- Email: [email protected]
P0147 : Malnutrition and adherence to nutritional recommendation in patients with cirrhosis
POSTERS ceived CVC 200 mg daily with tenofovir/emtricitabine for ≤48 weeks (Study 652–2–202). MCP-1 (CCR2 ligand) and MIP-1b (CCR5 ligand) plasma levels were measured at baseline (BL) and after 1 and 2 weeks of CVC treatment in both studies; other CCR5 ligands (MIP-1a and RANTES), cytokines (IL-1b, IL-6, TNF-a) and microbial translocation markers (soluble CD14 [sCD14], LPS binding protein [LBP], intestinal fatty acid binding protein [I-FABP], flagellin) were measured in Study 121. Wilcoxon tests and Spearman correlations were used. Results: Rapid and significant increases in MCP-1 and MIP-1b were observed after 1 and 2 weeks of treatment across all treatment groups (Table). In Study 121, as in Study 202, higher MCP-1 levels correlated with higher peak CVC concentration (r = 0.39, p = 0.03). In matched controls (moderate), TGF-b and RANTES increased during CVC treatment (p = 0.008, Week 2 vs BL). After 2 weeks of CVC treatment, there were no significant changes in MIP-1a, sCD14, LBP, I-FABP, flagellin, IL-1b, IL-6 or TNF-a. Flagellin correlated with I-FABP at BL (r = 0.44, p = 0.01) and Week 2 (r = 0.40, p = 0.03), and with ALT at BL (r = 0.41, p = 0.02) and Week 2 (r = 0.45, p = 0.01). In Study 202, sustained reductions in sCD14 were observed over 48-week CVC treatment (p < 0.001, CVC vs efavirenz). Conclusions: CVC treatment led to rapid, reciprocal increases of MCP-1 and MIP-1b, due to effective CCR2 and CCR5 blockade across all treatment groups, regardless of underlying pathology; the greater magnitude in MIP-1b changes in HIV-1-infected subjects could be attributed to HIV binding to CCR5. Correlation between MCP-1 and CVC concentrations suggests a dose-dependent effect. Importantly, increased MCP-1 and MIP-1b levels were not associated with increased markers of intestinal damage, or hepatic or systemic inflammation. P0147 MALNUTRITION AND ADHERENCE TO NUTRITIONAL RECOMMENDATION IN PATIENTS WITH CIRRHOSIS B.D. Procopet1 , A. Epure2 , L. Filip2 , M. Grigorescu1 , A. Habic1 , C. Radu1 , M. Tantau1 , D. Crisan1 . 1 Gastroenterology, 2 Nutrition – Pharmacology, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Cluj-Napoca, Romania E-mail: [email protected] Background and Aims: Malnutrition proved to be prevalent in patients with cirrhosis and has prognostic relevance. The aim of our study was to: check the prevalence of malnutrition in a population with decompensated cirrhosis and to evaluate the adherence to nutritional recommendations. Methods: 101 consecutive patients with cirrhosis (64 hospitalized for decompensation and 37 compensated from outpatient ward) were prospectively evaluated for the presence of malnutrition using Subjective Global Assessment (SGA) criteria and mid-arm circumference (MAC). Malnutrition was defined as SGA class B and C and MAC <10th . All patients were interviewed regarding their food intake using an adapted questionnaire and the energy and main nutrients (proteins, lipids, carbohydrates and salt) intake was calculated. Results: According to the SGA, in the decompensated group 48 patients (75%) had malnutrition, while only 9 patients (24%) were malnourished in the compensated group. Using the MAC criteria, malnutrition was present in 41 (64%) decompensated and 13 (35%) compensated patients. Only 13 (12.9%) patients had the recommended alimentary intake, 78 (77.2%) patients had a suboptimal energy intake and only 26 (25.7%) patients had the recommended protein intake. Only 26 (25.7%) among all and 16 (25%) among decompensated patients were adherent to low salt diet. Lower cholesterol levels (HR = 0.97, p = 0.001), lower sodium (HR = 0.71, p = 0.004) and female sex (HR = 8.25, p = 0.01) are independently associated with presence of malnutrition.
