2024
The Association Between Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Exposure and Key Cirrhosis-Related Outcomes.
Wang R, Serper M, Taddei T, Kaplan D, Mahmud N. The Association Between Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Exposure and Key Cirrhosis-Related Outcomes. The American Journal Of Gastroenterology 2024 PMID: 39051649, DOI: 10.14309/ajg.0000000000002976.Peer-Reviewed Original ResearchAssociated with hepatic decompensationAngiotensin-converting enzyme inhibitorsAssociated with reduced mortalityAngiotensin receptor blockersACE-I/ARBConverting enzyme inhibitorsCV-related mortalityHepatocellular carcinomaHepatic decompensationCox regressionAngiotensin receptor blocker exposureEnzyme inhibitorsVeterans Health AdministrationCalcium channel blockersSubsets of patientsChronic liver diseaseCause-specific hazard modelInverse probability treatmentIdentified new initiatorsOutcome of mortalityNew initiativesCirrhosis decompensationCompensated cirrhosisDecompensated cirrhosisChannel blockersOrganizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration
McCurdy H, Nobbe A, Scott D, Patton H, Morgan T, Bajaj J, Yakovchenko V, Merante M, Gibson S, Lamorte C, Baffy G, Ioannou G, Taddei T, Rozenberg-Ben-Dror K, Anwar J, Dominitz J, Rogal S. Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration. Digestive Diseases And Sciences 2024, 69: 2008-2017. PMID: 38616215, DOI: 10.1007/s10620-024-08409-6.Peer-Reviewed Original ResearchVeterans Affairs (VA) medical centersCirrhosis careDashboard usePopulation management toolCare processesSurveillance ratesDepartment of Veterans Affairs (VA) medical centersFactors associated with high performanceVeterans Health AdministrationHCC surveillanceSpecialty carePerceived barriersData Warehouse dataHealth AdministrationImplementation evaluationLinear regression modelsCareGastroenterology serviceMedical CenterMultivariate modelRegression modelsQuality measuresVeteransRate differencesWarehouse data
2023
Liver Stiffness Measurement and Risk Prediction of Hepatocellular Carcinoma After HCV Eradication in Veterans With Cirrhosis
John B, Dang Y, Kaplan D, Jou J, Taddei T, Spector S, Martin P, Bastaich D, Chao H, Dahman B. Liver Stiffness Measurement and Risk Prediction of Hepatocellular Carcinoma After HCV Eradication in Veterans With Cirrhosis. Clinical Gastroenterology And Hepatology 2023, 22: 778-788.e7. PMID: 38061410, PMCID: PMC10960676, DOI: 10.1016/j.cgh.2023.11.020.Peer-Reviewed Original ResearchSustained virological responseLiver stiffness measurementHepatitis C virusHepatocellular carcinomaHCV cirrhosisDiabetes mellitusAnnual riskChronic hepatitis C virusPortal hypertension-related complicationsRate of HCCRisk of HCCHypertension-related complicationsRetrospective cohort studyVeterans Health AdministrationStiffness measurementHCV eradicationVirological responseCohort studyC virusHCC riskLower riskCirrhosisCutoff levelHealth AdministrationAbstractTextThe Association Between Homelessness and Key Liver-Related Outcomes in Veterans With Cirrhosis
Pulaski M, Bittermann T, Taddei T, Kaplan D, Mahmud N. The Association Between Homelessness and Key Liver-Related Outcomes in Veterans With Cirrhosis. The American Journal Of Gastroenterology 2023, 119: 297-305. PMID: 37782293, DOI: 10.14309/ajg.0000000000002535.Peer-Reviewed Original ResearchInverse probability treatmentCause mortalityCohort studyCox regressionHepatocellular carcinomaProbability treatmentVeterans Health Administration patientsLiver-related outcomesTime-updated variablesLiver-related mortalityRetrospective cohort studyCause-specific mortality analysesVeterans Health AdministrationRisk regression modelsCirrhosis decompensationCirrhosis diagnosisPatient outcomesPatientsHomeless patientsHealth AdministrationMortality analysisCirrhosisMortalityDrivers of mortalityDecompensationPerformance of an automated deep learning algorithm to identify hepatic steatosis within noncontrast computed tomography scans among people with and without HIV
