Browsing by Author "Sarin, S.K."

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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.
Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)
(Springer International, 2009) Sarin, S.K.; Kumar, A.; Almeida, J.A.; Chawla, Y.K.; Fan, S.T.; Garg, H.; de Silva, H.J.; Hamid, S.S.; Jalan, R.; Komolmit, P.; Lau, G.K.; Liu, Q.; Madan, K.; Mohamed, R.; Ning, Q.; Rahman, S.; Rastogi, A.; Riordan, S.M.; Sakhuja, P.; Samuel, D.; Shah, S.; Sharma, B.C.; Sharma, P.; Takikawa, Y.; Thapa, B.R.; Wai, C.T.; Yuen, M.F.
The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on acute-on-chronic liver failure (ACLF) in 2004, with a mandate to develop consensus guidelines on various aspects of ACLF relevant to disease patterns and clinical practice in the Asia-Pacific region. Experts predominantly from the Asia-Pacific region constituted this working party and were requested to identify different issues of ACLF and develop the consensus guidelines. A 2-day meeting of the working party was held on January 22-23, 2008, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and subsequently presented at the Annual Conference of the APASL at Seoul, Korea, in March 2008. The consensus statements along with relevant background information are presented in this review.
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.
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.
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.
No abstract available
Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy
(Springer,New York, 2022) Kumar, M.; Abbas, Z.; Azami, M.; Belopolskaya, M.; Dokmeci, A.K.; Ghazinyan, H.; Jia, J.; Jindal, A.; Lee, H.C.; Lei, W.; Lim, S.G.; Liu, C.J.; Li, Q.; Mahtab, M.A.; Muljono, D.H.; Niriella, M.A.; Omata, M.; Payawal, D.A.; Sarin, S.K.; Ségéral, O.; Tanwandee, T.; Trehanpati, N.; Visvanathan, K.; Yang, J.M.; Yuen, M.F.; Zheng, Y.; Zhou, Y.H.
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.
Consensus on extra-hepatic portal vein obstruction
(Wiley-Blackwell, 2006) Sarin, S.K.; Sollano, J.D.; Chawla, Y.K.; Amarapurkar, D.; Hamid, S.; Hashizume, M.; Jafri, W.; Kumar, A.; Kudo, M.; Lesmana, L.A.; Sharma, B.C.; Shiha, G.; de Silva, H.J.
The Asian Pacific Association for the Study of the Liver (APASL) had set up a working party on portal hypertension in 2002 with a mandate to develop consensus on various aspects of portal hypertension. The first of these consensuses has been developed on extra-hepatic portal vein obstruction(EHPVO). It was discussed and prepared by the experts in this field from the Asian region and was presented at the annual meeting of the APASL, at Bali in August 2005. This article summarizes all the consensus statements approved by the APASL on various aspects of EHPVO.
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.
COVID-19 and gastroenterology: clinical insights and recommendations for gastroenterology care providers
(Universitetsforlager/Informa Healthcare, 2020) Niriella, M.A.; de Silva, A.P.; Liyanage, K.I.; Sarin, S.K.; de Silva, H.J.
ABSTRACT: While the COVID-19 pandemic evolves, we are beginning to understand the role the gastrointestinal tract plays in the disease and the impact of the infection on the care of patients with gastrointestinal (GI) and liver diseases. We review the data and understanding around the virus related to the digestive tract, impact of the pandemic on delivery of GI services and daily gastroenterology clinical practice, and the effects on patients with pre-existing GI diseases. KEYWORDS: COVID-19; gastroenterology; hepatology; pandemic.
Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations
(Springer International, 2011) Sarin, S.K.; Kumar, A.; Angus, P.W.; Baijal, S.S.; Baik, S.K.; Bayraktar, Y.; Chawla, Y.K.; Choudhuri, G.; Chung, J.W.; de Franchis, R.; de Silva, H.J.; Garg, H.; Garg, P.K.; Helmy, A.; Hou, M.C.; Jafri, W.; Jia, J.D.; Lau, G.K.; Li, C.Z.; Lui, H.F.; Maruyama, H.; Pandey, C.M.; Puri, A.S.; Rerknimitr, R.; Sahni, P.; Saraya, A.; Sharma, B.C.; Sharma, P.; Shiha, G.; Sollano, J.D.; Wu, J.; Xu, R.Y.; Yachha, S.K.; Zhang, C.; Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension.