Conclusions: Prevalence of malnutrition is high in patients with advanced cirrhosis and is related in part to a low adherence to nutritional recommendations. P0149 SIX-MONTH MORTALITY OF CIRRHOTIC PATIENTS WHO SURVIVED INTENSIVE CARE: A META-ANALYSIS D. Weil1 , V. Di Martino1 , E. Levesque2 , M. McPhail3 , R. Cavallazzi4 , E. Theocharidou5 , E. Cholongitas6 , A. Galbois7 , H.-C. Pan8 , C. Karvellas9 , B. Sauneuf10 , R. Robert11 , J. Fichet12 , G. Piton13 , 1 G. Capellier13 , T. Thevenot ´ , METAREACIR Group. 1 Service 2 d’h´epatologie, CHU Jean Minjoz, Besancon, ¸ Centre H´epatobiliaire, Hˆ opital Paul Brousse, Villejuif, France; 3 Liver Intensive care Unit, King’s College, London, United Kingdom; 4 Intensive care Unit, University of Louisville, Louisville (KY), United States; 5 Sheila Sherlock Liver Center, Royal free hospital, London, United Kingdom; 6 Liver Department, Aristotle University, Thessaloniki, Greece; 7 Intensive care Unit, Hˆ opital Saint Antoine, Paris, France; 8 Nephrology Department, Chang Gung Memorial Hopsital, Taipei, Taiwan; 9 Intensive care Unit, University of Alberta, Edmonton, Canada; 10 Intensive care Unit, Hˆ opital Cochin, Paris, 11 Intensive care Unit, CHU Poitiers, Poitiers, 12 Intensive care Unit, CHU de Tours, Tours, 13 Intensive care Unit, CHU Jean Minjoz, Besancon, ¸ France E-mail: [email protected] Background and Aims: The medium-term survival of cirrhotic patients who survived intensive care and its determinants have never been evaluated due to the small number of ICU survivors in the published studies. This meta-analysis evaluated the predictors of 6-month mortality in ICU survivors. Methods: 13 studies (2695 cirrhotics) were analyzed after selection of original articles and response to a standardized questionnaire by the corresponding authors. The endpoint was 6-month mortality of ICU survivors. 95 pooled analyses concerned patient characteristics, reason for admission, organ replacement therapy, and composite scores. Results: 5 studies reported the outcome of 412 ICU survivors. Only 48 patients (3.4%) were transplanted during follow-up. Six-month mortality was lower in high volume centers (OR = 0.45;95% CI:0.30–0.67;p < 0.001), in general ICUs (OR = 0.31;95% CI:0.21–0.47;p < 0.001) in centers with TIPS (OR = 0.42;95% CI:0.25–0.46;p = 0.002), but not with liver transplantation (OR = 2.21;95% CI:1.21–4.04;p = 0.008) available. Age, sex and alcohol-related cirrhosis had no significant impact on 6-month mortality. Unlike for in-ICU mortality, high values of SOFA did not predict 6-month mortality in ICU survivors. Eight parameters of liver and renal function were associated with 6-month mortality, including Child–Pugh C stage (OR = 2.43;95% CI:1.44–4.10;p < 0.001), MELD ≥26 on ICU admission (OR = 3.97;95% CI:1.92–8.22;p < 0.0001;PPV = 0.75), hepatorenal syndrome (OR = 4.67;95% CI:1.24–17.64;p = 0.022;PPV = 0.88) and admission for acute renal failure (OR = 3.29;95% CI:1.70– 6.40;p < 0.001;PPV = 0.73). Septic shock (OR = 3.95;95% CI:1.38– 11.30;p = 0.010;PPV = 0.62) and nosocomial infection on admission (OR = 2.72;95% CI:1.09–6.76;p = 0.031;PPV = 0.76) were also associated with higher 6-month mortality. Among medical interventions, only the use of norepinephrine (OR = 2.07;95% CI:1.07– 4.00;p = 0.029;PPV = 0.61), given for hepatorenal syndrome, was predictive of 6-month mortality in ICU survivors. Conclusions: Only a minority of ICU survivors undergo liver transplantation. Liver and renal failures in ICU have a sustained impact on long-term mortality. The prognostic performance of general ICU scores decreases over time, unlike Child–Pugh and MELD scores, even measured in the context of organ failure. Eligible patients could thus be listed for transplantation in ICUs or shortly after ICU discharge.
