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{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}

}