalia, additional, Thuluvath, Paul, additional, Sheshadri, Somya, additional, Keaveny, Andrew, additional, Duarte Rojo, Andres, additional, and Cabello Negrillo, Ricardo, additional

Published
2023
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48. Cognitive Reserve Is a Determinant of Health-related Quality of Life in Patients With Cirrhosis, Independent of Covert Hepatic Encephalopathy and Model for End-Stage Liver Disease Score

Author

Patel, Ankit V., Wade, James B., Thacker, Leroy R., Sterling, Richard K., Siddiqui, Muhammad S., Stravitz, R. Todd, Sanyal, Arun J., Luketic, Velimir, Puri, Puneet, Fuchs, Michael, Matherly, Scott, White, Melanie B., Unser, Ariel, Heuman, Douglas M., and Bajaj, Jasmohan S.

Published
2015
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50. Symptom Domain Groups of the Patient-Reported Outcomes Measurement Information System Tools Independently Predict Hospitalizations and Re-hospitalizations in Cirrhosis

Author

Patidar, Kavish R., Thacker, Leroy R., Wade, James B., White, Melanie B., Gavis, Edith A., Fagan, Andrew, Sterling, Richard K., Fuchs, Michael, Siddiqui, Mohammad S., Matherly, Scott, Stravitz, Richard T., Sanyal, Arun J., Puri, Puneet, Luketic, Velimir A., and Bajaj, Jasmohan S.

Published
2017
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