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MELD or MELD-Na as a Predictive Model for Mortality Following Transjugular Intrahepatic Portosystemic Shunt Placement

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Journal of Clinical and Translational Hepatology 2023年第1期11卷 38-44页

作者： Arunkumar Krishnan tinsay a.woreta Dhananjay Vaidya Yisi Liu James P.Hamilton Kelvin Hong Alia Dadabhai Michelle Ma Division of Gastroenterology and Hepatology Johns Hopkins University School of MedicineBaltimoreMDUSA Department of General Internal Medicine Johns Hopkins University School of MedicineBaltimoreMDUSA Department of Pediatrics Johns Hopkins University School of MedicineBaltimoreMDUSA Division of Interventional Radiology Johns Hopkins University School of MedicineBaltimoreMDUSA

Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for organ allocation for liver ***,there are limited studies to compare the MELD with MELD-Na to predict mortality after ***:We performed a retrospective chart review of patients who underwent TIPS placement between 2006 and 2016 at our *** primary outcome was mortality,and the secondary outcomes sought to assess which variables could provide prognostic information for mortality after TIPS *** performed receiver operating characteristic(ROC)curve analysis to assess the performance of MELD and ***:There were 186 eligible patients in the *** mean pre-TIPS MELD and MELD-Na were 13 and 15,***,mortality after TIPS was 15%at 30 days and 16.7%at 90 *** a comparison of the areas under the ROCs for MELD and MELD-Na,MELD was superior to MELD-Na for 30-day(0.762 vs.0.709)and 90-day(0.780 vs.0.730)mortality after *** optimal cutoff score for 30-day mortality was 15(0.676–0.848)for MELD and 17(0.610–0.808)for MELD-Na,whereas the optimal cutoff score for 90-day mortality was 16(95%CI:0.705–0.855)for MELD and 17(95%CI:0.643–0.817)for *** were 24 patients with high MELD-Na≥17,but with low MELD<15,and 90-day mortality in this group was 8.3%.Conclusions:Although MELD-Na is a superior prognostic tool to MELD for predicting overall mortality in cirrhotic patients,MELD tended to outperform MELD-Na to predict mortality after TIPS.

关键词： Cirrhosis Portal hypertension Model for end-stage liver disease Sodium Transjugular intrahepatic portosystemic shunt Outcomes Mortality

COVID-19: An overview and a clinical update

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World Journal of Clinical Cases 2021年第1期9卷 8-23页

作者： Arunkumar Krishnan James P Hamilton Saleh A Alqahtani tinsay a.woreta Division of Gastroenterology and Hepatology Johns Hopkins School of MedicineBaltimoreMD 21287United States Liver Transplant Center King Faisal Specialist Hospital&Research CenterRiyadh 12713Saudi Arabia

The outbreak of coronavirus disease-2019(COVID-19,previously known as 2019 nCoV)caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in Wuhan City,China,has spread rapidly around the *** patients from the first cluster had an epidemiological connection to the Wuhan's Huanan Seafood Wholesale *** evidence has shown that SARSCoV-2 can be easily transmitted from person to person through close contact and respiratory droplets,posing a substantial challenge to public *** present,the research on SARS-CoV-2 is still in the primary ***,dexamethasone and remdesivir are appeared to be promising medical ***,there is no definite specific treatment,and the mainstay of treatment is still focused on supportive ***,over 150 vaccines are under *** is necessary to understand the nature of the virus and its clinical characteristics in order to find effectively manage the *** knowledge about this virus is rapidly evolving,and clinicians must update themselves *** present review comprehensively summarizes the epidemiology,pathogenesis,clinical characteristics,and management of COVID-19 based on the current evidence.

