P0184 : Hepatopulmonary syndrome is not associated with higher rates of left ventricle diastolic dysfunction in patients with cirrhosis

POSTERS with the maximal R2 (75.3%) was: GFR = 62.5·(creatinine−0.839 ) × (urea−0.213 ) × (INR−0.186 ) × (age0.123 ) × (sodium0.898 ) × 1.256(if male) × 0.906(if severe ascites). The mean difference between observed/ predicted GFRs (residual) in the validation set was 8.6±14.9. According to the residual plots the model was a good fit. Conclusions: Measured creatinine overestimates renal function and leads to systematic biases in MELD calculation especially in high MELD scores. We developed and validated a new well-fitted model for renal function assessment in cirrhosis. This remains to be incorporated in prognostic scores in patients with cirrhosis.

comprising streptococci and staphylococci and cluster III (n = 13, 8.8%) revealed a dominant OTU belonging to Granulicatella spp. Streptococci OTU were missing in Cluster IV (n = 9, 6.1%). Blood samples and corresponding duodenal fluids revealed in all cases (n = 5) a different microbial composition and could never be assigned to the same T-RFLP cluster. Conclusions: The preliminary findings of different microbial clusters observed in blood and duodenal fluid from patients with cirrhosis argues against bacterial translocation originating from the duodenum. P0183 MEASUREMENT OF SPLEEN AND LIVER STIFFNESS BY SHEAR WAVE ELASTOGRAPHY TO NONINVASIVELY EVALUATE HEPATIC VENOUS PRESSURE GRADIENT AND PORTAL HYPERTENSION L. Vonghia1 , W. Verlinden1 , T. Vanwolleghem1 , P. Michielsen1 , S. Francque1 . 1 Gastroenterology Hepatology, University Hospital Antwerp, Edegem, Belgium E-mail: [email protected]

P0182 DUODENAL MICROBIOTA IS NOT THE ORIGIN FOR BACTERIAL TRANSLOCATION IN LIVER CIRRHOSIS 1 S. Krohn1 , C. Engelmann1 , P. Raatz1 , A. Hoffmeister1 , A. Bohlig ¨ , 1 K. Zeller1 , S. Bohm ¨ , A. Chatzinotas2 , T. Berg1 . 1 Division of Gastroenterology and Hepatology, University Hospital Leipzig, 2 Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany E-mail: [email protected] Background and Aims: Intestinal dysbiosis and bacterial translocation (BT) in cirrhosis has been regarded as the main driver for infections. Although the small intestine has been considered having the greatest potential for BT further results promoted that the colon has the largest rate of BT and permeability. We therefore investigated duodenal fluid and blood of liver disease patients regarding its bactDNA content and composition. Methods: 156 blood and duodenal samples were collected in cirrhotics (n = 114) and controls without liver disease (n = 42). Samples were analysed for bactDNA content using quantitative 16S rRNA gene based real time PCR. To define the microbial composition of bactDNA positive samples terminal restriction fragment length polymorphism (T-RFLP) was used and clone library analyses provided the assignment of sequence types to operational taxonomic units (OTU). Results: All 156 duodenal samples were tested positive for bactDNA with a median of 4.6×108 copies/ml (1.0×104 –7.7×1010 ). In total, 19/156 (12.2%) blood samples [cirrhosis 52.6% (n = 10) vs. noncirrhosis 47.4% (n = 9)] were bactDNA positive (median 5.8×103 copies/ml; 1.7×103 –1.5×105 ). According to T-RFLP analyses of 142/156 (91.0%) duodenal and so far 5/19 (26.3%) blood samples of patients with cirrhosis (n = 4; 80%) a division into four clusters could be performed. Cluster I (n = 10, 6.8%) revealed the lowest number of 16S rRNA gene copies (median 1.7×104 ; 3.1×103 – 7.1×105 ) and included 80% of bactDNA positive blood samples. Its microbial composition differed highly from the remaining groups. Cluster II (n = 115, 78.2%) showed two distinct OTU predominantly S372

