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| 1 | Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome显示文摘AIM:To compare the utility of the Chronic Liver FailureSequential Organ Failure Assessment(CLIF-SOFA)and Asia-Pacific Association for the Study of Liver(APASL)definitions of acute-on-chronic liver failure(ACLF)in predicting short-term prognosis of patients with ACLF.METHODS:Consecutive patients of cirrhosis with acute decompensation were prospectively included.They were grouped into ACLF and no ACLF groups as per CLIF-SOFA and APASL criteria.Patients were followed up for 3 mo from inclusion or mortality whichever was earlier.Mortality at 28-d and 90-d was compared between no ACLF and ACLF groups as per both criteria.Mortality was also compared between different grades of ACLF as per CLIF-SOFA criteria.Prognostic scores like CLIF-SOFA,Acute Physiology and ChronicHealth Evaluation(APACHE)-Ⅱ,Child-Pugh and Model for End-Stage Liver Disease(MELD)scores were evaluated for their ability to predict 28-d mortality using area under receiver operating curves(AUROC).RESULTS:Of 50 patients,38 had ACLF as per CLIFSOFA and 19 as per APASL criteria.Males(86%)were predominant,alcoholic liver disease(68%)was the most common etiology of cirrhosis,sepsis(66%)was the most common cause of acute decompensation while infection(66%)was the most common precipitant of acute decompensation.The 28-d mortality in no ACLF and ACLF groups was 8.3%and 47.4%(P=0.018)as per CLIF-SOFA and 39%and 37%(P=0.895)as per APASL criteria.The 28-d mortality in patients with no ACLF(n=12),ACLF grade 1(n=11),ACLF grade 2(n=14)and ACLF grade 3(n=13)as per CLIF-SOFA criteria was 8.3%,18.2%,42.9%and76.9%(χ2 for trend,P=0.002)and 90-d mortality was 16.7%,27.3%,78.6%and 100%(χ2 for trend,P<0.0001)respectively.Patients with prior decompensation had similar 28-d and 90-d mortality(39.3%and 53.6%)as patients without prior decompensation(36.4%and 63.6%)(P=NS).AUROCs for 28-d mortality were 0.795,0.787,0.739 and 0.710 for CLIF-SOFA,APACHE-Ⅱ,Child-Pugh and MELD scores respectively.On multivariate analysis of these scores,CLIF-SOFA was the only significant independent predictor of mortality with an odds ratio 1.538(95%CI:1.078-2.194).CONCLUSION:CLIF-SOFA criteria is better than APASL criteria to classify patients into ACLF based on their prognosis.CLIF-SOFA score is the best predictor of short-term mortality. | Radha K Dhiman Swastik Agrawal Tarana Gupta Ajay Duseja Yogesh Chawla | 2014 | World Journal of Gastroenterology2014，20，40： | 26 |
| 2 | Nonalcoholic steatohepatitis in Asian Indians is neither associated with iron overload nor with HFE gene mutations显示文摘AIM: The pathogenesis of occurrence of liver inflammation and fibrosis in patients with nonalcoholic steatohepatitis (NASH) is not completely understood. Other than insulin resistance, iron abnormalities have been thought to be one of the triggering factors. Therefore, our aim was to study the role of iron abnormalities and HFE gene mutations in patients with NASH.METHODS: Thirty-one patients of NASH diagnosed on the basis of clinical examination biochemistry, ultrasonography and liver biopsy (n = 14) were included in the study. Serum iron parameters (n = 23) (iron, ferritin, total iron-binding capacity and transferrin saturation), Peris' iron staining on liver biopsies (n = 14) and HFE gene mutations (C282Y and H63D) (n = 16) were studied in these patients. The association between iron staining, necroinflammatory activity and fibrosis stage on liver biopsies was also determined.RESULTS: Elevated serum iron, ferritin and transferrin saturation above 55% were observed in 4.3% of patients.On histology, 71% of the patients had negative iron staining,21.4% had 1+ staining, 7.2% had 2+ staining and none had 3+ or 4+ staining. There was no association between the degree of iron staining and necroinflammatory activity (P = 0.55) and fibrosis stage (P = 0.09) on histology. None of the patients had C282Y HFE gene mutation and four patients (25%) were found to be heterozygotes for H63D gene mutation.CONCLUSION: Our study does not favor iron overload and HFE gene mutations as major factors in the pathogenesis of NASH in Asian Indians. | Ajay Duseja Reena Das Mohit Nanda Ashim Das Gurjeewan Garewal Yogesh Chawla | 2005 | World Journal of Gastroenterology2005，11，3： | 9 |
