Browsing by Author "Maiwall, R."

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    AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study
    (Springer, 2023) Maiwall, R.; Pasupuleti, S.S.R.; Choudhury, A.; Kim, D.J.; Sood, A.; Goyal, O.; Midha, V.; Devarbhavi, H.; Arora, A.; Kumar, A.; Sahu, M.K.; Maharshi, S.; Duseja, A.K.; Singh, V.; Taneja, S.; Rao, P.N.; Kulkarni, A.; Ghazinian, H.; Hamid, S.; Eapen, C.E.; Goel, A.; Shreshtha, A.; Shah, S.; Hu, J.; Prasad, V.G.M.; Yuemin, N.; Shaojie, X.; Dhiman, R.K.; Chen, T.; Ning, Q.; Panackel, C.; Niriella, M.A.; Lama, T.K.; Tan, S.S.; Dokmeci, A.K.; Shukla, A.; Sharma, M.K.; Sarin, S.K.
    BACKGROUND AND AIM: Acute-on-chronic liver failure (ACLF) is a severe form of alcoholic hepatitis (SAH). We aimed to study the natural course, response to corticosteroids (CS), and the role of the Asian Pacific Association for the Study of Liver (APASL) research consortium (AARC) score in determining clinical outcomes in AH patients. METHODS: Prospectively collected data from the AARC database were analyzed. RESULTS: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild-moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille's model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12-0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14-0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63-4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell's C-index was 0.72 compared to other scores. CONCLUSION: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.
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    Acute-on-chronic liver failure:consensus recommendations of the Asian Pacific association for the study of the liver (APASL):an update.
    (Springer,, 2019) Sarin, S.K.; Choudhury, A.; Sharma, M.K.; Maiwall, R.; Al Mahtab, M.; Rahman, S.; Saigal, S.; Saraf, N.; Soin, A.S.; Devarbhavi, H.; Kim, D.J.; Dhiman, R.K.; Duseja, A.; Taneja, S.; Eapen, C.E.; Goel, A.; Ning, Q.; Chen, T.; Ma, K.; Duan, Z.; Yu, C.; Treeprasertsuk, S.; Hamid, S.S.; Butt, A.S.; Hamid, S.S.; Butt, A.S.; Jafri, W.; Shukla, A.; Saraswat, V.; Tan, S.S.; Sood, A.; Midha, V.; Goyal, O.; Ghazinyan, H.; Arora, A.; Hu, J.; Sahu, M.; Rao, P.N.; Lee, G.H.; Lim, S.G.; Lesmana, L.A.; Lesmana, C.R.; Shah, S.; Prasad, V.G.M.; Payawal, D.A.; Abbas, Z.; Dokmeci, A.K.; Sollano, J.D.; Carpio, G.; Shresta, A.; Lau, G.K.; Fazal Karim, M.; Shiha, G.; Gani, R.; Kalista, K.F.; Yuen, M.F.; Alam, S.; Khanna, R.; Sood, V.; Lal, B.B.; Pamecha, V.; Jindal, A.; Rajan, V.; Arora, V.; Yokosuka, O.; Niriella, M.A.; Li, H.; Qi, X.; Tanaka, A.; Mochida, S.; Chaudhuri, D.R.; Gane, E.; Win, K.M.; Chen, W.T.; Rela, M.; Kapoor, D.; Rastogi, A.; Kale, P.; Rastogi, A.; Sharma, C.B.; Bajpai, M.; Singh, V.; Premkumar, M.; Maharashi, S.; Olithselvan, A.; Philips, C.A.; Srivastava, A.; Yachha, S.K.; Wani, Z.A.; Thapa, B.R.; Saraya, A.; Shalimar; Kumar, A.; Wadhawan, M.; Gupta, S.; Madan, K.; Sakhuja, P.; Vij, V.; Sharma, B.C.; Garg, H.; Garg, V.; Kalal, C.; Anand, L.; Vyas, T.; Mathur, R.P.; Kumar, G.; Jain, P.; Pasupuleti, S.S.R.; Chawla, Y.K.; Chowdhury, A.; Alam, S.; Song, D.S.; Yang, J.M.; Yoon, E.L.; APASL ACLF Research Consortium (AARC) for APASL ACLF working Party
    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.
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    APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure.
    (Springer, 2024) Maiwall, R.; Singh, S.P.; Angeli, P.; Moreau, R.; Krag, A.; Singh, V.; Singal, A.K.; Tan, S.S.; Puri, P.; Mahtab, M.; Lau, G.; Ning, Q.; Sharma, M.K.; Rao, P.N.; Kapoor, D.; Gupta, S.; Duseja, A.; Wadhawan, M.; Jothimani, D.; Saigal, S.; Taneja, S.; Shukla, A.; Govil, D.; Pandey, G.; Madan, K.; Eapen, C.E.; Benjamin, J.; Chowdhury, A.; Salao, V.; Yang, J.M.; Hamid, S.; Shalimar; Jasuja, S.; Kulkarni, A.V.; Niriella, M.A.; Tevethia, H.V.; Arora, V.; Mathur, R.P.; Roy, A.; Jindal, A.; Saraf, N.; Verma, N.; Arka, D.; Choudhary, N.S.; Mehtani, R.; Chand, P.; Rudra, O.; Sarin, S.K.; Puri, P.; Singh, S.
