Publications by authors named "Archita P Desai"
Objective: Clinical decision instruments (CDIs) could be useful to aid risk stratification and disposition of emergency department (ED) patients with cirrhosis. Our primary objective was to derive and internally validate a novel Cirrhosis Risk Instrument for Stratifying Post-Emergency department mortality (CRISPE) for the outcomes of 14- and 30-day post-ED mortality. Secondarily, we externally validated the existing Model for End-Stage Liver Disease (MELD) scores for explicit use in ED patients and prediction of the same outcomes.
View Article and Find Full Text PDFObjective: To investigate how individual social determinants of health (SDOH) and cumulative social disadvantage (CSD) affect survival and receipt of liver transplant (LT) in patients with hepatocellular carcinoma (HCC).
Methods: We enrolled 139 adult patients from two Indianapolis hospital systems between June 2019 and April 2022. Structured questionnaires collected SDOH and social risk factor data.
Background: In today's digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. "AgileNudge+" (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions.
View Article and Find Full Text PDFBackground And Aims: While TIPS is traditionally considered a bridge to liver transplant (LT), some patients achieve long-term transplant-free survival (TFS) with TIPS alone. Prognosis and need for LT should not only be assessed at time of procedure, but also re-evaluated in patients with favorable early outcomes.
Approach And Results: Adult recipients of TIPS in the multicenter advancing liver therapeutic approaches retrospective cohort study were included (N=1127 patients; 2040 person-years follow-up).
Introduction: Diagnostic paracentesis is recommended for patients with cirrhosis admitted to the hospital, but adherence is suboptimal with unclear impact on clinical outcomes. The aim of this meta-analysis was to assess the outcomes of early vs delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites.
Methods: We searched multiple databases for studies comparing early vs delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites.
Introduction: Emergency department (ED)-based care is required for cirrhosis management, yet the burden of cirrhosis-related ED healthcare utilization is understudied. We aimed to describe ED utilization within a statewide health system and compare the outcomes of high ED use (HEDU) vs non-HEDU in individuals with cirrhosis.
Methods: We retrospectively reviewed charts of adults with cirrhosis who presented to any of 16 EDs within the Indiana University Health system in 2021.
Background & Aims: The hospital frailty risk score (HFRS) identifies older patients at risk of poor outcomes and may have value in cirrhosis. We compared the Charlson (CCI), Elixhauser (ECI), and cirrhosis (CirCom) comorbidity indices with the HFRS in predicting outcomes for cirrhosis hospitalisations.
Methods: Using the National Inpatient Sample (quarter 4 of 2015-2019), we analysed cirrhosis hospitalisations.
Background: Alcohol relapse occurs frequently in alcohol-associated hepatitis (AH) survivors, but data on the frequency and course of recurrent alcohol-associated hepatitis (rAH) are sparse. We investigated the incidence, risk factors, and outcomes of rAH.
Methods: Hospitalized patients with AH from 2010 to 2020 at a large health care system were followed until death/liver transplant, last follow-up, or end of study (December 31, 2021).
Article Synopsis
- Patients with acute liver failure (ALF) can face multiple organ failures, which do not affect their prioritization on the liver transplant waitlist, prompting a study to assess the implications of these organ failures on survival rates.
- The study analyzed data from the United Network for Organ Sharing (UNOS) involving over 3,200 adults waitlisted for transplant, finding that having three or more organ failures significantly increased the risk of mortality both while waiting and after the transplant.
- Specifically, neurologic and respiratory failures were identified as critical factors influencing short-term mortality risk, suggesting that recognizing these failures could help in better organ allocation decisions.
Background And Aims: Little is known about the clinical characteristics and prognosis of hospitalized patients with moderate alcohol-associated hepatitis (mAH) as compared to severe alcohol-associated hepatitis (sAH). Therefore, we aimed to describe the clinical characteristics and risk factors associated with mortality in hospitalized mAH patients.
Methods: Patients hospitalized with alcohol-associated hepatitis (AH) from 1 January 2010 to 31 December 2020 at a large US healthcare system [11 hospitals, one liver transplant centre] were retrospectively analysed for outcomes.
Introduction: Hospital readmissions are common in patients with cirrhosis, but there are few studies describing readmission preventability. We aimed to describe the incidence, causes, and risk factors for preventable readmission in this population.
Methods: We performed a prospective cohort study of patients with cirrhosis hospitalized at a single center between June 2014 and March 2020 and followed up for 30 days postdischarge.