关键词： Coronaviruses COVID-19 SARS-CoV-2 Epidemiology Symptoms Laboratory Imaging Treatment Vaccines Prevention

Clinical Considerations of Coagulopathy in Acute Liver Failure

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Journal of Clinical and Translational Hepatology 2020年第4期8卷 407-413页

作者： hyoung Kim Bolin Niu tinsay woreta Po-Hung Chen Division of Gastroenterology&Hepatology Department of MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA Division of Gastroenterology&Hepatology Department of MedicineCase Western Reserve University School of MedicineClevelandOHUSA

Acute liver failure (ALF) is the rapid onset of severe liver dysfunction, defined by the presence of hepatic encephalop-athy and impaired synthetic function (international normal-ized ratio of≥1.5) in the absence of underlying liver disease. The elevated international normalized ratio value in ALF is often misinterpreted as an increased hemorrhagic tendency, which can lead to inappropriate, prophylactic transfusions of blood products. However, global assessments of coagulop-athy via viscoelastic tests or thrombin generation assay suggest a reestablished hemostatic, or even hypercoagu-lable, status in patients with ALF. Although the current versions of global assays are not perfect, they can provide more nuanced insights into the hemostatic system in ALF than the conventional measures of coagulopathy.

关键词： Acute liver failure Coagulopathy Thrombin generation assay Viscoelastic test

Longitudinal assessment of liver stiffness by transient elastography for chronic hepatitis C patients

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World Journal of Clinical Cases 2022年第17期10卷 5566-5576页

作者： Anya Mezina Arunkumar Krishnan tinsay a.woreta Kevin B Rubenstein Eric Watson Po-Hung Chen Carla Rodriguez-Watson Department of Medicine Johns Hopkins School of MedicineBaltimoreMD 21287United States Division of Gastroenterology and Hepatology Johns Hopkins School of MedicineBaltimoreMD 21231United States Mid-Atlantic Permanente Research Institute Kaiser Permanente Mid-Atlantic StatesRockville 20852United States Department of Health Policy and Management Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMD 21287United States Innovation in Medical Evidence Development and Surveillance(IMEDS)Program Reagan-Udall Foundation for the FDAWashington20036United States

BACKGROUND Liver fibrosis is a common pathway of liver injury and is a feature of most chronic liver *** progression varies markedly in patients with hepatitis C virus(HCV).Liver stiffness has been recommended as a parameter of fibrosis progression/regression in patients with *** To investigate changes in liver stiffness measured by transient elastography(TE)in a large,racially diverse cohort of United States patients with chronic hepatitis C(CHC).METHODS We evaluated the differences in liver stiffness between patients treated with direct-acting antiviral(DAA)therapy and untreated *** had≥2 TE measurements and no prior DAA *** used linear regression to measure the change in liver stiffness between first and last TE in response to treatment,controlling for age,sex,race,diabetes,smoking status,human immunodeficiency virus status,baseline alanine aminotransferase,and baseline liver *** regression models analyzed the change in liver stiffness as measured by kPa,stratified by cirrhosis *** Of 813 patients,419(52%)initiated DAA *** liver stiffness was 12 kPa in 127(16%).Median time between first and last TE was 11.7 and 12.7 mo among treated and untreated patients,*** was no significant change in liver stiffness observed over time in either the group initiating DAA treatment(0.016 kPa/month;CI:-0.051,0.084)or in the untreated group(0.001 kPa/mo;CI:-0.090,0.092),controlling for covariates.A higher baseline kPa score was independently associated with decreased liver *** DAA treatment was not associated with a differential change in liver stiffness over time in patients with CHC compared to untreated patients.

关键词： Chronic hepatitis C Liver stiffness Cirrhosis Transient elastography Direct-acting antiviral therapy

Clinical characteristics and outcomes of COVID-19 in patients with autoimmune hepatitis:A population-based matched cohort study

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World Journal of Hepatology 2023年第1期15卷 68-78页

作者： Arunkumar Krishnan Ruhee A Patel Yousaf Bashir Hadi Diptasree Mukherjee Sarah Shabih Shyam Thakkar Shailendra Singh tinsay a.woreta Saleh A Alqahtani Section of Gastroenterology and Hepatology West Virginia University School of MedicineMorgantownWV 26505United States Division of Gastroenterology and Hepatology Johns Hopkins University School of MedicineBaltimoreMD 21287United States Department of Medicine Apex Institute of Medical ScienceKolkata 700075West BengalIndia Liver Transplant Center King Faisal Specialist Hospital and Research CenterRiyadh 12713Saudi Arabia