    Acute-on-chronic liver failure (ACLF) is a syndrome that is characterized by the rapid development of organ failures predisposing these patients to a high risk of short-term early death. The main causes of organ failure in these patients are bacterial infections and systemic inflammation, both of which can be severe. For the majority of these patients, a prompt liver transplant is still the only effective course of treatment. Kidneys are one of the most frequent extrahepatic organs that are affected in patients with ACLF, since acute kidney injury (AKI) is reported in 22.8-34% of patients with ACLF. Approach and management of kidney injury could improve overall outcomes in these patients. Importantly, patients with ACLF more frequently have stage 3 AKI with a low rate of response to the current treatment modalities. The objective of the present position paper is to critically review and analyze the published data on AKI in ACLF, evolve a consensus, and provide recommendations for early diagnosis, pathophysiology, prevention, and management of AKI in patients with ACLF. In the absence of direct evidence, we propose expert opinions for guidance in managing AKI in this very challenging group of patients and focus on areas of future research. This consensus will be of major importance to all hepatologists, liver transplant surgeons, and intensivists across the globe.
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    Asia-Pacific association for study of liver guidelines on management of ascites in liver disease
    (Springer, 2023) Singh, V.; De, A.; Mehtani, R.; Angeli, P.; Maiwall, R.; Satapathy, S.; Singal, A.K.; Saraya, A.; Sharma, B.C.; Eapen, C.E.; Rao, P.N.; Shukla, A.; Shalimar; Choudhary, N.S.; Alcantara-Payawal, D.; Arora, V.; Aithal, G.; Kulkarni, A.; Roy, A.; Shrestha, A.; Mamun, A.M.; Niriella, M.A.; Siam, T.S.; Zhang, C.Q.; Huei, L.G.; Yu, M.L.; Roberts, S.K.; Peng, C.Y.; Chen, T.; George, J.; Wong, V.; Yilmaz, Y.; Treeprasertsuk, S.; Kurniawan, J.; Kim, S.U.; Younossi, Z.M.; Sarin, S.K.
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    Correction to: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update
    (Springer, 2019) Sarin, S.K.; Choudhury, A.; Sharma, M.K.; Maiwall, R.; Al Mahtab, M.; Rahman, S.; Saigal, S.; Saraf, N.; Soin, A.S.; Devarbhavi, H.; Kim, D.J.; Dhiman, R.K.; Duseja, A.; Taneja, S.; Eapen, C.E.; Goel, A.; Ning, Q.; Chen, T.; Ma, K.; Duan, Z.; Yu, C.; Treeprasertsuk, S.; Hamid, S.S.; Butt, A.S.; Jafri, W.; Shukla, A.; Saraswat, V.; Tan, S.S.; Sood, A.; Midha, V.; Goyal, O.; Ghazinyan, H.; Arora, A.; Hu, J.; Sahu, M.; Rao, P.N.; Lee, G.H.; Lim, S.G.; Lesmana, L.A.; Lesmana, C.R.; Shah, S.; Prasad, V.G.M.; Payawal, D.A.; Abbas, Z.; Dokmeci, A.K.; Sollano, J.D.; Carpio, G.; Shresta, A.; Lau, G.K.; Karim, M.F.; Shiha, G.; Gani, R.; Kalista, K.F.; Yuen, M.F.; Alam, S.; Khanna, R.; Sood, V.; Lal, B.B.; Pamecha, V.; Jindal, A.; Rajan, V.; Arora, V.; Yokosuka, O.; Niriella, M.A.; Li, H.; Qi, X.; Tanaka, A.; Mochida, S.; Chaudhuri, D.R.; Gane, E.; Win, K.M.; Chen, W.T.; Rela, M.; Kapoor, D.; Rastogi, A.; Kale, P.; Rastogi, A.; Sharma, C.B.; Bajpai, M.; Singh, V.; Premkumar, M.; Maharashi, S.; Olithselvan, A.; Philips, C.A.; Srivastava, A.; Yachha, S.K.; Wani, Z.A.; Thapa, B.R.; Saraya, A.; Shalimar; Kumar, A.; Wadhawan, M.; Gupta, S.; Madan, K.; Sakhuja, P.; Vij, V.; Sharma, B.C.; Garg, H.; Garg, V.; Kalal, C.; Anand, L.; Vyas, T.; Mathur, R.P.; Kumar, G.; Jain, P.; Pasupuleti, S.S.R.; Chawla, Y.K.; Chowdhury, A.; Alam, S.; Song, D.S.; Yang, J.M.; Yoon, E.L.; APASL ACLF Research Consortium (AARC) for APASL ACLF working Party
    The article Acute-on-chronic liver failure: consensus recommendations of the Asian Pacifc association for the study of the liver (APASL): an update, written by [Shiv Sarin], was originally published electronically on the publisher’s internet portal (currently SpringerLink) on June 06, 2019 without open access. This corrects the article "Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update" in Hepatol Int, volume 13 on page 353. Hepatology International. 2019 ;13(4):353-390.