Background and Aims: Hepatic venous pressure gradient (HVPG) is the gold standard used to determine the degree of sinusoidal portal hypertension and an important prognostic factor for patients with cirrhosis. HVPG can only be determined invasively in specialized centers. Recent data demonstrated that measurement of spleen stiffness (SS) and liver stiffness (LS) by transient elastography correlates with HVPG levels. To date, the performance of swear wave elastography (SWE) in this setting has not been reported. Therefore, the aim of the present study was to assess the diagnostic performance of SS and LS, measured by SWE, as noninvasive predictor of portal hypertension (PH) using HVPG as the gold standard. Methods: We measured SS and LS in patients with liver disease undergoing HVPG measurement. Results: Between September 2013 and October 2014, 63 patients were consecutively included. 67% were male and mean age was 55.3±12.4 years. Main aetiologies of liver disease were alcohol (41%), non-alcoholic fatty liver disease (29%), hepatitis B (14%) and autoimmune hepatitis (8%). Linear regression showed a significant correlation between HVPG and SS (R2 0.433, p < 0.001), LS (R2 0.468, p < 0.0001) and SS/LS combined (R2 0.540, p < 0.0001). AUROC of SS for HVPG <10 mmHg versus ≥10 mmHg and HVPG <12 mmHg versus ≥12 mmHg was 0.86 and 0.84, respectively. A SS cut-off value of 29.6 kPa had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 74%, 90%, 85% and 81%, and of 78%, 82%, 70% and 88% for HVPG ≥10 mmHg and HVPG ≥12 mmHg, respectively. AUROC of LS for HVPG <10 mmHg versus ≥10 mmHg and HVPG <12 mmHg versus ≥12 mmHg was 0.85 and 0.80, respectively. A LS cut-off value of 15.9 kPa had a sensitivity, specificity, PPV and NPV of 96%, 69%, 73% and 96%, and of 95%, 56%, 54% and 96% for HVPG ≥10 mmHg and HVPG ≥12 mmHg, respectively. Conclusions: This is the first study of SWE measurement of SS and correlation with HVPG. Measurement of SS can be used for noninvasive assessment of PH, and is a slightly better predictor than LS. P0184 HEPATOPULMONARY SYNDROME IS NOT ASSOCIATED WITH HIGHER RATES OF LEFT VENTRICLE DIASTOLIC DYSFUNCTION IN PATIENTS WITH CIRRHOSIS A. Voiosu1 , I. Daha2 , T. Voiosu1 , M. Diculescu3 , ACCEPT. 1 Gastroenterology, 2 Cardiology, Colentina Clinical Hospital, 3 Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania E-mail: [email protected] Background and Aims: Hepatopulmonary syndrome (HPS) and cirrhotic cardiomyopathy are common complications of liver cirrhosis but their real prevalence and importance are not yet known. Common pathogenetic mechanisms may be involved and some studies have shown possible links between HPS and left

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POSTERS ventricle diastolic dysfunction. We aimed to further investigate the relationship between HPS and echocardiographic parameters of diastolic dysfunction in cirrhotic patients. Methods: Consecutive patients with cirrhosis and no preexisting heart or lung conditions were included in a prospective observational study. Transthoracic echocardiography (TTE) with injected agitated saline was performed in all patients. HPS was diagnosed in the presence of increased age-adjusted alveolararterial gradient and intrapulmonary vascular dilatations detected by contrast TTE. Diastolic dysfunction of the left ventricle was assessed through TTE measurements of left atrial volume (LAV), early (E ) and late (A ) diastolic mitral annular velocity, mitral early (E-wave) and late diastolic filling (A-wave) velocities, E/A ratio, mitral inflow E velocity to tissue Doppler E (E/E ) ratio, deceleration time (DT) of early filling velocity and isovolumetric relaxation time (IVRT). N-terminal prohormone of brain natriuretic peptide (NTproBNP) levels were also measured in all patients. These variables were compared in univariate and multivariate analysis (using binary logistic regression) between patients with and those without HPS. Results: Fifty-four patients with cirrhosis (21 female, mean age 59 years) were included. 32 were Child–Pugh class A, 12 were Child Pugh B and 10 Child Pugh C. 28 patients had intrapulmonary vascular dilatations but only 17 (31%) fulfilled all criteria for HPS. Mean NT-proBNP levels did not differ between patients with and those without HPS (260 vs. 251 pg/mL, p = 0.88 student t test). None of the evaluated echocardiographic parameters (LAV, E , A , E/E , IVRT, E/A and DT) correlated significantly with the presence of HPS in either univariate or multivariate analysis. Conclusions: In this cohort of 54 consecutive cirrhotic patients the presence of hepatopulmonary syndrome did not associate with increased rates of left ventricle diastolic dysfunction as evaluated by echocardiographic parameters or NT-proBNP levels. Acknowledgments: This study is part of the ACCEPT initiative and POSDRU 159/1.5/S/141531. P0185 ACUTE-ON-CHRONIC LIVER FAILURE NOT ASSOCIATED WITH BACTERIAL INFECTIONS. CHARACTERISTICS, PROGNOSIS AND IMPORTANCE OF SYSTEMIC INFLAMMATORY RESPONSE C. Sole` 1,2,3,4,5 , E. Sola1,2,3,4,5 , J. Fernandez1,2,3,4,5 , M. Pavesi1,6 , A. Amoros1,7 , R. Moreau8 , P. Angeli9 , R. Jalan10 , F. Durand11 , T. Gustot12 , F. Saliba13 , M. Domenicali14 , A. Gerbes15 , J. Wendon16 , C. Alessandria17 , W. Laleman18 , S. Zeuzem19 , J. Trebicka20 , M. Bernardi21 , V. Arroyo1,2,3 , P. Gines1,2,3,4,5 , for the Canonic Study Investigators of the EASL–CLIF Consortium. 1 Hospital Clinic de Barcelona, 2 University of Barcelona, 3 Institut d’Investigacions Biom`ediques August-Pi-Sunyer (IDIBAPS), 4 Centro de Investigaci´ on Biom´edica en Red de Enfermedades Hep´ aticas y Digestivas (CIBEREHED), 5 Instituto Reina Sof´ıa de Investigaci´ on Nefrol´ ogica (IRSIN), 6 Data Management Centre, 7 CLIF Consortium, Barcelona, Spain; 8 INSERM, Hospital Beaujon, Clichy, France; 9 Hepatology, University of Padova, Padova, Italy; 10 Royal Free Hospital, Univerrsity College London, London, United Kingdom; 11 Hepatology, Hospital Beaujon, Clichy, France; 12 University of Brussels, Brussels, Belgium; 13 Hospital Paul Brousse, Villejuif, France; 14 University of Bologna, Bologna, Italy; 15 University of Munich, Munich, Germany; 16 Liver studies, Kings College London, London, United Kingdom; 17 Hepatology, University of Turin, Turin, Italy; 18 Hepatology, University of Leuven, Leuven, Belgium; 19 Hepatology, JW Goethe University Hospital, Frankfurt, 20 Hepatology, University of Bonn, Bonn, Germany; 21 Hepatology, University of Bologna, Bologna, Italy E-mail: [email protected] Background and Aims: Acute-on-Chronic Liver Failure (ACLF) is a frequent syndrome that occurs in patients with cirrhosis that is associated with high short-term mortality. Frequently, it occurs in the context of systemic inflammatory response caused by

