Publications by authors named "Christina Lindenmeyer"
Article Synopsis
- Blood products, specifically RBC transfusions, are commonly used in critically ill patients, prompting a detailed review of current practices and evidence to guide healthcare providers.
- A panel of experts evaluated existing literature and developed specific questions regarding RBC transfusions, ultimately analyzing 23 key studies to form strong and conditional recommendations.
- Overall, a restrictive transfusion strategy was found to be safer for most critically ill patients, decreasing RBC use without raising the risk of death or complications; however, it may not be suitable for patients with acute coronary syndrome (ACS).
Article Synopsis
- - Acetaminophen (APAP) overdose is the leading cause of acute liver failure (ALF) in the U.S., making timely intervention crucial.
- - Liver transplantation (LT) is a life-saving option for ALF, but its availability is often limited in healthcare settings.
- - A case study highlights a 44-year-old man with APAP-related ALF who successfully recovered liver function after treatment with the Molecular Adsorbent Recirculating System (MARS), though the device's role in ALF treatment is still unclear.
Background: Due to development of an immune-dysregulated phenotype, advanced liver disease in all forms predisposes patients to sepsis acquisition, including by opportunistic pathogens such as fungi. Little data exists on fungal infection within a medical intensive liver unit (MILU), particularly in relation to acute on chronic liver failure.
Aim: To investigate the impact of fungal infections among critically ill patients with advanced liver disease, and compare outcomes to those of patients with bacterial infections.
Article Synopsis
- Rifaximin is often given to critically ill liver disease patients, but studies typically exclude those recently treated with antibiotics, leading to potential overlap in therapy; a pharmacist-driven protocol was tested to withhold rifaximin during broad-spectrum antibiotic use.
- The study aimed to assess the safety and financial impact of stopping rifaximin in these patients, evaluating outcomes like days free of delirium and coma, ICU length of stay, and cost savings.
- Results showed no significant difference in delirium and coma-free days between patients who had rifaximin withheld and those who received it alongside antibiotics; thus, the protocol did not negatively impact patient safety or outcomes.
Article Synopsis
- The SALT-M score was developed to predict 1-year mortality after liver transplantation (LT) in patients with severe acute-on-chronic liver failure (ACLF) due to high mortality rates associated with this condition.
- The study analyzed data from 735 patients across 15 LT centers and identified key predictors of post-LT mortality and length of stay, such as age, inotrope use, respiratory failure, diabetes, and BMI.
- The results showed strong discrimination and calibration for the SALT-M score, indicating its potential use in evaluating transplant outcomes and guiding clinical decisions for patients with ACLF.
From cause to consequence: Insights into incident diabetes mellitus after hepatic steatosis.
Clin Liver Dis (Hoboken)
February 2023
Endo-hepatology: The changing paradigm of endoscopic ultrasound in cirrhosis.
Clin Liver Dis (Hoboken)
December 2022
Content available: Author Interview and Audio Recording.
View Article and Find Full Text PDFBackground: Patients undergoing simultaneous liver-kidney transplantation (SLK) have impaired native kidney function. The relative contribution of allograft versus native function after SLK is unknown. We sought to characterize the return of native kidney function following SLK.
View Article and Find Full Text PDFCirrhosis has been regarded as a hypocoagulable state associated with an increased risk of bleeding. But patients with cirrhosis also have a high incidence of thrombotic complications, challenging this dogma. We now recognize that in cirrhosis there is a simultaneous decrease in both clotting and anticlotting factors, leading to a new equilibrium.
View Article and Find Full Text PDFAims: Previous studies have reported conflicting results regarding prevalence of elevated LC (2-70%) in celiac disease (CD). This systematic review and meta-analysis assessed the prevalence of elevated LC at time of CD diagnosis and associated response to GFD. We also report the prevalence of CD in patients with unexplained elevation of LC.
View Article and Find Full Text PDFEpstein-Barr virus (EBV)-associated smooth muscle tumors (SMT) have been described in immunosuppressed states, including in post-transplant patients. Here, we discuss a heart-liver transplant recipient who was found to have multifocal hepatic EBV-SMT. His immunosuppression was initially transitioned from tacrolimus to sirolimus because of the proposed benefits of the mechanistic target of rapamycin inhibitors on EBV-SMT.
View Article and Find Full Text PDFBackground & Aims: Although liver transplantation (LT) has been demonstrated to provide survival benefit for patients with acute-on-chronic liver failure (ACLF), data are lacking regarding resource utilization for this population after LT.
Methods: We retrospectively reviewed data from 10 centers in North America of patients transplanted between 2018 and 2019. ACLF was identified by using the European Association for the Study of the Liver-Chronic Liver Failure criteria.
Although liver transplantation (LT) yields survival benefit for patients with acute-on-chronic liver failure grade 3 (ACLF-3), knowledge gaps remain regarding risk factors for post-LT mortality. We retrospectively reviewed data from 10 centers in the United States and Canada for patients transplanted between 2018 and 2019 and who required care in the intensive care unit prior to LT. ACLF was identified using the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) criteria.
View Article and Find Full Text PDFThe multi-organ failure syndrome associated with acute and acute-on-chronic liver failure (ACLF) is thought to be mediated by overwhelming systemic inflammation triggered by both microbial and non-microbial factors. Therapeutic plasma exchange (TPE) has been proven to be an efficacious therapy in autoimmune conditions and altered immunity, with more recent data supporting its use in the management of liver failure. Few therapies have been shown to improve survival in critically ill patients with liver failure who are not expected to survive until liver transplantation (LT), who are ineligible for LT or who have no access to LT.
View Article and Find Full Text PDFConsumption of herbal supplements has been linked to multiorgan toxicities. Kratom is an herbal extract that has gained popularity for its analgesic and psychotropic properties. Several cases of kratom-induced liver injury have been reported, but data on multiorgan involvement remain scarce.
View Article and Find Full Text PDFObjectives: Studies of the use of IV N-acetylcysteine in the management of non-acetaminophen-induced acute liver failure have evaluated various dosing regimens. The only randomized trial studying this application described a 72-hour regimen. However, observational studies have reported extended duration until normalization of international normalized ratio.
View Article and Find Full Text PDFAcute on chronic liver failure (ACLF) is a unique syndrome that afflicts patients with chronic liver disease and results in high short-term mortality, in the setting of organ system failures. Given this prognosis, there is an urgent need to understand risk factors for this condition, for appropriate medical management of organ failures, and for selection criteria for patients who may benefit from liver transplantation (LT). Although several definitions exist to identify ACLF, all of them are designed to identify patients with uniquely high mortality.
View Article and Find Full Text PDFHypoxic hepatitis is a common cause of abnormal liver biochemistries in hospitalized patients. It is important clinicians maintain a high index of suspicion for diagnosis so that appropriate supportive therapies may be implemented in a timely manner. We present a rare case of takotsubo cardiomyopathy-induced hypoxic hepatitis and resultant acute liver failure in a patient after an intentional drug overdose.
View Article and Find Full Text PDFArticle Synopsis
- Providers recognize the need for improved Hepatocellular carcinoma (HCC) surveillance, with nearly all endorsing semi-annual checks for patients with cirrhosis, mostly recommending ultrasound with alpha fetoprotein.
- Barriers to effective surveillance include limited treatment options, questions about screening effectiveness, transportation issues, and high costs, while professional guidelines are seen as helpful facilitators.
- Providers are open to adjusting surveillance strategies based on a patient's HCC risk, showing a preference for more tailored approaches rather than a universal strategy.