Browsing by Author "Yoder, Lindsay"

Now showing 1 - 5 of 5
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    An Outbreak Presents an Opportunity to Learn About a Rare Phenotype: Autoimmune Hepatitis After Acute Hepatitis A
    (2020-11-01) S.-Are, Vijay; Yoder, Lindsay; Samala, Niharika; Nephew, Lauren; Lammert, Craig; Vuppalanchi, Raj
    There are rare instances where patients with acute hepatitis A virus infection subsequently developed autoimmune hepatitis. The diagnosis of autoimmune hepatitis in this setting is challenging. Furthermore, information on treatment with steroids or other immune suppressants, duration of therapy and possibility of treatment discontinuation is currently unclear. Here we report a case series of four patients with histology proven autoimmune hepatitis after hepatitis A virus infection. We describe the presenting features, diagnosis, treatment and long-term outcomes of these cases. This case series provides a insight into the clinical presentation and treatment of autoimmune hepatitis after hepatitis A infection with interesting take home points for clinical hepatologists.
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    Attendance at a Transitional Liver Clinic May Be Associated with Reduced Readmissions for Patients with Liver Disease
    (Elsevier, 2022) Yoder, Lindsay; Mladenovic, Andrea; Pike, Francis; Vuppalanchi, Raj; Hanson, Haleigh; Corbito, Laura; Desai, Archita P.; Chalasani, Naga; Orman, Eric S.; Medicine, School of Medicine
    Introduction: Patients with liver disease have high rates of early hospital readmission, but there are no studies of effective, scalable interventions to reduce this risk. In this study, we examined the impact of a Physician Assistant (PA)-led post-discharge Transitional Liver Clinic (TLC) on hospital readmissions. Methods: We performed a cohort study of all adults seen by a hepatologist during admission to a tertiary care center in 2019 (excluding transplant patients). We compared those who attended the TLC with those who did not, with respect to 30-day readmission and mortality. Propensity score-adjusted modeling was used to control for confounding. Results: Of 498 patients, 98 were seen in the TLC; 35% had alcoholic liver disease and 58% had cirrhosis. Attendees were similar to non-attendees with respect to demographics, liver disease characteristics and severity, comorbidities, and discharge disposition. Thirty-day cumulative incidence of readmissions was 12% in TLC attendees, compared with 22% in non-attendees (P = .02), while 30-day mortality was similar (2.0% vs 4.3%; P = .29). In a model using propensity score adjustment, TLC attendance remained associated with reduced readmissions (subhazard ratio 0.52; 95% confidence interval, 0.27-0.997; P = .049). The effect of TLC was greater in women compared with men (P = .07) and in those without chronic kidney disease (P = .02), but there were no differences across other subgroups. Conclusions: Patients with liver disease seen in a PA-led TLC may have a significant reduction in the 30-day readmission rate. Randomized trials are needed to establish the efficacy of PA-led post-discharge transitional care for this population.
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    Development and Validation of Model Consisting of Comorbidity Burden to Calculate Risk of Death Within 6 months for Patients With Suspected Drug-Induced Liver Injury
    (Elsevier, 2019-11) Ghabril, Marwan; Gu, Jiezhun; Yoder, Lindsay; Corbito, Laura; Ringel, Amit; Beyer, Christian D.; Vuppalanchi, Raj; Barnhart, Huiman; Hayashi, Paul H.; Chalasani, Naga; Medicine, School of Medicine
    Background & Aims: Patients with drug-induced liver injury (DILI) frequently have comorbid conditions, but the effects of non-liver comorbidities on outcome is not well understood. We investigated the association between co-morbidity burden and outcomes of patients with DILI, and developed and validated a model to calculate risk of death within 6 months. Methods: A multiple logistic regression model identified variables independently associated with death within 6 months of presenting with suspected DILI (6-month mortality) for 306 patients enrolled in the DILIN prospective study at Indiana University (discovery cohort). The model was validated using data from 247 patients with suspected DILI enrolled in the same study at the University of North Carolina (validation cohort). Medical comorbidity burden was calculated using the Charlson comorbidity index—patients with scores higher than 2 were considered to have significant comorbidities. Results: Six-month mortality was 8.5% in the discovery cohort and 4.5% in the validation cohort. In the discovery cohort, significant comorbidities (odds ratio [OR], 5.4; 95% CI 2.1 – 13.8), model for end-stage liver disease score (OR, 1.11; 95% CI, 1.04–1.17), and serum level of albumin at presentation (OR, 0.39; 95% CI, 0.2–0.76) were independently associated with 6-month mortality. A model based on these 3 variables identified patients who died within 6 months with c-statistic values of 0.89 (95% CI, 0.86–0.94) in the discovery cohort and 0.91 (95% CI, 0.83–0.99) in the validation cohort. We developed a web-based calculator to determine risk of death within 6 months for patients with suspected DILI for use in the clinic. Conclusions: We developed and validated a model based on comorbidity burden, model for end-stage liver disease score, and serum level of albumin that predicts 6-month mortality in patients with suspected DILI.