| 3 | Clinical Validation of Global Coagulation Tests to Guide Blood Component Transfusions in Cirrhosis and ACLF显示文摘Background and Aims:Patients with cirrhosis and acuteon-chronic liver failure(ACLF)may have bleeding complications and need for invasive procedures.Point-of-care(POC)coagulation tests like thromboelastography(TEG)and Sonoclot may be better for guiding patient management than the standard coagulation tests(SCTs),like prothrombin time,platelet count and international normalized ratio.Methods:We prospectively compared and validated the POC tests and SCTs in 70 persons with ACLF and 72 persons with decompensated cirrhosis who had clinical bleeding and checked for episodes of re-bleeding and transfusion requirements.We assessed pre-procedure requirement of blood components when correction was done based on an SCT or POC strategy.Results:Episodes of bleeding were seen in 45%and 28%of ACLF and cirrhosis patient,respectively(p=0.036),with the major site of bleeding being gastrointestinal(31%and 16%,respectively).Platelet counts correlated with TEG-maximum amplitude in cirrhosis(p=0.045)and prothrombin time correlated positively with TEG-reaction(R)time(p=0.032),TEG-Clot kinetics(K)time(p=0.042),Son-activated clotting time(p=0.038)and negatively with clot rate(p=0.043)in ACLF,making these correctable target variables in POC transfusion algorithms.Of 223 procedures,transfusion of fresh frozen plasma and platelet concentrate was reduced by 25%(p=0.035)and 20.8%(p=0.045)by using a POC strategy in 76 patients.Correction of deranged Son-activated clotting time and TEG-reaction time was noted in 68%and 72%after 24 h of fresh frozen plasma transfusion in ACLF and 85%and 80%in cirrhosis,respectively.Conclusions:Our study clinically validates that POC tests can better detect coagulation defects and transfusion thresholds in ACLF and cirrhosis,whereas use of conventional tests appear to be less suitable in patients with clinical bleeding.Trial Registration:NCT04332484. | Madhumita Premkumar Rohit Mehtani Smita Divyaveer Kamal Kajal Anand VKulkarni Syed Ahmed Harmanpreet Kaur Harpreet Kaur Radhakrishna Dhiman Ajay Duseja Arka De | 2021 | Journal of Clinical and Translational Hepatology2021，9，2： | 7 |
| 4 | Genetic polymorphism in CD14 gene, a co-receptor of TLR4 associated with non-alcoholic fatty liver disease显示文摘AIM To evaluate the pathogenic role of toll-like receptor(TLR) gene polymorphisms in patients with nonalcoholic fatty liver disease(NAFLD).METHODS Two hundred and fifty subjects(NAFLD = 200, healthy volunteers = 50) underwent polymerase chain reaction and restriction fragment length polymorphism to assess one polymorphism in the toll-like receptor 2(TLR2) gene(A753G), two polymorphisms in the TLR4 gene(TLR4 Asp299 Gly and Thr399 Ile allele), and two polymorphisms in the cluster of differentiation 14(CD14)(C-159 T and C-550T) gene, a co-receptor of TLR4. Association of TLR gene polymorphisms with NAFLD and its severity was evaluated by genetic models of association.RESULTS On both multiplicative and recessive models of gene polymorphism association, there was significant association of CD14 C(-159) T polymorphism with NAFLD; patients with TT genotype had a 2.6 fold increased risk of developing NAFLD in comparison to CC genotype. There was no association of TLR2 Arg753 Gln, TLR4 Asp299 Gly, Thr399 Ile, and CD14 C(-550) T polymorphisms with NAFLD. None of the TLR gene polymorphisms had an association with histological severity of NAFLD.CONCLUSION Patients with CD14 C(-159) T gene polymorphism, a co-receptor of TLR4, have an increased risk of NAFLD development. | Shweta Kapil Ajay Duseja Bal Krishan Sharma Bhupesh Singla Anuradha Chakraborti Ashim Das Pallab Ray Radha K Dhiman Yogesh Chawla | 2016 | World Journal of Gastroenterology2016，22，42： | 7 |
| 5 | Frequency of primary iron overload and HFE gene mutations (C282Y,H63D and S65C) in chronic liver disease patients in north India显示文摘AIM:To identify the frequency of iron overload and study the three mutations in the HFE gene (C282Y,H63D,and S65C) in patients with chronic liver disorders (CLD) and controls. METHODS:To identify patients with iron overload (transferrin saturation > 45% in females and > 50% in males and serum ferritin > 1000 ng/mL) we evaluated 236 patients with CLD,including 59 with non-alcoholic steatohepatitis (NASH),22 with alcoholic liver disease (ALD),19 of cirrhosis due to viruses (HBV,HCV),and 136 with cryptogenic cirrhosis. Mutations of the HFE gene were analyzed by PCR-RE. hundred controls were screened for iron status and the mutations. RESULTS:Seventeen