Asia–Pacific association for study of liver guidelines on management of ascites in liver disease

Singh, Virendra; De, Arka; Mehtani, Rohit; Angeli, Paolo; Maiwall, Rakhi; Singal, Amit; Sharma, Sanchit; Sharma, Barjesh Chander; Eapen, C E; Rao, Padaki Nagaraja; Shukla, Akash; Shalimar, S.; Choudhary, Narendra S.; Alcantara-Payawal, Diana; Arora, Vinod; Aithal, Guruprasad P.; Kulkarni, Anand V.; Roy, Akash; Shrestha, Ananta; Mahtab, Mamun Al; Niriella, Madunil Anuk; Siam, Tan Soek; Zhang, Chunqing; Lee, Guan Huei; Yu, Ming‐Lung; Roberts, Stuart K.; Peng, Cheng‐Yuan; Chen, Tao; George, Jacob; Wong, Vincent Wai‐Sun; Yılmaz, Yusuf; Treeprasertsuk, Sombat; Kurniawan, Juferdy; Kim, Seung Up; Younossi, Zobair M.; Sarin, Shiv Kumar

doi:10.1007/s12072-023-10536-7

Cited by 16 publications

(9 citation statements)

References 185 publications

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“… 8 – 12 However, in countries facing financial constraints, the use of HA is often restricted by hospital administrations and health authorities due to its higher cost compared with other fluids, leading to an underutilization of HA for indications supported by strong clinical evidence such as SBP, HRS and LVP. 10 …”

Section: Discussionmentioning

confidence: 99%

“…Its efficacy in these conditions has been well established and is recommended in international guidelines. 8 – 10 Randomized clinical trials and meta-analyses have demonstrated the efficacy of HA to treat and prevent clinical complications of cirrhosis, which are characterized by effective hypovolaemia. 8 – 12 Recently, HA has emerged as a potential disease-modifying agent in decompensated cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in resource-limited healthcare settings

Hasan,

Murti,

Bayupurnama

et al. 2024

DIC

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Background Human albumin (HA) is an effective adjuvant treatment for patients with cirrhosis developing spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and ascites requiring large-volume paracentesis (LVP). However, cost remains a barrier to use, particularly in resource-limited settings. This study aims to assess the cost-effectiveness of HA in patients with cirrhosis with SBP, HRS or ascites requiring LVP in the Indonesian healthcare system as a representative of a resource-limited setting. Methods Three decision-tree models were developed to assess the cost-effectiveness of (1) antibiotics and HA versus antibiotics alone in patients with SBP, (2) terlipressin and HA versus terlipressin alone in patients with HRS, and (3) LVP and HA versus LVP and gelatine for patients with ascites. Clinical utility and economic inputs were pooled from the available literature. Time horizon was 3 months. Outcomes were expressed as incremental cost-effectiveness ratios (ICER) reported as 2021 IDR per quality-adjusted life year (QALY) (exchange rate June 30, 2021: 1 EUR = 17,245 IDR). Willingness-to-pay thresholds considered were: three times the GDP per capita (199,355,561 IDR/QALY; 11,560 EUR/QALY) and one time the GDP per capita (66,451,854 IDR/QALY; 3853 EUR/QALY). Results The ICER for antibiotics and HA ( versus antibiotics alone) for SBP was 80,562,652 IDR per QALY gained (4672 EUR/QALY). The ICER for terlipressin and HA ( versus terlipressin) for HRS was 23,085,004 IDR per QALY gained (1339 EUR/QALY). The ICER for LVP and HA versus LVP and gelatine was 24,569,827 IDR per QALY gained (1425 EUR/QALY). Conclusion Adjunctive HA may be a cost-effective treatment for SBP, HRS and LVP in resource-limited settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in resource-limited healthcare settings

Hasan,

Murti,

Bayupurnama

et al. 2024

DIC

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“…SBP is one of the most commonly found bacterial infections in liver cirrhosis and is detected in 35% of patients admitted to Asian hospitals [ 2 ]. SBP recurrence is seen in 44% of patients.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Instigator of Spontaneous Bacterial Peritonitis: Salmonella typhimurium

Mahashabde,

Bhimani,

Chaudhary

2024

Cureus

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Salmonella is an unusual cause of spontaneous bacterial peritonitis (SBP). It is commonly seen in asymptomatic patients with normal or high ascitic fluid protein levels and an immunocompromised state such as AIDS and hematological and solid organ malignancies other than liver. SBP from non-typhoidal Salmonella species should be considered, even in the absence of underlying immunosuppression. Our patient presented with a history of high-grade fever and frequent loose stools with decompensated alcoholic liver cirrhosis. While evaluating the SBP etiology, ascitic fluid turned out positive for the non-typhoidal Salmonella species, which was red, turbid, and hemorrhagic due to portal vein and superior mesenteric vein thrombosis. We thus report an extremely rare case of SBP caused by Salmonella typhimurium in our patient.

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“…Usually, low ascitic fluid protein (<2.5 g/dL) with elevated SAAG (>1.1 g/dL) indicates cirrhotic ascites, and low ascitic fluid protein (<1.5 g/dL) predicts a higher risk for the development of spontaneous bacterial peritonitis. 24 Of note, a meta‐analysis demonstrated that long‐term norfloxacin prophylaxis reduces the risk of spontaneous bacterial peritonitis in patients with low ascites protein concentration 25 . For gross ascites or RA, LVP is the first‐line therapy to reduce the volume of ascites and alleviate symptoms.…”

Section: Current Data On the Use Of Medical Treatments In Patients Wi...mentioning

confidence: 99%

Recent developments in the management of ascites in cirrhosis

Lan,

Chen,

Tang

et al. 2024

UEG Journal

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In recent years, advances have been made for treating ascites in patients with cirrhosis. Recent studies have indicated that several treatments that have been used for a long time in the management of portal hypertension may have beneficial effects that were not previously identified. Long‐term albumin infusion may improve survival in patients with cirrhosis and ascites while beta‐blockers may reduce ascites occurrence. Transjugular intrahepatic porto‐systemic shunt (TIPS) placement may also improve survival in selected patients in addition to the control with ascites. Low‐flow ascites pump insertion can be another option for some patients with intractable ascites. In this review, we summarize the latest data related to the management of ascites occurring in cirrhosis. There are still unanswered questions, such as the optimal use of albumin as a long‐term therapy, the place of beta‐blockers, and the best timing for TIPS placement to improve the natural history of ascites, as well as the optimal stent diameter to reduce the risk of shunt‐related side‐effects. These issued should be addressed in future studies.

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Asia–Pacific association for study of liver guidelines on management of ascites in liver disease

Cited by 16 publications

References 185 publications

Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in resource-limited healthcare settings

Cost-effectiveness of albumin in the treatment of decompensated cirrhosis in resource-limited healthcare settings

An Unusual Instigator of Spontaneous Bacterial Peritonitis: Salmonella typhimurium

Recent developments in the management of ascites in cirrhosis

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