المؤلفون: Chen, Tao, Chen, Guang, Wang, Guiqiang, Treeprasertsuk, Sombat, Lesmana, Cosmas Rinaldi Adithya, Lin, Han-Chieh, Al-mahtab, Mamun, Chawla, Yogesh K., Tan, Soek-Siam, Kao, Jia-Horng, Yuen, Man-Fung, Lee, Guan-Huei, Alcantara-Payawal, Diana, Nakayama, Nobuaki, Abbas, Zaigham, Jafri, Wasim, Kim, Dong-Joon, Choudhury, Ashok, Mahiwall, Rakhi, Hou, Jinlin

المصدر: Hepatology International; Jun2024, Vol. 18 Issue 3, p817-832, 16p

مستخلص: End-stage liver disease (ESLD) is a life-threatening clinical syndrome and when complicated with infection the mortality is markedly increased. In patients with ESLD, bacterial or fungal infection can induce or aggravate the occurrence or progression of liver decompensation. Consequently, infections are among the most common complications of disease deterioration. There is an overwhelming need for standardized protocols for early diagnosis and appropriate management for patients with ESLD complicated by infections. Asia Pacific region has the largest number of ESLD patients, due to hepatitis B and the growing population of alcohol and NAFLD. Concomitant infections not only add to organ failure and high mortality but also to financial and healthcare burdens. This consensus document assembled up-to-date knowledge and experience from colleagues across the Asia–Pacific region, providing data on the principles as well as evidence-based current working protocols and practices for the diagnosis and treatment of patients with ESLD complicated by infections. [ABSTRACT FROM AUTHOR]

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المؤلفون: Thanapirom, Kessarin, Treeprasertsuk, Sombat, Choudhury, Ashok, Verma, Nipun, Dhiman, Radha Krishan, Al Mahtab, Mamun, Devarbhavi, Harshad, Shukla, Akash, Hamid, Saeed Sadiq, Jafri, Wasim, Tan, Soek Siam, Lee, Guan H., Ghazinyan, Hasmik, Sood, Ajit, Kim, Dong Joon, Eapen, C. E., Tao, Han, Yuemin, Nan, Dokmeci, A. Kadir, Sahu, Manoj

المصدر: Scientific Reports; 3/9/2024, Vol. 14 Issue 1, p1-8, 8p

مصطلحات موضوعية: LIVER failure, AMMONIA, HEPATIC encephalopathy, BACTERIAL diseases, CONSORTIA

مستخلص: The relationship between ammonia and liver-related complications (LRCs) in acute-on-chronic liver failure (ACLF) patients is not clearly established. This study aimed to evaluate the association between ammonia levels and LRCs in patients with ACLF. The study also evaluated the ability of ammonia in predicting mortality and progression of LRCs. The study prospectively recruited ACLF patients based on the APASL definition from the ACLF Research Consortium (AARC) from 2009 to 2019. LRCs were a composite endpoint of bacterial infection, overt hepatic encephalopathy (HE), and ascites. A total of 3871 cases were screened. Of these, 701 ACLF patients were enrolled. Patients with LRCs had significantly higher ammonia levels than those without. Ammonia was significantly higher in patients with overt HE and ascites, but not in those with bacterial infection. Multivariate analysis found that ammonia was associated with LRCs. Additionally, baseline arterial ammonia was an independent predictor of 30-day mortality, but it was not associated with the development of new LRCs within 30 days. In summary, baseline arterial ammonia levels are associated with 30-day mortality and LRCs, mainly overt HE and ascites in ACLF patients. [ABSTRACT FROM AUTHOR]

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المؤلفون: Zhou, Xiao-Dong, Targher, Giovanni, Byrne, Christopher D., Somers, Virend, Kim, Seung Up, Chahal, C. Anwar A., Wong, Vincent Wai-Sun, Cai, Jingjing, Shapiro, Michael D., Eslam, Mohammed, Steg, Philippe Gabriel, Sung, Ki-Chul, Misra, Anoop, Li, Jian-Jun, Brotons, Carlos, Huang, Yuli, Papatheodoridis, George V., Sun, Aijun, Yilmaz, Yusuf, Chan, Wah-Kheong, Huang, Hui, Méndez-Sánchez, Nahum, Alqahtani, Saleh A., Cortez-Pinto, Helena, Lip, Gregory Y. H., Knegt, Robert J. de, Ocama, Ponsiano, Romero-Gómez, Manuel, Fudim, Marat, Sebastiani, Giada, Son, Jang Won, Ryan, John D., Ikonomidis, Ignatios, Treeprasertsuk, Sombat, Pastori, Daniele, Lupsor-Platon, Monica, Tilg, Herbert, Ghazinyan, Hasmik, Boursier, Jerome, Hamaguchi, Masahide, Nguyen, Mindie H., Fan, Jian-Gao, Goh, George Boon-Bee, Al-Mahtab, Mamun, Hamid, Saeed, Perera, Nilanka, George, Jacob, Zheng, Ming-Hua