Article Synopsis
- This study investigates the relationship between race and ethnicity and the receipt of lifesaving procedures for patients with decompensated cirrhosis in the US over a decade, from 2009 to 2018.
- The research utilized data from the National Inpatient Sample, focusing on hospitalized patients with complications related to portal hypertension and analyzed the trends in treatment accessibility and mortality rates among different racial and ethnic groups.
- Findings show that among a significant number of hospital admissions, there are noteworthy disparities in the procedure rates for Black and Hispanic patients, suggesting ongoing racial inequities in medical interventions for cirrhosis.
Background And Aims: The Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used to measure health-related quality of life, yet, it has not been well-studied in chronic liver disease (CLD). This study compares PROMIS Profile-29 to Short-Form Health Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ) in patients with CLD.
Approach And Results: In all, 204 adult outpatients with CLD completed PROMIS-29, CLDQ, SF-36 and usability questionnaires.
Background: In patients with cirrhosis and acute kidney injury (AKI), longer time to AKI-recovery may increase the risk of subsequent major-adverse-kidney-events (MAKE).
Aims: To examine the association between timing of AKI-recovery and risk of MAKE in patients with cirrhosis.
Methods: Hospitalised patients with cirrhosis and AKI (n = 5937) in a nationwide database were assessed for time to AKI-recovery and followed for 180-days.
Background: The prognostic impact of acute kidney injury (AKI) recovery patterns in critically ill patients with cirrhosis is unknown. We aimed to compare mortality stratified by AKI recovery patterns and identify predictors of mortality in patients with cirrhosis and AKI admitted to the intensive care unit.
Materials And Methods: Patients with cirrhosis and AKI from 2016 to 2018 at 2 tertiary care intensive care units were analyzed (N=322).
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in persons with HIV (PWH) (HIV-NAFLD). It is unknown if HIV-NAFLD is associated with impairment in health-related quality of life (HRQOL). We examined HRQOL in PWH with and without NAFLD, compared HRQOL in HIV- versus primary NAFLD, and determined factors associated with HRQOL in these groups.
View Article and Find Full Text PDFBackground And Aims: The social determinants of health can pose barriers to accessing cancer screening and treatment and have been associated with cancer mortality. However, it is not clear whether area deprivation is independently associated with mortality in HCC and cholangiocarcinoma when controlling for individual-level social determinants of health.
Approach And Results: The cohort included individuals over 18 years old diagnosed with HCC (N=3460) or cholangiocarcinoma (N=781) and reported to the Indiana State Cancer Registry from 2009 to 2017.
Background And Aims: Single-center studies in patients undergoing TIPS suggest that elevated right atrial pressure (RAP) may influence survival. We assessed the impact of pre-TIPS RAP on outcomes using the Advancing Liver Therapeutic Approaches (ALTA) database.
Approach And Results: Total 883 patients in ALTA multicenter TIPS database from 2010 to 2015 from 9 centers with measured pre-TIPS RAP were included.
Article Synopsis
- Hepatic encephalopathy (HE) is a serious brain problem that can happen in people with liver disease, and it usually leads to bad health outcomes.
- The study looked at a tool called CAM-ICU, which helps check for delirium, and compared it to another method called West Haven Criteria to see how well it predicts patient outcomes.
- Results showed that people who tested positive with CAM-ICU had a much higher chance of dying in the hospital or within 30 to 90 days, showing that this tool is really good at identifying patients who are at risk.
Measuring Medication Use, Obstacles, and Knowledge in Individuals With Cirrhosis.
Clin Gastroenterol Hepatol
July 2023
Background & Aims: Although patient knowledge is modifiable, there are no widely accepted tools to measure patient understanding during cirrhosis care. We aimed to develop and validate "My Cirrhosis Coach" (MCC), a personalized, self-administered questionnaire to evaluate cirrhosis-related medication use, obstacles, and understanding.
Methods: Adults with cirrhosis were prospectively enrolled at 3 tertiary centers from July 2016 through July 2020.
Psychiatric Disorders and Their Treatment: Impact of Outcomes in Patients With Chronic Liver Disease.
Clin Liver Dis (Hoboken)
August 2022
Content available: Audio Recording.
View Article and Find Full Text PDFIntroduction: Alcohol-related liver disease (ALD) is now the leading indication for liver transplantation (LT) in the United States (US). It remains unclear how centers are managing the medical and psychosocial issues associated with these patients.
Methods: We conducted a web-based survey of LT centers in the United States to identify center-level details on peri-LT management of ALD and related issues.