Publications by authors named "Anand V Kulkarni"

Article Synopsis
  • The study investigates the impact of functional status, measured by Karnofsky performance status (KPS), on the outcomes of patients with severe alcohol-associated hepatitis (AH).
  • It compares long-term survival rates, recompensation, corticosteroid responses, and complications between patients with good KPS (score ≥50) and poor KPS (score <50).
  • Results show that patients with good KPS have significantly better survival rates, higher recompensation rates, and more favorable responses to treatment compared to those with poor KPS.
View Article and Find Full Text PDF
Article Synopsis
  • - The study investigates the risk of hepatocellular carcinoma (HCC) in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) and a low fibrosis-4 index (FIB-4), which is used to assess liver health.
  • - Out of 613 participants diagnosed with MASLD-related HCC, 13% had a low FIB-4, with 26% among those without cirrhosis, indicating potential missed cases for further evaluation.
  • - The findings suggest that current guidelines may fail to identify over a quarter of MASLD-related HCC patients without cirrhosis who present a low FIB-4, highlighting a need for updated clinical pathways.
View Article and Find Full Text PDF
Article Synopsis
  • - Liver is heavily impacted by alcohol misuse, with conditions ranging from simple fat accumulation to severe liver cirrhosis, and alcohol-associated hepatitis has a high risk of short-term mortality.
  • - Current research on alcohol-associated liver disease (ALD) often overlooks important aspects, focusing mainly on short-term survival instead of broader issues related to alcohol-use disorder.
  • - The authors emphasize the existing gaps in understanding ALD, describe ongoing clinical trials, and outline future research priorities for better treatment and management strategies.
View Article and Find Full Text PDF

Background & Aims: Chronic hepatitis C-related decompensated cirrhosis is associated with lower sustained virologic response (SVR)-12 rates and variable regression of disease severity after direct-acting antiviral agents. We assessed rates of SVR-12, recompensation (Baveno VII criteria), and survival in such patients.

Methods: Between July 2018 and July 2023, patients with decompensated chronic hepatitis C-related cirrhosis after direct-acting antiviral agents treatment were evaluated for SVR-12 and then had 6-monthly follow-up.

View Article and Find Full Text PDF

Globally, nearly half of deaths from cirrhosis and chronic liver diseases (CLD) and three-quarters of deaths from hepatocellular carcinoma (HCC) occur in the Asia-Pacific region. Chronic hepatitis B is responsible for the vast majority of liver-related deaths in the region. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of CLD, affecting an estimated 30% of the adult population.

View Article and Find Full Text PDF
Article Synopsis
  • Acute liver failure (ALF) is a critical condition that may require liver transplantation, with its main causes in India being viral, particularly hepatitis A which accounts for 44.2% of cases.
  • A study analyzed 183 ALF patients from four major hospitals in India between 2021 and 2023, highlighting the effectiveness of interventions such as plasma exchange (PLEx) and continuous renal replacement therapy (CRRT), showing a low rate of liver transplants at only 3.8%.
  • Key predictors of mortality included advanced hepatic encephalopathy and meeting specific medical criteria at admission, suggesting the importance of early intervention and potential for improved outcomes with vaccination against hepatitis A.
View Article and Find Full Text PDF

Acute liver failure (ALF) is a life-threatening disorder characterised by rapid deterioration of liver function, coagulopathy, and hepatic encephalopathy in the absence of pre-existing liver disease. The cause of ALF varies across the world. Common causes of ALF in adults include drug toxicity, hepatotropic and non-hepatotropic viruses, herbal and dietary supplements, antituberculosis drugs, and autoimmune hepatitis.

View Article and Find Full Text PDF

Background: Steatotic liver disease (SLD) encompasses metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (AALD) at extremes as well as an overlap group termed MASLD with increased alcohol intake (MetALD). The Alcoholic Liver Disease/Nonalcoholic Fatty Liver Disease Index (ANI) was proposed to differentiate ALD from nonalcoholic fatty liver disease (NAFLD). We analysed the performance of the ANI in differentiating within the SLD spectrum.