مصطلحات موضوعية: Metabolic (dysfunction)-associated fatty liver disease, MAFLD, Non-alcoholic fatty liver disease, Cardiovascular disease, Consensus, Delphi survey

الوصف: [Background] Fatty liver disease in the absence of excessive alcohol consumption is an increasingly common condition with a global prevalence of ~ 25–30% and is also associated with cardiovascular disease (CVD). Since systemic metabolic dysfunction underlies its pathogenesis, the term metabolic (dysfunction)-associated fatty liver disease (MAFLD) has been proposed for this condition. MAFLD is closely intertwined with obesity, type 2 diabetes mellitus and atherogenic dyslipidemia, which are established cardiovascular risk factors. Unlike CVD, which has received attention in the literature on fatty liver disease, the CVD risk associated with MAFLD is often underestimated, especially among Cardiologists. ; [Methods and results] A multidisciplinary panel of fifty-two international experts comprising Hepatologists, Endocrinologists, Diabetologists, Cardiologists and Family Physicians from six continents (Asia, Europe, North America, South America, Africa and Oceania) participated in a formal Delphi survey and developed consensus statements on the association between MAFLD and the risk of CVD. Statements were developed on different aspects of CVD risk, ranging from epidemiology to mechanisms, screening, and management. ; [Conculsions] The expert panel identified important clinical associations between MAFLD and the risk of CVD that could serve to increase awareness of the adverse metabolic and cardiovascular outcomes of MAFLD. Finally, the expert panel also suggests potential areas for future research. ; Peer reviewed

العلاقة: The underlying dataset has been published as supplementary material of the article in the publisher platform at https://doi.org/10.1007/s12072-023-10543-8Test; https://doi.org/10.1007/s12072-023-10543-8Test; Sí; Hepatology International 17(4): 773-791 (2023); http://hdl.handle.net/10261/353472Test

الإتاحة: https://doi.org/10.1007/s12072-023-10543-8Test
http://hdl.handle.net/10261/353472Test

المؤلفون: Islam, Md Shahidul, Ebrahimi-Barough, Somayeh, Al Mahtab, Mamun, Shirian, Sadegh, Aghayan, Hamid Reza, Arjmand, Babak, Allahverdi, Amir, Ranjbar, Faezeh Esmaeili, Sadeg, Amin Bigham, Ai, Jafar

المصدر: Progress in Biomaterials; Dec2022, Vol. 11 Issue 4, p385-396, 12p

المؤلفون: Kumar, Manoj, Abbas, Zaigham, Azami, Milad, Belopolskaya, Maria, Dokmeci, A. K., Ghazinyan, Hasmik, Jia, Jidong, Jindal, Ankur, Lee, Han Chu, Lei, Wei, Lim, Seng Gee, Liu, Chun-Jen, Li, Qiang, Al Mahtab, Mamun, Muljono, David H., Niriella, Madunil Anuk, Omata, Masao, Payawal, Diana A., Sarin, Shiv K., Ségéral, Olivier

المصدر: Hepatology International; Apr2022, Vol. 16 Issue 2, p211-253, 43p

مستخلص: Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia–Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia–Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers. [ABSTRACT FROM AUTHOR]

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المؤلفون: Thanapirom, Kessarin, Teerasarntipan, Tongluk, Treeprasertsuk, Sombat, Choudhury, Ashok, Sahu, Manoj K., Maiwall, Rakhi, Pamecha, Viniyendra, Moreau, Richard, Al Mahtab, Mamun, Chawla, Yogesh Kumar, Devarbhavi, Harshad, Yu, Chen, Ning, Qin, Amarapurkar, Deepak, Eapen, Chundamannil E., Hamid, Saeed Sadiq, Butt, Amna Subhan, Kim, Dong Joon, Lee, Guan H., Sood, Ajit

المصدر: Hepatology International; Feb2022, Vol. 16 Issue 1, p171-182, 12p

مستخلص: Background and aims: Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database. Methods: A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis. Results: Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36–0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43–0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred. Conclusions: The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were significantly higher than those with cirrhosis in alcoholic CLD. The presence of cirrhosis and its stage should be evaluated at baseline to guide for management. Thai Clinical Trials Registry, TCTR20191226002. [ABSTRACT FROM AUTHOR]

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المؤلفون: Verma, Nipun, Dhiman, Radha Krishan, Choudhury, Ashok, Taneja, Sunil, Duseja, Ajay, Singh, Virender, Al Mahtab, Mamun, Devarbhavi, Harshad, Shukla, Akash, Ning, Q., Hamid, Saeed Sadiq, Butt, Amna Shubhan, Jafri, Wasim, Tan, Soek Siam, Hu, Jinhua, Zhongping, Duan, Treeprasertsuk, Sombat, Lee, Guan H., Ghazinyan, Hasmik, Lesmana, Laurentius A.