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    Early experience with resmetirom to treat metabolic dysfunction–associated steatohepatitis with fibrosis in a real-world setting
    (Wolters Kluwer, 2025-04-03) Ravela, Neel; Shackelford, Phoebe; Blessing, Nadia; Yoder, Lindsay; Chalasani, Naga; Samala, Niharika; Medicine, School of Medicine
    Background: Resmetirom was conditionally approved in the United States recently for treating metabolic dysfunction-associated steatohepatitis with stage 2 and 3 fibrosis. However, its availability to patients requires preauthorization by the payors and is dispensed only through selected specialty pharmacies. Methods: We established a multistakeholder and multistep resmetirom prescription process pivoting to a dedicated pharmacist. It incorporates liver biochemistry testing at 12 weeks and liver clinic follow-up at 6 months after starting resmetirom. Results: Fifteen hepatology providers prescribed resmetirom to 113 patients from April 1, 2024, to November 8, 2024, with histologic eligibility in 70% and noninvasive criteria in 30%. Resmetirom treatment was approved for 110 patients (97%), including 8 patients receiving the pharmaceutical company's patient assistance and 6 patients receiving bridge support to cover the co-pay. Eighty-three patients initiated resmetirom at an average of 30 days after its prescription. Adverse events were reported by 41% of patients taking resmetirom, and they were predominantly related to gastrointestinal symptoms and pruritus and/or rash with no evidence of hypersensitivity. Thirteen patients (16%) discontinued resmetirom after an average of 25.5 days (range: 2-68 d), with 11 patients discontinuing due to adverse events. The adverse events leading to discontinuation were nausea, diarrhea, and vomiting (n=4), right upper quadrant discomfort (n=2), left lower quadrant pain (n=1), rash with pruritus (n=1), pruritus and rash with indirect hyperbilirubinemia (n=1), dizziness (n=1), and mental fogginess (n=1). Follow-up liver biochemistries available in 24 patients showed no evidence of DILI. Conclusions: Our prescription pathway effectively dispensed resmetirom to nearly all patients who were prescribed resmetirom. One in 6 patients discontinued resmetirom, primarily due to side effects. This high discontinuation rate may be mitigated by modifying our follow-up from "prescribe and forget" to "prescribe and closely follow."
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    When Enough Is Not Enough: Screening, Brief Intervention and Referral to Treatment for Hepatitis C in Patients Presenting to the Emergency Department
    (Wiley, 2018) Yoder, Lindsay; Vuppalanchi, Raj; Medicine, School of Medicine
    Chronic hepatitis C viral (HCV)infection is the most common blood‐borne infection affecting at least 3.5 million people in the USA.1 HCV is a public health threat as it can lead to cirrhosis, liver decompensation with variceal bleeding, ascites, hepatic encephalopathy, hepatocellular carcinoma or death.2 The World Health Organization (WHO) estimates that 399,000 individuals died from cirrhosis or hepatocellular carcinoma caused by HCV infection in 2015.