View Article and Find Full Text PDF

Acute liver failure (ALF) and acute-on-chronic liver (ACLF) are distinct phenotypes of liver failure and, thus, need to be compared and contrasted for appropriate management. There has been a significant improvement in the outcomes of these patients undergoing liver transplantation (LT). Survival post-LT for ALF and ACLF ranges between 90% and 95% and 80% and 90% at 1 year, futility criteria have been described in both ALF and ACLF where organ failures define survival.

View Article and Find Full Text PDF

Hazardous alcohol consumption is the leading cause of liver disease worldwide. Alcohol-associated hepatitis (AH) is an acute and serious presentation of alcohol-associated liver disease that is associated with high short-term mortality. Medical management remains limited to corticosteroid therapy and intensive nutrition but improves survival in <50% of individuals.

View Article and Find Full Text PDF
Article Synopsis
  • MAFLD (Metabolic Dysfunction-Associated Fatty Liver Disease) is becoming more common, and it can lead to serious liver problems called MAFLD-ACLF, but what affects patient recovery isn't fully known yet.
  • In a study, researchers looked at data from patients with MAFLD-ACLF to understand their health conditions and see who survived after 90 days, finding that about 51% of patients did survive.
  • They discovered new scoring systems to better predict survival, which included factors like diabetes and the causes of liver damage, and these new scores worked better than older ones.
View Article and Find Full Text PDF

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in India. This review explores the epidemiological trends and the landscape of systemic therapy for HCC in the Indian context, acknowledging the recent shift in etiology from viral hepatitis to lifestyle-associated factors. A comprehensive review of the literature was conducted, including data from the Global Cancer Observatory and the Indian Council of Medical Research, along with a critical analysis of various clinical trials.

View Article and Find Full Text PDF

Hospitalized patients with cirrhosis frequently require critical care management for sepsis, HE, respiratory failure, acute variceal bleeding, acute kidney injury (AKI), shock, and optimization for liver transplantation, while outpatients have unique care considerations. Point-of-care ultrasonography (POCUS) enhances bedside examination of the hepatobiliary system and relevant extrahepatic sites. POCUS includes cardiac US and is used to assess volume status and hemodynamic parameters like cardiac output, systemic vascular resistance, cardiac contractility, and pulmonary artery pressure, which aid in the early and accurate diagnosis of heart failure, cirrhotic cardiomyopathy, porto-pulmonary hypertension, hepatopulmonary syndrome, arrhythmia, and pulmonary embolism.

View Article and Find Full Text PDF

Backgrounds/aims: Hepatocellular carcinoma (HCC) is generally diagnosed at an advanced stage, which limits curative treatment options for these patients. Locoregional therapy (LRT) is the standard approach to bridge and downstage unresectable HCC for liver transplantation (LT). Atezolizumab-bevacizumab (atezo-bev) can induce objective responses in nearly one-third of patients; however, the role and outcomes of downstaging using atezo-bev remains unknown.

View Article and Find Full Text PDF

Importance: Cohort studies demonstrating an association of hepatocellular carcinoma (HCC) screening with reduced mortality are prone to lead-time and length-time biases.

Objective: To characterize the clinical benefits of HCC screening, adjusting for lead-time and length-time biases, in a diverse, contemporary cohort of at-risk patients.

Design, Setting, And Participants: This retrospective cohort study of patients with HCC was conducted between January 2008 and December 2022 at 2 large US health systems.

View Article and Find Full Text PDF

Background And Objectives: Hepatitis A virus (HAV)-related hepatitis is witnessing an epidemiological transition with increasing trends in adults. While uncomplicated hepatitis remains common, evidence suggests it to be a growing cause for acute liver failure (ALF). In between the two extremes exists severe acute liver injury (s-ALI) which has a propensity to transition to ALF.

View Article and Find Full Text PDF

Background And Aims: Alcohol-associated hepatitis (AH) poses significant short-term mortality. Existing prognostic models lack precision for 90-day mortality. Utilizing artificial intelligence in a global cohort, we sought to derive and validate an enhanced prognostic model.

View Article and Find Full Text PDF