المصدر: Hepatology International; Aug2021, Vol. 15 Issue 4, p970-982, 13p

مستخلص: Background: We evaluated the dynamics of hepatic encephalopathy (HE) and ammonia estimation in acute-on-chronic liver failure (ACLF) patients due to a paucity of evidence. Methods: ACLF patients recruited from the APASL-ACLF Research Consortium (AARC) were followed up till 30 days, death or transplantation, whichever earlier. Clinical details, including dynamic grades of HE and laboratory data, including ammonia levels, were serially noted. Results: Of the 3009 ACLF patients, 1315 (43.7%) had HE at presentation; grades I–II in 981 (74.6%) and grades III–IV in 334 (25.4%) patients. The independent predictors of HE at baseline were higher age, systemic inflammatory response, elevated ammonia levels, serum protein, sepsis and MELD score (p < 0.05; each). The progressive course of HE was noted in 10.0% of patients without HE and 8.2% of patients with HE at baseline, respectively. Independent predictors of progressive course of HE were AARC score (≥ 9) and ammonia levels (≥ 85 μmol/L) (p < 0.05; each) at baseline. A final grade of HE was achieved within 7 days in 70% of patients and those with final grades III–IV had the worst survival (8.9%). Ammonia levels were a significant predictor of HE occurrence, higher HE grades and 30-day mortality (p < 0.05; each). The dynamic increase in the ammonia levels over 7 days could predict nonsurvivors and progression of HE (p < 0.05; each). Ammonia, HE grade, SIRS, bilirubin, INR, creatinine, lactate and age were the independent predictors of 30-day mortality in ACLF patients. Conclusions: HE in ACLF is common and is associated with systemic inflammation, poor liver functions and high disease severity. Ammonia levels are associated with the presence, severity, progression of HE and mortality in ACLF patients. [ABSTRACT FROM AUTHOR]

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المؤلفون: Verma, Nipun, Dhiman, Radha Krishan, Singh, Virendra, Duseja, Ajay, Taneja, Sunil, Choudhury, Ashok, Sharma, Manoj Kumar, Eapen, C. E., Devarbhavi, Harshad, Al Mahtab, Mamun, Shukla, Akash, Hamid, Saeed Sadiq, Jafri, Wasim, Butt, Amna Shubhan, Ning, Qin, Chen, Tao, Tan, Soek Siam, Lesmana, Laurentius A., Lesmana, Cosmas Rinaldi A., Sahu, Manoj K.

المصدر: Hepatology International; Jun2021, Vol. 15 Issue 3, p753-765, 13p

مستخلص: Background: Multiple predictive models of mortality exist for acute-on-chronic liver failure (ACLF) patients that often create confusion during decision-making. We studied the natural history and evaluated the performance of prognostic models in ACLF patients. Methods: Prospectively collected data of ACLF patients from APASL-ACLF Research Consortium (AARC) was analyzed for 30-day outcomes. The models evaluated at days 0, 4, and 7 of presentation for 30-day mortality were: AARC (model and score), CLIF-C (ACLF score, and OF score), NACSELD-ACLF (model and binary), SOFA, APACHE-II, MELD, MELD-Lactate, and CTP. Evaluation parameters were discrimination (c-indices), calibration [accuracy, sensitivity, specificity, and positive/negative predictive values (PPV/NPV)], Akaike/Bayesian Information Criteria (AIC/BIC), Nagelkerke-R², relative prediction errors, and odds ratios. Results: Thirty-day survival of the cohort (n = 2864) was 64.9% and was lowest for final-AARC-grade-III (32.8%) ACLF. Performance parameters of all models were best at day 7 than at day 4 or day 0 (p < 0.05 for C-indices of all models except NACSELD-ACLF). On comparison, day-7 AARC model had the numerically highest c-index 0.872, best accuracy 84.0%, PPV 87.8%, R² 0.609 and lower prediction errors by 10–50%. Day-7 NACSELD-ACLF-binary was the simple model (minimum AIC/BIC 12/17) with the highest odds (8.859) and sensitivity (100%) but with a lower PPV (70%) for mortality. Patients with day-7 AARC score > 12 had the lowest 30-day survival (5.7%). Conclusions: APASL-ACLF is often a progressive disease, and models assessed up to day 7 of presentation reliably predict 30-day mortality. Day-7 AARC model is a statistically robust tool for classifying risk of death and accurately predicting 30-day outcomes with relatively lower prediction errors. Day-7 AARC score > 12 may be used as a futility criterion in APASL-ACLF patients. [ABSTRACT FROM AUTHOR]