Torgersen J, Akers S, Huo Y, Terry J, Carr J, Ruutiainen A, Skanderson M, Levin W, Lim J, Taddei T, So‐Armah K, Bhattacharya D, Rentsch C, Shen L, Carr R, Shinohara R, McClain M, Freiberg M, Justice A, Re V. Performance of an automated deep learning algorithm to identify hepatic steatosis within noncontrast computed tomography scans among people with and without HIV. Pharmacoepidemiology And Drug Safety 2023, 32: 1121-1130. PMID: 37276449, PMCID: PMC10527049, DOI: 10.1002/pds.5648.Peer-Reviewed Original ResearchConceptsSevere hepatic steatosisHepatic steatosisHIV statusLiver attenuationHounsfield unitsPredictive valueRadiologist assessmentUS Veterans Health AdministrationNoncontrast abdominal CTVeterans Health AdministrationCross-sectional studySample of patientsNegative predictive valueReal-world studyPositive predictive valueAbdominal CTLiver fatTomography scanSteatosisCT imagesHealth AdministrationPharmacoepidemiologic studiesRadiologist reviewHIVPercent agreementThe association between mental illness and all-cause mortality in patients with cirrhosis: a Veterans Affairs retrospective cohort study
Shaffer L, Kaplan D, Taddei T, Mahmud N. The association between mental illness and all-cause mortality in patients with cirrhosis: a Veterans Affairs retrospective cohort study. Hepatology Communications 2023, 7: e0129. PMID: 36996031, PMCID: PMC10069831, DOI: 10.1097/hc9.0000000000000129.Peer-Reviewed Original ResearchConceptsMental health diagnosesAUD/SUDCause mortalityMental health visitsRetrospective cohort studyCohort studyHealth diagnosisHealth visitsSUD diagnosisMental illnessMental health clinic visitsMental health-related diagnosisOutpatient mental health visitsOutpatient mental health careVeterans Health AdministrationHealth-related careHealth-related diagnosesClinical practice changesHealth clinic visitsMental health careClinic visitsClinic utilizationCox regressionPsychiatric comorbiditySubgroup analysisAssociation between statin exposure and short-term mortality in patients with high-grade acute-on-chronic liver failure
Chapin S, Kaplan D, Taddei T, Mahmud N. Association between statin exposure and short-term mortality in patients with high-grade acute-on-chronic liver failure. JHEP Reports 2023, 5: 100740. PMID: 37215188, PMCID: PMC10193237, DOI: 10.1016/j.jhepr.2023.100740.Peer-Reviewed Original ResearchChronic liver failureShort-term mortalityRetrospective cohort studyStatin exposureLiver failureStatin useCohort studyLogistic regression modelsLower oddsHigh short-term mortalityVeterans Health Administration patientsDose exposureMultivariable logistic regression modelClasses of medicationsFuture prospective studiesVeterans Health AdministrationDose-dependent reductionPotential beneficial effectsStatin therapyTerm mortalityAnalytic cohortRegression modelsProspective studyReduced oddsACLF
2022
Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis
John BV, Ferreira RD, Doshi A, Kaplan DE, Taddei TH, Spector SA, Paulus E, Deng Y, Bastaich D, Dahman B. Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis. Journal Of Hepatology 2022, 77: 1349-1358. PMID: 36181987, PMCID: PMC9519143, DOI: 10.1016/j.jhep.2022.07.036.Peer-Reviewed Original ResearchConceptsCOVID-19 mRNA vaccinesCritical COVID-19COVID-19-related deathsThird doseMRNA vaccinesCOVID-19Propensity-matched control groupRetrospective cohort studyModerate COVID-19Symptomatic COVID-19Veterans Health AdministrationBNT-162b2BNT162b2 mRNAModerna mRNACohort studyImmune dysregulationCirrhosisSimilar riskGeneral populationMagnitude of reductionPatientsControl groupHealth AdministrationVaccineAbstractTextType of Infection Is Associated with Prognosis in Acute-on-Chronic Liver Failure: A National Veterans Health Administration Study