bacterial infections. However, in some cases, ACLF occurs without an identifiable bacterial infection. Although there is information about ACLF associated with infections, information about characteristics and outcome of ACLF not associated with infections is very limited. The aim of this study is to investigate the characteristics, evolution and survival of patients with ACLF not associated with infections. Methods: We analyzed 302 patients with ACLF included in the European multicentric CANONIC study of EASL-CLIF consortium. Patients were classified into two groups according to the absence or presence of bacterial infections (ACLF-noinf and ACLF-inf, respectively). Diagnosis of bacterial infection was based on standard procedures. Results: One-hundred and forty-three patients (47%) had ACLFnoinf, while 159 had ACLF-inf (53%). Among patients with ACLFnoinf no precipitating event could be found in 54% despite extensive assessment. In the remaining patients, precipitating events were active alcoholism, gastrointestinal bleeding or miscellaneous causes. Comparison of frequencies of organ failures included in the definition of ACLF showed a similar frequency of kidney, liver, and coagulation failures and a significantly lower frequency of brain, circulatory, and lung failures in patients with ACLF-noinf compared to patients with ACLF-inf. Patients with ACLF-noinf had higher leukocyte count and C-reactive protein levels than those of patients without ACLF, yet lower compared to values of patients with ACLF-inf. CLIF-Organ failure and CLIF-C-ACLF scores, two classifications to assess severity of ACLF, were significantly higher in patients with ACLF-inf than in those with ACLF-noinf. However, 3-month mortality of patients with ACLF-noinf was similar to that of patients with ACLF-inf, and close to 50%. In patients with ACLFnoinf leukocyte count was an independent predictive factor of 3-month mortality. Conclusions: ACLF-noinf is common and associated with poor prognosis. Current findings suggest that ACLF-noinf occurs in the setting of a systemic inflammatory response, the severity of which is associated with prognosis. Further studies are needed to investigate characteristics of this inflammatory response and identify new therapeutic targets. P0186 A MODEL TO PREDICT MORTALITY IN CIRRHOTICS PRESENTING WITH CELLULITIS C.A. Philips1 , R. Prabhat1 , A. Sahney1 , L. Anand1 , D. Rangegowda1 , A. Kumar1 , G. Kumar2 , V. Bhatia1 , S.K. Sarin1 . 1 Hepatology, 2 Research, Institute of Liver and Biliary Sciences, New Delhi, India E-mail: [email protected] Background and Aims: Infections are arguably the commonest cause of mortality in cirrhosis patients. Due to significant hemodynamic alterations, pedal edema, ascites, coagulopathy and cirrhosis associated immune deficiency syndrome, skin and soft tissue infections (SSTI) are not uncommon in cirrhotics. Prevalence and outcome of cirrhotics presenting with SSTI and predictors of mortality have not been adequately studied. Methods: From Aug 2012 to Oct 2014, 2368 patients of cirrhosis and acute on chronic liver failure (defined as per Asian Pacific Association for Study of Liver criteria) were admitted. The electronic records were analysed retrospectively for presentation with regards to SSTI and their influence on mortality. A model was developed to predict mortality due to SSTI. Results: Two hundred and fifty patients (9.47%, M-212, F-38) were diagnosed to have cellulitis or severe skin infections. The commonest aetiology was HBV related cirrhosis, followed by non-alcoholic fatty liver and alcoholic liver disease. Fifty-three patients died due to refractory septic shock (M-49, F-4; 21.2%). The commonest organism cultured from wound site was E. coli, followed by Klebsiella and Acinetobacter species. Commonest systemic infection associated with SSTI was pneumonia. The most

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