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المؤلفون: Chen, Tao, Yang, Zhongyuan, Choudhury, Ashok Kumar, Al Mahtab, Mamun, Li, Jun, Chen, Yu, Tan, Soek-Siam, Han, Tao, Hu, Jinhua, Hamid, Saeed S., Huei, Lee Guan, Ghazinian, Hasmik, Nan, Yuemin, Chawla, Yogesh K., Yuen, Man-Fung, Devarbhavi, Harshad, Shukla, Akash, Abbas, Zaigham, Sahu, Manoj, Dokmeci, A. K.

المصدر: Hepatology International; Nov2019, Vol. 13 Issue 6, p695-705, 11p

مستخلص: Background and Aim: Cirrhosis is a controversial determinant of mortality in HBV-related acute-on-chronic liver failure (HBV–ACLF). The present study aimed to explore the effects of cirrhosis and the associated risk factors, especially its complications, on the outcome of HBV–ACLF. Methods: A prospective–retrospective cohort of 985 patients was identified from the APASL–ACLF Research Consortium (AARC) database and the Chinese Study Group. Complications of ACLF (ascites, infection, hepatorenal syndrome, hepatic encephalopathy, upper gastrointestinal bleeding) as well as cirrhosis and the current main prognostic models were measured for their predictive ability for 28- or 90-day mortality. Results: A total of 709 patients with HBV–ACLF as defined by the AARC criteria were enrolled. Among these HBV–ACLF patients, the cirrhotic group showed significantly higher mortality and complications than the non-cirrhotic group. A total of 36.1% and 40.1% of patients met the European Association for the Study of Liver (EASL)–Chronic Liver Failure consortium (CLIF-C) criteria in the non-cirrhotic and cirrhotic groups, respectively; these patients had significantly higher rates of mortality and complications than those who did not satisfy the CLIF-C criteria. Furthermore, among patients who did not meet the CLIF-C criteria, the cirrhotic group exhibited higher mortality and complication rates than the non-cirrhotic group, without significant differences in organ failure. The Tongji prognostic predictor model score (TPPMs), which set the number of complications as one of the determinants, showed comparable or superior ability to the Chinese Group on the Study of Severe Hepatitis B–ACLF score (COSSH–ACLFs), APASL–ACLF Research Consortium score (AARC–ACLFs), CLIF-C organ failure score (CLIF–C OFs), CLIF-C–ACLF score (CLIF-C–ACLFs), Model for End-Stage Liver Disease score (MELDs) and MELD–sodium score (MELD–Nas) in HBV–ACLF patients, especially in cirrhotic HBV-–ACLF patients. Patients with two (OR 4.70, 1.88) or three (OR 8.27, 2.65) complications had a significantly higher risk of 28- or 90-day mortality, respectively. Conclusion: The presence of complications is a major risk factor for mortality in HBV–ACLF patients. TPPM possesses high predictive ability in HBV–ACLF patients, especially in cirrhotic HBV–ACLF patients. [ABSTRACT FROM AUTHOR]

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المؤلفون: Sarin, Shiv Kumar, Choudhury, Ashok, Sharma, Manoj K., Maiwall, Rakhi, Al Mahtab, Mamun, Rahman, Salimur, Saigal, Sanjiv, Saraf, Neeraj, Soin, A. S., Devarbhavi, Harshad, Kim, Dong Joon, Dhiman, R. K., Duseja, Ajay, Taneja, Sunil, Eapen, C. E., Goel, Ashish, Ning, Q., Chen, Tao, Ma, Ke, Duan, Z.

المصدر: Hepatology International; Jul2019, Vol. 13 Issue 4, p353-390, 38p

مستخلص: The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the "APASL ACLF Research Consortium (AARC)" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the 'Golden Therapeutic Window', extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here. Article Highlights: Updated on the basis of AARC data of >3300 cases enrolled into AARC registry prospectively ACLF is distinct form Acute Decompensation of cirrhosis Newer sections on DILI-ACLF, AIH-ACLF, PVT/HVOTO–ACLF Reversibility of Chronic Liver Disease in ACLF Portal and systemic hemodynamics and their relevance in ACLF Acute Portal Hypertension and Variceal progression in ACLF AARC score as a guide for treatment strategies in ACLF ACLF in Children-first consensus on pediatric ACLF [ABSTRACT FROM AUTHOR]

: Copyright of Hepatology International is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)