Mahmud N, Reddy KR, Taddei TH, Kaplan DE. Type of Infection Is Associated with Prognosis in Acute-on-Chronic Liver Failure: A National Veterans Health Administration Study. Digestive Diseases And Sciences 2022, 68: 1632-1640. PMID: 36083379, PMCID: PMC9995592, DOI: 10.1007/s10620-022-07680-9.Peer-Reviewed Original ResearchConceptsSpontaneous bacterial peritonitisChronic liver failureShort-term mortalityLiver failureHigh short-term mortalityACLF grade 3Retrospective cohort studyUrinary tract infectionMultivariable logistic regressionVeterans Health AdministrationType of infectionInverse probability treatmentLarge national databaseSource of infectionACLF gradeMSK infectionsCohort studyTract infectionsBacterial peritonitisMusculoskeletal infectionsFrequent precipitantInfectious sourceGrade 3Relative oddsHealth AdministrationThe Association Between Proton Pump Inhibitor Exposure and Key Liver-Related Outcomes in Patients With Cirrhosis: A Veterans Affairs Cohort Study
Mahmud N, Serper M, Taddei TH, Kaplan DE. The Association Between Proton Pump Inhibitor Exposure and Key Liver-Related Outcomes in Patients With Cirrhosis: A Veterans Affairs Cohort Study. Gastroenterology 2022, 163: 257-269.e6. PMID: 35398042, PMCID: PMC10020994, DOI: 10.1053/j.gastro.2022.03.052.Peer-Reviewed Original ResearchConceptsLiver-related mortalityPPI exposureGastrointestinal bleedingCause mortalityProton pump inhibitor exposurePrior gastrointestinal bleedingTime-updated variablesCause-specific mortality analysesLarge national cohortVeterans Health AdministrationRisk of infectionCardiovascular comorbiditiesPPI useCohort studyStatin exposureCox regressionRetrospective studyAdverse outcomesAppropriate indicationsNational cohortInhibitor exposureSevere infectionsCirrhosis diagnosisAdditional adjustmentAdjusted modelStatin exposure is associated with reduced development of acute-on-chronic liver failure in a Veterans Affairs cohort
Mahmud N, Chapin S, Goldberg DS, Reddy KR, Taddei TH, Kaplan DE. Statin exposure is associated with reduced development of acute-on-chronic liver failure in a Veterans Affairs cohort. Journal Of Hepatology 2022, 76: 1100-1108. PMID: 35066085, PMCID: PMC9018495, DOI: 10.1016/j.jhep.2021.12.034.Peer-Reviewed Original ResearchConceptsChronic liver failureStatin exposureLiver failureStatin useCohort studyChronic liver failure developmentInverse probability treatment weightingProportional hazards regression modelsDoses of statinsVeterans Affairs cohortRetrospective cohort studyChronic liver diseaseHazards regression modelsLarge national cohortVeterans Health AdministrationNumerous beneficial effectsMarginal structural modelsMedian followStatin therapyLiver diseaseNational cohortACLFTreatment weightingCirrhosisPatients
2021
Rates of decompensation, hepatocellular carcinoma and mortality in AMA‐negative primary biliary cholangitis cirrhosis
John BV, Dahman B, Deng Y, Khakoo NS, Taddei TH, Kaplan DE, Levy C. Rates of decompensation, hepatocellular carcinoma and mortality in AMA‐negative primary biliary cholangitis cirrhosis. Liver International 2021, 42: 384-393. PMID: 34614294, PMCID: PMC8810619, DOI: 10.1111/liv.15079.Peer-Reviewed Original ResearchConceptsLiver-related deathAMA-negative PBCPBC cirrhosisHepatocellular carcinomaMale patientsAMA-positive patientsAMA-positive PBCLiver-related outcomesSimilar unadjusted ratesAnti-mitochondrial antibodiesSimilar ratesNumber of patientsVeterans Health AdministrationRate of decompensationDevelopment of deathUDCA responseOverall deathUnadjusted ratesCirrhosis diagnosisCirrhosisLarge cohortDecompensationPatientsHealth AdministrationNatural historyAssociation of BNT162b2 mRNA and mRNA-1273 Vaccines With COVID-19 Infection and Hospitalization Among Patients With Cirrhosis