patients with CLD showed evidence of iron overload. Fifteen cases of iron overload had cryptogenic cirrhosis and two had ALD. None of the controls showed iron overload. We did not find any individual with 282Y or 65C either in the cases or in the controls. The prevalence of H63D heterozygosity was 12% in normal individuals,14.8% in 236 patients (16.9% in NASH,13.6% in ALD,26.3% in viral and 12.5% in cryptogenic cirrhosis) and the overall prevalence was 13.98%. Only two of the 17 patients with primary iron overload were heterozygous for H63D. One patient with NASH and one normal individual who were homozygous for H63D showed no iron overload.CONCLUSION:Primary iron overload in Indians is nonHFE type,which is different from that in Europeans and further molecular studies are required to determine the defect in various iron regulatory genes. | Barjinderjit Kaur Dhillon Reena Das Gurjeewan Garewal Yogesh Chawla RK Dhiman Ashim Das Ajay Duseja GR Chandak | 2007 | World Journal of Gastroenterology2007，13，21： | 5 |
| 6 | APACHE II score is superior to SOFA , CTP and MELD in predicting the short‐term mortality in patients with acute‐on‐chronic liver failure ( ACLF )显示文摘 | Ajay Duseja Narendra S Choudhary Sachin Gupta Radha Krishan Dhiman Yogesh Chawla | 2013 | Journal of Digestive Diseases2013，，9： | 2 |
| 7 | Non-hepatic Insults Are Common Acute Precipitants in Patients with Acute on Chronic Liver Failure (ACLF)显示文摘 | Ajay Duseja Y. K. Chawla R. K. Dhiman Amit Kumar Narendra Choudhary Sunil Taneja | 2010 | Digestive Diseases and Sciences2010，，11： | 2 |
| 8 | Indian patients with nonalcoholic fatty liver disease presenting with raised transaminases are different at presentation显示文摘 | Ajay Duseja Ashim Das Radha Krishan Dhiman Yogesh Kumar Chawla Reena Das Sanjay Bhadada Ravinder Sialy Kiran Kumar Thumburu Anil Bhansali Naveen Kalra | 2007 | World Journal of Gastroenterology2007，13，4： | 2 |
| 9 | Nonalcoholic fatty liver in a developing country is responsible for significant liver disease显示文摘 | Duseja A Sharma B Kumar A | 2010 | Hepatology2010，52，6： | 1 |
| 10 | Insulin Resistance Is Common in Patients with Predominantly Genotype 3 Chronic Hepatitis C显示文摘 | Ajay Duseja R. K. Dhiman Yogesh Chawla Kiran K. Thumburu Amit Kumar Ashim Das Sanjay Bhadada Anil Bhansali | 2009 | Digestive Diseases and Sciences2009，，8： | 1 |
| 11 | Functional reconstitution of defective myeloid dendritic cells in chronic hepatitis C infection on successful antiviral treatment显示文摘 | Deepa Rana Yogesh K. Chawla Ajay Duseja Radhakrishan Dhiman Sunil K. Arora | 2012 | Liver Int2012，，7： | 1 |
| 12 | Nonalcoholic fatty liver disease in India-a lot done,yet more required!显示文摘 | Duseja A | | 0，，： | 1 |
| 13 | Metformin is effectivein achieving biochemical response in patients withnonalcoholic fatty liver disease ( NAFLD ) not responding tolifestyle interventions 显示文摘 | Duseja A Das A Dhiman RK | 2007 | Ann Hepatol2007，6，4： | 1 |
| 14 | Role of small intestinal bacterial overgrowth and delayed gastrointestinal transit time in cirrhotic patients with minimal hepatic encephalopathy显示文摘 | Ankur Gupta Radha K Dhiman Savita Kumari Satyavati Rana Ritesh Agarwal Ajay Duseja Yogesh Chawla | 2010 | Journal of Hepatology2010，，5： | 1 |
| 15 | Non-alcoholic fatty liver dis- ease : east versus west显示文摘 | Agrawal A Duseja AK | 2012 | J Clin Exp Hepatol2012，2，2： | 1 |
| 16 | APACHE Ⅱ score is superior to SOFA,CTP and MELD in predicting the short-term mortality in patients with acute-on-chronic liver failure (ACLF)显示文摘 | Duseja A Choudhary NS Gupta S | | 0，，09： | 1 |
| 17 | The effect of e- mergency department crowdiong on clinically oriented out- comes 显示文摘 | Bernstein SL Aronsky D Duseja R | 2009 | Acad Emerg Med2009，16，1： | 1 |
| 18 | Diagnosis and Prognostic Significance of Minimal Hepatic Encephalopathy in Patients with Cirrhosis of Liver显示文摘 | Radha K. Dhiman Roshan Kurmi Kiran K. Thumburu Sunil H. Venkataramarao Ritesh Agarwal Ajay Duseja Yogesh Chawla | 2010 | Digestive Diseases and Sciences2010，，8： | 1 |
| 19 | Lactulose improves cognitive functions and health‐related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy显示文摘 | Srinivasa Prasad Radha K. Dhiman Ajay Duseja Yogesh K. Chawla Arpita Sharma Ritesh Agarwal | 2007 | Hepatology2007，，3： | 1 |
| 20 | Review article:the modern management of portal vein thrombosis显示文摘 | Chawla Y Duseja A Dhiman RK | 2009 | Aliment Phannacol Ther2009，30，9： | 1 |
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