Publications by authors named "Eric Orman"
Background: Chronic kidney disease (CKD) frequency is increasing in patients with cirrhosis and these individuals often experience acute kidney injury (AKI). Direct comparisons of outcomes between AKI-only vs. AKI on CKD (AoCKD) among patients with cirrhosis are not well described.
View Article and Find Full Text PDFBackground: Sarcopenia at the time of liver transplantation (LT) is an established risk factor for mortality following LT. However, most studies in this context have defined sarcopenia by one-time, static measurements. The aims of this study were (I) to determine the impact of the rate of muscle loss in waitlisted LT recipients on post-LT outcomes and (II) to identify patterns of serum metabolites associated with patients with more progressive sarcopenia.
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.
Article Synopsis
- The study investigates the relationship between different causes of acute kidney injury requiring renal replacement therapy (AKI-RRT) and mortality in hospitalized patients with cirrhosis.
- Conducted across multiple U.S. hospitals in 2019, the research included 2,063 patients, finding that 18.1% underwent AKI-RRT.
- Results indicate that while patients with hepatorenal syndrome (HRS-AKI) received different treatment approaches compared to those with other causes of AKI, there was no significant difference in 90-day mortality risk between the two groups.
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 PDFAcute kidney injury (AKI) frequently complicates the course of hospitalized patients with cirrhosis and negatively affects their prognosis. How AKI response influences the timing of liver transplantation (LT) remains unclear. We sought to assess the impact of AKI response to treatment on survival and LT rates in patients with cirrhosis awaiting LT.
View Article and Find Full Text PDFBackground: Polypharmacy and anticholinergic medications are associated with cognitive decline in elderly populations. Although several medications have been associated with HE, associations between medication burden, anticholinergics, and HE have not been explored. We examined medication burden and anticholinergics in patients with cirrhosis and their associations with HE-related hospitalization.
View Article and Find Full Text PDFBackground & Aims: The development of acute kidney injury (AKI) in the setting of alcohol-associated hepatitis (AH) portends a poor prognosis. Whether the presence of AH itself drives worse outcomes in patients with cirrhosis and AKI is unknown.
Methods: Retrospective cohort study of 11 hospital networks of consecutive adult patients admitted in 2019 with cirrhosis and AKI.
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.
Understanding the prognostic significance of acute kidney injury (AKI) stage 1B [serum creatinine (sCr) ≥1.5 mg/dL] compared with stage 1A (sCr < 1.5 mg/dL) in a US population is important as it can impact initial management decisions for AKI in hospitalized cirrhosis patients.
View Article and Find Full Text PDFIntroduction: 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.
Background & Aims: Acute kidney injury (AKI) in cirrhosis is common and associated with high morbidity, but the incidence rates of different etiologies of AKI are not well described in the US. We compared incidence rates, practice patterns, and outcomes across etiologies of AKI in cirrhosis.
Methods: We performed a retrospective cohort study of 11 hospital networks, including consecutive adult patients admitted with AKI and cirrhosis in 2019.
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.
Article Synopsis
- Major adverse cardiac events (MACE) are a significant health risk after orthotopic liver transplantation (OLT), and cirrhotic cardiomyopathy (CCM) is a contributing factor to MACE in these patients.
- A study involving 131 adult patients who underwent OLT found that those who had ascites and hepatorenal syndrome, along with those meeting the 2005 CCM criteria, were more likely to experience MACE within a year.
- The 2005 CCM criteria were better predictors of MACE and showed a 34% reversibility post-OLT, while the newer 2019 criteria were less effective and only showed a 57% reversibility rate among fewer patients.
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).
Background 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.
Article Synopsis
- Coronary artery disease (CAD) is prevalent among patients with cirrhosis facing orthotopic liver transplantation (OLT) evaluation, and traditional stress echocardiograms can miss it.
- This study involved 88 patients with obstructive CAD and 97 without, using stress echo, CT scans, and cardiac catheterization to evaluate the role of vascular and valvular calcification in detecting CAD.
- The combination of calcification data from CT and echo with stress echo significantly enhanced CAD detection accuracy (area under the curve improved from 0.58 to 0.73), especially when considering age, gender, and diabetes history (further increased to 0.80).