Publications

@article{Subhani2022-er,

title = {Diagnostic accuracy of serum ascites albumin gradient (SAAG) 

 in a contemporary unselected medical cohort},

author = {Mohsan Subhani and Abhishek Sheth and Naaventhan Palaniyappan and Peuish Sugathan and Emilie A Wilkes and Guruprasad P Aithal},

year  = {2022},

date = {2022-11-01},

journal = {J. Int. Med. Res.},

volume = {50},

number = {11},

pages = {3000605221140310},

publisher = {SAGE Publications},

abstract = {OBJECTIVES: To describe the different aetiologies of ascites and 

 test the validity of serum ascites albumin gradient (SAAG) and 

 cytology in a contemporary unselected medical cohort. METHODS: 

 All adult patients admitted to Nottingham University Hospitals, 

 UK, between 1 May 2013 and 30 April 2018 with new-onset 

 radiologically-confirmed ascites were included. Data were 

 analysed to determine the distribution of different aetiologies 

 of ascites and the diagnostic accuracy of SAAG in portal 

 hypertension and cytology in malignancy as underlying causes of 

 ascites. RESULTS: Over 5 years, 286 patients presented with 

 new-onset ascites; 122 surgical cases were excluded. Most patients were men (n = 84, 51.2%) over 50 years of age (n = 142, 86.6%). Cirrhosis accounted for 54.9% (n = 90) of the cases of ascites followed by malignancy (n = 48, 29.3%) and cardiac failure (n = 10, 6.1%). SAAG $geq$11 g/L had a 

 sensitivity of 85.5% and specificity of 60.6% for diagnosing portal hypertension as a cause of ascites (diagnostic accuracy = 

 78.5%, 95% confidence interval (CI): 69.8-85.5; area under the curve (AUC) = 0.756, 95% CI: 0.652-0.860). Ascitic fluid 

 cytology was positive in 50% of malignant cases and 66% of 

 primary peritoneal carcinomatosis cases. CONCLUSION: The 

 underlying aetiology and the validity of available tests varied 

 substantially compared with previous reports.},

keywords = {ascites, cirrhosis, contemporary cohort, cytology, liver   disease, retrospective, serum ascites albumin gradient},

pubstate = {published},

tppubtype = {article}

}

@article{Macken2021-pd,

title = {Large volume paracentesis: to do or where to do?},

author = {Lucia Macken and Naaventhan Palaniyappan and Sumita Verma and Guruprasad Aithal},

year  = {2021},

date = {2021-12-01},

journal = {Gut},

volume = {70},

number = {12},

pages = {2401\textendash2402},

publisher = {BMJ},

keywords = {ascites, cirrhosis},

pubstate = {published},

tppubtype = {article}

}

@article{Mattock2021-fz,

title = {Economic evaluation of covered stents for transjugular 

 intrahepatic portosystemic stent shunt in patients with variceal 

 bleeding and refractory ascites secondary to cirrhosis},

author = {Richard Mattock and Dhiraj Tripathi and Frank O'Neill and Joyce Craig and Jennifer Tanner and David Patch and Guruprasad Aithal},

year  = {2021},

date = {2021-08-01},

journal = {BMJ Open Gastroenterol.},

volume = {8},

number = {1},

pages = {e000641},

publisher = {BMJ},

abstract = {OBJECTIVES: Transjugular intrahepatic portosystemic stent shunt 

 (TIPSS) is clinically effective in variceal bleeding and 

 refractory ascites; however, the cost-effectiveness of TIPSS has 

 yet to be evaluated in the UK. This study aimed to establish the 

 cost-effectiveness of (i) pre-emptive TIPSS versus endoscopic 

 band ligation (EBL) in populations with variceal bleeding and 

 (ii) TIPSS versus large volume paracentesis (LVP) in refractory 

 ascites. METHODS: A cost-utility analysis was conducted with the 

 perspective including healthcare costs and quality-adjusted life 

 years (QALYs). A Markov model was constructed with a 2-year time 

 horizon, health states for mortality and survival and 

 probabilities for the development of variceal bleeding, ascites 

 and hepatic encephalopathy. A survival analysis was conducted to 

 extrapolate 12-month to 24-month mortality for the refractory 

 ascites indication. Uncertainty was analysed in deterministic 

 and probabilistic sensitivity analyses. RESULTS: TIPSS was 

 cost-effective (dominant) and cost saving for both indications. 

 For variceal bleeding, pre-emptive TIPSS resulted in 0.209 

 additional QALYs, and saved pounds600 per patient compared 

 with EBL. TIPSS had a very high probability of being 

 cost-effective (95%) but was not cost saving in scenario 

 analyses driven by rates of variceal rebleeding. For refractory 

 ascites, TIPSS resulted in 0.526 additional QALYs and saved 

 pounds17 983 per patient and had a 100% probability of being 

 cost-effective and cost saving when compared with LVP. 

 CONCLUSIONS: TIPSS is a cost-effective intervention for variceal 

 bleeding and refractory ascites. TIPSS is highly cost-saving for 

 refractory ascites. Robust randomised trial data are required to 

 confirm whether pre-emptive TIPSS is cost saving for variceal 

 bleeding.},

keywords = {ascites, bleeding, cost-effectiveness, economic evaluation, liver cirrhosis},

pubstate = {published},

tppubtype = {article}

}

@article{Aithal2021-ns,

title = {Guidelines on the management of ascites in cirrhosis},

author = {Guruprasad P Aithal and Naaventhan Palaniyappan and Louise China and Suvi H\"{a}rm\"{a}l\"{a} and Lucia Macken and Jennifer M Ryan and Emilie A Wilkes and Kevin Moore and Joanna A Leithead and Peter C Hayes and Alastair J O'Brien and Sumita Verma},

year  = {2021},

date = {2021-01-01},

journal = {Gut},

volume = {70},

number = {1},

pages = {9\textendash29},

publisher = {BMJ},

abstract = {The British Society of Gastroenterology in collaboration with 

 British Association for the Study of the Liver has prepared this 

 document. The aim of this guideline is to review and summarise 

 the evidence that guides clinical diagnosis and management of 

 ascites in patients with cirrhosis. Substantial advances have 

 been made in this area since the publication of the last 

 guideline in 2007. These guidelines are based on a comprehensive 

 literature search and comprise systematic reviews in the key 

 areas, including the diagnostic tests, diuretic use, therapeutic 

 paracentesis, use of albumin, transjugular intrahepatic 

 portosystemic stent shunt, spontaneous bacterial peritonitis and 

 beta-blockers in patients with ascites. Where recent systematic 

 reviews and meta-analysis are available, these have been updated 

 with additional studies. In addition, the results of prospective 

 and retrospective studies, evidence obtained from expert 

 committee reports and, in some instances, reports from case 

 series have been included. Where possible, judgement has been 

 made on the quality of information used to generate the 

 guidelines and the specific recommendations have been made 

 according to the 'Grading of Recommendations Assessment, 

 Development and Evaluation (GRADE)' system. These guidelines are 

 intended to inform practising clinicians, and it is expected 

 that these guidelines will be revised in 3 years' time.},

keywords = {ascites, cirrhosis},

pubstate = {published},

tppubtype = {article}

}