John BV, Deng Y, Scheinberg A, Mahmud N, Taddei TH, Kaplan D, Labrada M, Baracco G, Dahman B. Association of BNT162b2 mRNA and mRNA-1273 Vaccines With COVID-19 Infection and Hospitalization Among Patients With Cirrhosis. JAMA Internal Medicine 2021, 181: 1306-1314. PMID: 34254978, PMCID: PMC8278308, DOI: 10.1001/jamainternmed.2021.4325.Peer-Reviewed Original ResearchConceptsCOVID-19 infectionCOVID-19-related hospitalizationBNT162b2 mRNAFirst doseCohort studySecond doseMRNA vaccinesClinical trialsControl groupPropensity-matched control groupPhase 3 clinical trialsCOVID-19 mRNA vaccinesAssociation of vaccinationRetrospective cohort studyUS veteran populationAssociation of receiptVeterans Health AdministrationCoronavirus disease 2019COVID-19 hospitalizationMRNA vaccine administrationCOVID-19Vaccine recipientsImmune dysregulationModerna mRNAMedian ageMale Sex Is Associated With Higher Rates of Liver‐Related Mortality in Primary Biliary Cholangitis and Cirrhosis
John BV, Aitcheson G, Schwartz KB, Khakoo NS, Dahman B, Deng Y, Goldberg D, Martin P, Taddei T, Levy C, Kaplan DE. Male Sex Is Associated With Higher Rates of Liver‐Related Mortality in Primary Biliary Cholangitis and Cirrhosis. Hepatology 2021, 74: 879-891. PMID: 33636012, DOI: 10.1002/hep.31776.Peer-Reviewed Original ResearchConceptsPrimary biliary cholangitisLiver-related deathHepatocellular carcinomaBiliary cholangitisMale sexTime-updated Cox proportional hazards modelsCox proportional hazards modelUrsodeoxycholic acid responseLiver-related mortalityHigher unadjusted ratesRisk of deathVeterans Health AdministrationProportional hazards modelAssociation of sexImpact of sexPBC cirrhosisMale patientsUnadjusted ratesWorse outcomesTotal bilirubinCirrhosisLarge cohortHigh riskHazards modelTransplantationRisk Prediction Models for Postoperative Decompensation and Infection in Patients With Cirrhosis: A Veterans Affairs Cohort Study
Mahmud N, Fricker Z, Lewis JD, Taddei TH, Goldberg DS, Kaplan DE. Risk Prediction Models for Postoperative Decompensation and Infection in Patients With Cirrhosis: A Veterans Affairs Cohort Study. Clinical Gastroenterology And Hepatology 2021, 20: e1121-e1134. PMID: 34246794, PMCID: PMC8741885, DOI: 10.1016/j.cgh.2021.06.050.Peer-Reviewed Original ResearchConceptsLiver diseasePostoperative decompensationPostoperative mortalityPostoperative infectionRisk scoreAlcohol-related liver diseaseEnd-stage liver diseaseMayo risk scoreSurgical risk scoresData of patientsMultivariable logistic regressionVeterans Health AdministrationRange of surgeryRisk prediction modelCirrhosis decompensationPugh scoreChild-TurcottePostoperative complicationsCohort studyPostoperative dayRetrospective studyStratify patientsVeteran outcomesDecompensationExcellent calibrationThe Predictive Role of Model for End‐Stage Liver Disease–Lactate and Lactate Clearance for In‐Hospital Mortality Among a National Cirrhosis Cohort
Mahmud N, Asrani SK, Kaplan DE, Ogola GO, Taddei TH, Kamath PS, Serper M. The Predictive Role of Model for End‐Stage Liver Disease–Lactate and Lactate Clearance for In‐Hospital Mortality Among a National Cirrhosis Cohort. Liver Transplantation 2021, 27: 177-189. PMID: 33025731, PMCID: PMC7880877, DOI: 10.1002/lt.25913.Peer-Reviewed Original ResearchConceptsEnd-stage liver diseaseHospital mortalityLactate clearanceCirrhosis hospitalizationsMELD-NaLiver diseaseDay 1Predictive roleRetrospective cohort studyIn-Hospital MortalityRisk-stratify patientsVeterans Health AdministrationCirrhosis cohortMELD categoriesGastrointestinal bleedingCohort studyClinical dataLimited cohortStratified analysisLactate levelsHospitalizationHealth AdministrationMELDClinical toolMortality
2020
Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans
Rogal SS, Yakovchenko V, Morgan T, Bajaj JS, Gonzalez R, Park A, Beste L, Miech EJ, Lamorte C, Neely B, Gibson S, Malone PS, Chartier M, Taddei T, Garcia-Tsao G, Powell BJ, Dominitz JA, Ross D, Chinman MJ. Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans. Implementation Science 2020, 15: 92. PMID: 33087156, PMCID: PMC7579930, DOI: 10.1186/s13012-020-01050-7.Peer-Reviewed Original ResearchConceptsVA Medical CenterCirrhosis careVeterans Health AdministrationEvidence-based practiceImplementation interventionsAim 1Stepped-wedge clusterBackground cirrhosisImplementation strategiesMedical CenterWedge clusterAim 3Health AdministrationEBP uptakeCirrhosisAim 2CareExpert recommendationsSuccessful implementation strategiesInterventionVeteransChange taxonomyImplementation support toolsProgram evaluationSemi-structured interviewsEffects of Metformin Exposure on Survival in a Large National Cohort of Patients With Diabetes and Cirrhosis
Kaplan DE, Serper M, John BV, Tessiatore KM, Lerer R, Mehta R, Fox R, Aytaman A, Baytarian M, Hunt K, Albrecht J, Taddei TH, Group V. Effects of Metformin Exposure on Survival in a Large National Cohort of Patients With Diabetes and Cirrhosis. Clinical Gastroenterology And Hepatology 2020, 19: 2148-2160.e14. PMID: 32798709, DOI: 10.1016/j.cgh.2020.08.026.Peer-Reviewed Original ResearchConceptsDiagnosis of cirrhosisEnzyme inhibitors/angiotensinMetformin exposureHepatic decompensationHepatocellular carcinomaDiabetes mellitusPrognosis of cirrhosisPropensity-matched approachPre-existing diabetesRetrospective cohort studyLarge national cohortVeterans Health AdministrationMarginal structural modelsConcomitant statinCohort studyMultiple medicationsStatin exposureNational cohortCirrhosisPatientsDiabetesDecompensationMetforminConcomitant exposureHealth AdministrationSurvival Benefit of Liver Transplantation for Hepatocellular Carcinoma.
Kanneganti M, Mahmud N, Kaplan DE, Taddei TH, Goldberg DS. Survival Benefit of Liver Transplantation for Hepatocellular Carcinoma. Transplantation 2020, 104: 104-112. PMID: 31283688, PMCID: PMC6928443, DOI: 10.1097/tp.0000000000002816.Peer-Reviewed Original ResearchConceptsIncremental survival benefitLiver transplantSurvival benefitHepatocellular carcinomaEnd-stage liver disease (MELD) scoreOverall long-term survivalIntermediate-stage hepatocellular carcinomaLiver Disease scoreRetrospective cohort studyStage hepatocellular carcinomaHazard of deathVeterans Health AdministrationImmortal time biasLong-term survivalUnderwent resectionLiver transplantationAnalytic cohortCohort studyCurative optionMultivariable modelHCC diagnosisDisease scoreResectionPatientsHealth Administration
2019
Increased Risk for Hepatocellular Carcinoma Persists Up to 10 Years After HCV Eradication in Patients With Baseline Cirrhosis or High FIB-4 Scores
Ioannou GN, Beste LA, Green PK, Singal AG, Tapper EB, Waljee AK, Sterling RK, Feld JJ, Kaplan DE, Taddei TH, Berry K. Increased Risk for Hepatocellular Carcinoma Persists Up to 10 Years After HCV Eradication in Patients With Baseline Cirrhosis or High FIB-4 Scores. Gastroenterology 2019, 157: 1264-1278.e4. PMID: 31356807, PMCID: PMC6815714, DOI: 10.1053/j.gastro.2019.07.033.Peer-Reviewed Original ResearchMeSH KeywordsAgedAntiviral AgentsCarcinoma, HepatocellularFemaleHepatitis CHumansIncidenceLiver CirrhosisLiver NeoplasmsMaleMiddle AgedRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexTime FactorsTreatment OutcomeUnited StatesUnited States Department of Veterans AffairsVeterans Health ServicesConceptsFIB-4 scoreSustained virologic responseAnnual HCC riskHCC riskHCV eradicationAnnual incidenceLower riskHepatitis C virus eradicationHigh FIB-4 scoreAbsolute annual riskHCV antiviral treatmentFibrosis-4 scoreInterferon-treated patientsVeterans Health AdministrationHepatocellular carcinoma riskHigh enough riskBaseline cirrhosisIncident HCCVirologic responseFIB-4HCC surveillanceHCV infectionAntiviral treatmentCarcinoma riskCirrhosis