Browsing by Author "Brandman, Danielle"

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    Cardiology Assessment of Patients Undergoing Evaluation for Orthotopic Liver Transplantation
    (Elsevier, 2022-11-25) Lee, Michael S.; Wadia, Subeer; Yeghiazarians, Yerem; Matthews, Ray; White, Christopher J.; Herrmann, Howard C.; O’Donnell, William; McPherson, John; Leesar, Massoud A.; Kreutz, Rolf P.; Brandman, Danielle; Gupta, Anuj; Mandras, Stacy; Kandzari, David E.; Medicine, School of Medicine
    Orthotopic liver transplantation (OLT) is a viable treatment option for end-stage liver disease. Significant perioperative stress is placed on the cardiovascular system because of hemodynamic changes and the length of the operation. Diagnosis and treatment of cardiovascular disease before OLT are imperative to ensure favorable outcomes. Considerable variability exists among practitioners caring for these patients. Institutions tailor their protocols on the basis of local and historical practices, the preferences of the cardiologists, and the OLT team, and algorithms are not often revised or updated on the basis of the available evidence. In collaboration with cardiology and hepatology experts from leading OLT centers, we sought to examine the diagnostic cardiovascular workup of OLT candidates, including a review of the available literature on the diagnostic modalities used to screen cardiovascular disease before OLT. We advocate an emphasis on noninvasive methods to assess cardiovascular risk with reserved use of invasive risk stratification in select patients.
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    Comparison of clinical prediction rules for ruling out cirrhosis in nonalcoholic fatty liver disease (NAFLD)
    (Wiley, 2022) Brandman, Danielle; Boyle, Marie; McPherson, Stuart; Van Natta, Mark L.; Sanyal, Arun J.; Kowdley, Kris; Neuschwander-Tetri, Brent; Chalasani, Naga; Abdelmalek, Manal F.; Terrault, Norah A.; McCullough, Art; Bettencourt, Ricki; Caussy, Cyrielle; Kleiner, David E.; Behling, Cynthia; Tonascia, James; Anstee, Quentin M.; Loomba, Rohit; Members of the Nonalcoholic Steatohepatitis Clinical Research Network; Medicine, School of Medicine
    Background and aims: Patients with nonalcoholic fatty liver disease (NAFLD) cirrhosis benefit from referral to subspecialty care. While several clinical prediction rules exist to identify advanced fibrosis, the cutoff for excluding cirrhosis due to NAFLD is unclear. This analysis compared clinical prediction rules for excluding biopsy-proven cirrhosis in NAFLD. Methods: Adult patients were enrolled in the NASH Clinical Research Network (US) and the Newcastle Cohort (UK). Clinical and laboratory data were collected at enrolment, and a liver biopsy was taken within 1 year of enrolment. Optimal cutoffs for each score (eg, FIB-4) to exclude cirrhosis were derived from the US cohort, and sensitivity, specificity, positive predictive value, negative predictive value and AUROC were calculated. The cutoffs were evaluated in the UK cohort. Results: 147/1483 (10%) patients in the US cohort had cirrhosis. All prediction rules had similarly high NPV (0.95-0.97). FIB-4 and NAFLD fibrosis scores were the most accurate in characterising patients as having cirrhosis (AUROC 0.84-0.86). 59/494 (12%) patients in the UK cohort had cirrhosis. Prediction rules had high NPV (0.92-0.96), and FIB-4 and NAFLD fibrosis score the most accurate in the prediction of cirrhosis in the UK cohort (AUROC 0.87-0.89). Conclusions: This cross-sectional analysis of large, multicentre international datasets shows that current clinical prediction rules perform well in excluding cirrhosis with appropriately chosen cutoffs. These clinical prediction rules can be used in primary care to identify patients, particularly those who are white, female, and <65, unlikely to have cirrhosis so higher-risk patients maintain access to specialty care.