BACKGROUND: Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live. METHODS: The expert working party, predominantly from the Asia-Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. RESULTS: AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (<30 min of hospitalization) and endoscopic variceal ligation (door to scope time <6 h) is accepted as first-line therapy. Rebleeding (48 h of T (0)) is further sub-classified as very early rebleeding (48 to 120 h from T (0)), early rebleeding (6 to 42 days from T (0)) and late rebleeding (after 42 days from T (0)) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of non-response to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients. CONCLUSION: Management of acute variceal bleeding in Asia-Pacific region needs special attention for uniformity of treatment and future clinical trials.
A global survey on the use of the international classification of diseases codes for metabolic dysfunction-associated fatty liver disease
(Springer, 2024) Zhang, H.; Targher, G.; Byrne, C.D.; Kim, S.U.; Wong, V.W.; Valenti, L.; Glickman, M.; Ponce, J.; Mantzoros, C.S.; Crespo, J.; Gronbaek, H.; Yang, W.; Eslam, M.; Wong, R.J.; Machado, M.V.; Yu, M.; Ghanem, O.M.; Okanoue, T.; Liu, J.; Lee, Y.; Xu, X.; Pan, Q.; Sui, M.; Lonardo, A.; Yilmaz, Y.; Zhu, L.; Moreno, C.; Miele, L.; Lupsor-Platon, M.; Zhao, L.; LaMasters, T.L.; Gish, R.G.; Zhang, H.; Nedelcu, M.; Chan, W.K.; Xia, M.; Bril, F.; Shi, J.; Datz, C.; Romeo, S.; Sun, J.; Liu, D.; Sookoian, S.; Mao, Y.; Méndez-Sánchez, N.; Wang, X.; Pyrsopoulos, N.T.; Fan, J.; Fouad, Y.; Sun, D.; Giannini, C.; Chai, J.; Xia, Z.; Jun, D.W.; Li, G.; Treeprasertsuk, S.; Li, Y.; Cheung, T.T.; Zhang, F.; Goh, G.B.; Furuhashi, M.; Seto, W.; Huang, H.; Sessa, A.D.; Li, Q.; Cholongitas, E.; Zhang, L.; Silveira, T.R.; Sebastiani, G.; Adams, L.A.; Chen, W.; Qi, X.; Rankovic, I.; Ledinghen, V.D.; Lv, W.; Hamaguchi, M.; Kassir, R.; Müller-Wieland, D.; Romero-Gomez, M.; Xu, Y.; Xu, Y.; Chen, S.; Kermansaravi, M.; Kuchay, M.S.; Lefere, S.; Parmar, C.; Lip, G.Y.H.; Liu, C.; Åberg, F.; Lau, G.; George, J.; Sarin, S.K.; Zhou, J.; Zheng, M.; Niriella, M.A. (MAFLD ICD-11 coding collaborators)
BACKGROUND With the implementation of the 11th edition of the International Classification of Diseases (ICD-11) and the publication of the metabolic dysfunction-associated fatty liver disease (MAFLD) nomenclature in 2020, it is important to establish consensus for the coding of MAFLD in ICD-11. This will inform subsequent revisions of ICD-11.METHODS Using the Qualtrics XM and WJX platforms, questionnaires were sent online to MAFLD-ICD-11 coding collaborators, authors of papers, and relevant association members.RESULTS A total of 890 international experts in various fields from 61 countries responded to the survey. We also achieved full coverage of provincial-level administrative regions in China. 77.1% of respondents agreed that MAFLD should be represented in ICD-11 by updating NAFLD, with no significant regional differences (77.3% in Asia and 76.6% in non-Asia, p = 0.819). Over 80% of respondents agreed or somewhat agreed with the need to assign specific codes for progressive stages of MAFLD (i.e. steatohepatitis) (92.2%), MAFLD combined with comorbidities (84.1%), or MAFLD subtypes (i.e., lean, overweight/obese, and diabetic) (86.1%).CONCLUSIONS This global survey by a collaborative panel of clinical, coding, health management and policy experts, indicates agreement that MAFLD should be coded in ICD-11. The data serves as a foundation for corresponding adjustments in the ICD-11 revision.