BACKGROUND Patients with autoimmune hepatitis(AIH)require life-long immunosuppressive agents that may increase the risk of poor coronavirus disease 2019(COVID-19)*** is a paucity of large data at the population level to assess whether patients with AIH have an increased risk of severe *** To evaluate the impact of pre-existing AIH on the clinical outcomes of patients with *** We conducted a population-based,multicenter,propensity score-matched cohort study with consecutive adult patients(≥18 years)diagnosed with COVID-19 using the TriNeTx research network *** outcomes of patients with AIH(main group)were compared to a propensity score-matched cohort of patients:(1)Without chronic liver disease(CLD);and(2)Patients with CLD except AIH(non-AIH CLD)control *** patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding *** primary outcome was all-cause mortality,and secondary outcomes were hospitalization rate,need for critical care,severe disease,mechanical ventilation,and acute kidney injury(AKI).For each outcome,the risk ratio(RR)and confidence intervals(CI)were calculated to compare the association of AIH with the *** We identified 375 patients with AIH,1647915 patients with non-CLD,and 15790 patients with non-AIH CLD with COVID-19 *** to non-CLD patients,the AIH cohort had an increased risk of all-cause mortality(RR=2.22;95%CI:1.07-4.61),hospitalization rate(RR=1.78;95%CI:1.17-2.69),and severe disease(RR=1.98;95%CI:1.19-3.26).The AIH cohort had a lower risk of hospitalization rate(RR=0.72;95%CI:0.56-0.92),critical care(RR=0.50;95%CI:0.32-0.79),and AKI(RR=0.56;95%CI:0.35-0.88)compared to the non-AIH CLD *** Patients with AIH are associated with increased hospitalization risk,severe disease,and all-cause mortality compared to patients without pre-existing CLD from the diagnosis of ***,p

关键词： Autoimmune hepatitis SARS-CoV-2 COVID-19 Mortality Outcomes Liver disease Severe

Abnormal liver chemistries as a predictor of COVID-19 severity and clinical outcomes in hospitalized patients

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World Journal of Gastroenterology 2022年第5期28卷 570-587页

作者： Arunkumar Krishnan Laura Prichett Xueting Tao Saleh A Alqahtani James P Hamilton Esteban Mezey Alexandra T Strauss Ahyoung Kim James J Potter Po-Hung Chen tinsay a.woreta Division of Gastroenterology and Hepatology Johns Hopkins University School of MedicineBaltimoreMD 21287United States Department of Pediatrics Johns Hopkins University School of MedicineBaltimoreMD 21287United States Liver Transplant Center King Faisal Specialist Hospital&Research CenterRiyadh 12713Saudi Arabia

BACKGROUND Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019(COVID-19).However,the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood AIM We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital *** This retrospective,observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System(Baltimore,MD,United States).Demographic data,clinical characteristics,laboratory findings,treatment measures,and outcome data were *** regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis RESULTS A total of 2698(70.4%)had abnormal alanine aminotransferase(ALT)at the time of *** more prevalent abnormal liver chemistries were aspartate aminotransferase(AST)(44.4%),alkaline phosphatase(ALP)(16.1%),and total bilirubin(T-Bil)(5.9%).Factors associated with liver injury were older age,Asian ethnicity,other race,being overweight,and *** ALT,AST,T-Bil,and ALP levels were more commonly associated with disease *** adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during *** AST,T-Bil,and ALP were associated with a need for vasopressor drugs,whereas higher levels of AST,T-Bil,and a decreased albumin levels were associated with mechanical ventilation CONCLUSION Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient’s severity and *** liver chemistries,specifically ALT,AST,ALP,and T-Bil levels,can be used to stratify risk and predict the need for advanced therapies in t

关键词： Severe acute respiratory syndrome coronavirus 2 Liver injury Liver tests Aspartate aminotransferase Alanine aminotransferase bilirubin