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    Performance Characteristics of Vibration-Controlled Transient Elastography for Evaluation of Non-Alcoholic Fatty Liver Disease
    (Wiley, 2017) Vuppalanchi, Raj; Siddiqui, Mohammad S.; Van Natta, Mark L.; Hallinan, Erin; Brandman, Danielle; Kowdley, Kris; Neuschwander-Tetri, Brent A.; Loomba, Rohit; Dasarathy, Srinivas; Abdelmalek, Manal; Doo, Edward; Tonascia, James A.; Kleiner, David E.; Sanyal, Arun J.; Chalasani, Naga; Department of Medicine, School of Medicine
    Background: Vibration-controlled transient elastography (VCTE) estimates liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) which are noninvasive assessments of hepatic fibrosis and steatosis respectively. However, prior VCTE studies reported high failure rate in patients with non-alcoholic fatty liver disease (NAFLD). Aim: To examine the performance characteristics of Fibroscan 502 Touch with two probes, medium (M+) and extra-large (XL+), in patients with NAFLD in a multicenter setting. Methods: A total of 1696 exams were attempted in 992 patients (BMI: 33.6 ± 6.5 kg/m2) with histologically confirmed NAFLD. Simultaneous assessment of LSM and CAP was performed using Fibroscan 502 Touch with an automatic probe selection tool. Testing was conducted twice in patients by either a single operator (88%) or two operators (12%). Failure was defined as the inability to obtain a valid examination. An examination was considered unreliable if LSM IQR/median was >30%. Significant disagreement between two readings was defined as greater than >95% limits of agreement between two readings. Results: A total of 1641 examinations yielded valid results with a failure rate of 3.2% (55/1696). The proportion of unreliable scans for LSM was 2.4%. The proportion of unreliable scans with operator experience in the top quartile (≥ 59 procedures) was significantly lower than lower three quarters combined (1.6% vs.4.7%, p=0.01 by Fisher's Exact test). The significant disagreement between first and second readings for LSM and CAP when obtained back to back was 18% and 11% respectively. Conclusion: VCTE for estimation of LSM and CAP can be successfully deployed in a multicenter setting with low failure (3.2%) and high reliability (>95%) rates and high reproducibility.
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    Vibration-controlled Transient Elastography to Assess Fibrosis and Steatosis in Patients With Nonalcoholic Fatty Liver Disease
    (Elsevier, 2018) Siddiqui, Mohammad S.; Vuppalanchi, Raj; Van Natta, Mark L.; Hallinan, Erin; Kowdley, Kris V.; Abdelmalek, Manal; Neuschwander-Tetri, Brent A.; Loomba, Rohit; Dasarathy, Srinivasan; Brandman, Danielle; Doo, Edward; Tonascia, James A.; Kleiner, David E.; Chalasani, Naga; Sanyal, Arun J.; Medicine, School of Medicine
    Background & Aims Vibration-controlled transient elastography (VCTE), which measures liver stiffness, has become an important tool for evaluating patients with nonalcoholic fatty liver disease (NAFLD). We aimed to determine the diagnostic accuracy of VCTE in detection of NAFLD in a multicenter cohort of patients. Methods We performed a prospective study of 393 adults with NAFLD who underwent VCTE within 1 year of liver histology analysis (median time, 49 days; interquartile range, 25–78 days), from July 1, 2014 through July 31, 2017. Liver stiffness measurement (LSM) cutoffs for pairwise fibrosis stage and controlled attenuation parameter (CAP) cutoffs for pairwise steatosis grade were determined using cross-validated area under the receiver operating characteristics curve (AUROC) analyses. Diagnostic statistics were computed at sensitivity fixed at 90% and specificity fixed at 90%. Results LSM identified patients with advanced fibrosis with an AUROC of 0.83 (95% CI, 0.79– 0.87) and patients with cirrhosis with an AUROC of 0.93 (95% CI, 0.90–0.97). At fixed sensitivity, a cutoff LSM of 6.5 kPa excluded advanced fibrosis with a negative predictive value of 0.91; a cut-off LSM of 12.1 kPa excluded cirrhosis with a negative predictive value of 0.99. At fixed specificity, LSM identified patients with advanced fibrosis with a positive predictive 0.71 and patients with cirrhosis with a positive predictive value of 0.41. CAP analysis detected steatosis with an AUROC of 0.76 (95% CI, 0.64–0.87). In contrast, the VCTE was less accurate in distinguishing lower fibrosis stages, higher steatosis grades, or presence of NASH. Conclusion In a prospective study of adults with NAFLD, we found VCTE to accurately distinguish advanced vs earlier stages of fibrosis, using liver histology as the reference standard.