Journal of Hepatology 2015 vol. 62 | S263–S864
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Conclusions: Prevalence of malnutrition is high in patients with advanced cirrhosis and is related in part to a low adherence to nutritional recommendations. P0149 SIX-MONTH MORTALITY OF CIRRHOTIC PATIENTS WHO SURVIVED INTENSIVE CARE: A META-ANALYSIS D. Weil1 , V. Di Martino1 , E. Levesque2 , M. McPhail3 , R. Cavallazzi4 , E. Theocharidou5 , E. Cholongitas6 , A. Galbois7 , H.-C. Pan8 , C. Karvellas9 , B. Sauneuf10 , R. Robert11 , J. Fichet12 , G. Piton13 , 1 G. Capellier13 , T. Thevenot ´ , METAREACIR Group. 1 Service 2 d’h´epatologie, CHU Jean Minjoz, Besancon, ¸ Centre H´epatobiliaire, Hˆ opital Paul Brousse, Villejuif, France; 3 Liver Intensive care Unit, King’s College, London, United Kingdom; 4 Intensive care Unit, University of Louisville, Louisville (KY), United States; 5 Sheila Sherlock Liver Center, Royal free hospital, London, United Kingdom; 6 Liver Department, Aristotle University, Thessaloniki, Greece; 7 Intensive care Unit, Hˆ opital Saint Antoine, Paris, France; 8 Nephrology Department, Chang Gung Memorial Hopsital, Taipei, Taiwan; 9 Intensive care Unit, University of Alberta, Edmonton, Canada; 10 Intensive care Unit, Hˆ opital Cochin, Paris, 11 Intensive care Unit, CHU Poitiers, Poitiers, 12 Intensive care Unit, CHU de Tours, Tours, 13 Intensive care Unit, CHU Jean Minjoz, Besancon, ¸ France E-mail: [email protected] Background and Aims: The medium-term survival of cirrhotic patients who survived intensive care and its determinants have never been evaluated due to the small number of ICU survivors in the published studies. This meta-analysis evaluated the predictors of 6-month mortality in ICU survivors. Methods: 13 studies (2695 cirrhotics) were analyzed after selection of original articles and response to a standardized questionnaire by the corresponding authors. The endpoint was 6-month mortality of ICU survivors. 95 pooled analyses concerned patient characteristics, reason for admission, organ replacement therapy, and composite scores. Results: 5 studies reported the outcome of 412 ICU survivors. Only 48 patients (3.4%) were transplanted during follow-up. Six-month mortality was lower in high volume centers (OR = 0.45;95% CI:0.30–0.67;p < 0.001), in general ICUs (OR = 0.31;95% CI:0.21–0.47;p < 0.001) in centers with TIPS (OR = 0.42;95% CI:0.25–0.46;p = 0.002), but not with liver transplantation (OR = 2.21;95% CI:1.21–4.04;p = 0.008) available. Age, sex and alcohol-related cirrhosis had no significant impact on 6-month mortality. Unlike for in-ICU mortality, high values of SOFA did not predict 6-month mortality in ICU survivors. Eight parameters of liver and renal function were associated with 6-month mortality, including Child–Pugh C stage (OR = 2.43;95% CI:1.44–4.10;p < 0.001), MELD ≥26 on ICU admission (OR = 3.97;95% CI:1.92–8.22;p < 0.0001;PPV = 0.75), hepatorenal syndrome (OR = 4.67;95% CI:1.24–17.64;p = 0.022;PPV = 0.88) and admission for acute renal failure (OR = 3.29;95% CI:1.70– 6.40;p < 0.001;PPV = 0.73). Septic shock (OR = 3.95;95% CI:1.38– 11.30;p = 0.010;PPV = 0.62) and nosocomial infection on admission (OR = 2.72;95% CI:1.09–6.76;p = 0.031;PPV = 0.76) were also associated with higher 6-month mortality. Among medical interventions, only the use of norepinephrine (OR = 2.07;95% CI:1.07– 4.00;p = 0.029;PPV = 0.61), given for hepatorenal syndrome, was predictive of 6-month mortality in ICU survivors. Conclusions: Only a minority of ICU survivors undergo liver transplantation. Liver and renal failures in ICU have a sustained impact on long-term mortality. The prognostic performance of general ICU scores decreases over time, unlike Child–Pugh and MELD scores, even measured in the context of organ failure. Eligible patients could thus be listed for transplantation in ICUs or shortly after ICU discharge.
Journal of Hepatology 2015 vol. 62 | S263–S864
S357