- Email: [email protected]
Survival of Patients with Cirrhosis Following First Episode of Decompensation
ABSTRACTS
Cirrhosis and Complications
patients with Child C cirrhosis and spontaneous bacterial peritonitis (SBP) were enrolled as cases and C 50 matched Child C cirrhotic patients without SBP were taken as controls. The diagnosis of cirrhosis was made by liver function tests, ultrasound examination, with or without liver biopsy. Patients who did not have a c medication list, prior organ transplantation, on immunosuppressive therapy, gastrointestinal bleeding within 2 weeks, were excluded. All patients underwent ascitic fluid analysis at admission. SBP was diagnosed if ascitic fluid yielding 250 or more polymorphonuclear leukocytes/mm3 with or without a positive culture. The Controls were CHILD C cirrhotic patients without SBP (<250 polymorphonuclear leukocytes and a negative culture). PPI use was defined as regular use of any proton pump inhibitor during the last 30 days prior to the admission. Results: Out of the 50 Child C cirrhotic patients with SBP 36 (72%) were males and 14 (28%) were females (mean age 57.38 10.6 years. The patient characteristics were comparable among the cases and controls. The presence of PPI use was present in 37 (74%) Child C cirrhotic patients with SBP compared to 26 (52%) Child C cirrhotic patients without SBP. When both cases and controls are taken together PPI use was noted in 63% in Child C cirrhotic patients. The risk estimate showed a significant association between PPI use and SBP in Child C cirrhotic patients (P = 0.023, OR = 2.627, 95% CI = 1.133–6.091). Out of the 63 patients with PPI use 26 had appropriate indication for PPI therapy. Conclusion: PPI use is high in Child C patients even without appropriate indications. PPI use is associated with SBP in Child C cirrhotic patients. Corresponding author: Sijil K.S. Email: [email protected]
SURVIVAL OF PATIENTS WITH CIRRHOSIS FOLLOWING FIRST EPISODE OF DECOMPENSATION Yamuna Pillai, H. Abhilash, Devang Tank, K. S. Sijil, Premaletha Narayanan, K. R. Vinayakumar Department of Medical Gastroenterology, Medical College Trivandrum, Kerala, India Background: Hepatic decompensation is a crucial turning point in cirrhosis with over 50% risk of complications or death within a relatively short period. Acute-on-chronic liver failure (ACLF) has high mortality of about 50–90%. Despite the magnitude of the problem, there is scarcity of data from our country that assessed the outcome of patients with cirrhosis since the onset of decompensation according to its clinical features.
S40
22ND ANNUAL CONFERENCE – 2014
Objective: 1) To assess transplant free survival rates of patients with cirrhosis after first episode of decompensation 2) To study the difference between survival rates of patients with cirrhosis according to first episode of decompensation 3) To assess impact of ACLF in overall survival of cirrhosis patients. Methods: Retrospective inception cohort study conducted in Department of Medical Gastroenterology, Medical College, Thiruvananthapuram in patients presenting with first episode of decompensation between 2008–2012. Decompensated cirrhosis defined as clinically evident complications of portal hypertension (ascites, variceal hemorrhage, hepatic encephalopathy) and ACLF by APASL guidelines. Exclusion criteria 1) Patients with HCC at study entry 2) Unwilling to participate 3) Death due to causes unrelated to cirrhosis 4) Patients with inadequate data. Follow up period censored at either death or lost to follow-up. Survival analysis was done by Kaplan Meier curve for each exposure variable such as ascites, variceal bleed, hepatic encephalopathy and ACLF. Effect on survival was assessed by log rank test. Results: Of 490 cirrhotic patients, 155 fulfilled the study criteria (143 males; mean age 52.7 11.47). Etiology was alcohol in 93.5%. Ascites found in 91 (59.45%), variceal bleed in 63 (40.9%), hepatic encephalopathy (HE) in 15 (9.7%) and ACLF in 21 (13.5%). Follow-up for mean period of 14.4 months. Overall survival after decompensation was 70.3%, 49.1% and 34.7% at 1 year, 2 years and 3 years respectively. The cumulative survival of patients with ascites at first presentation was 56.4%, 40.3%, 16% at 1 year, 2 years and 3 years respectively compared to 87%, 59.7%, 56.3% in variceal bleeding (P = 0.000). HE found to have 1 year survival of 54.5%, median survival 13 months (P = 0.055). ACLF (1 year survival = 46%, median survival = 10months) was found to have significantly lesser survival with P = 0.005. Conclusions: (1) Overall survival after decompensation was 70.3%, 49.1% and 34.7% at 1 year, 2 years and 3 years respectively (2) Survival of decompensated cirrhotic patients with ascites at first episode of decompensation was significantly low compared to variceal bleed (3) ACLF is associated with worst prognosis with median survival of 10 months after index presentation. Corresponding author: Yamuna Pillai. Email: [email protected]
RISK FACTORS OF CELLULITIS IN CIRRHOSIS AND ROLE OF ANTIBIOTICS IN PREVENTING RECURRENCE E. H. Rooby, P. V. Mashhood, Deni Joseph, G. Chethan, George Peter, N. Premalatha, K. R. Vinayakumar Department of Medical Gastroenterology, Medical College Trivandrum, Kerala, India © 2014, INASL
Cirrhosis and Complications
patients with Child C cirrhosis and spontaneous bacterial peritonitis (SBP) were enrolled as cases and C 50 matched Child C cirrhotic patients without SBP were taken as controls. The diagnosis of cirrhosis was made by liver function tests, ultrasound examination, with or without liver biopsy. Patients who did not have a c medication list, prior organ transplantation, on immunosuppressive therapy, gastrointestinal bleeding within 2 weeks, were excluded. All patients underwent ascitic fluid analysis at admission. SBP was diagnosed if ascitic fluid yielding 250 or more polymorphonuclear leukocytes/mm3 with or without a positive culture. The Controls were CHILD C cirrhotic patients without SBP (<250 polymorphonuclear leukocytes and a negative culture). PPI use was defined as regular use of any proton pump inhibitor during the last 30 days prior to the admission. Results: Out of the 50 Child C cirrhotic patients with SBP 36 (72%) were males and 14 (28%) were females (mean age 57.38 10.6 years. The patient characteristics were comparable among the cases and controls. The presence of PPI use was present in 37 (74%) Child C cirrhotic patients with SBP compared to 26 (52%) Child C cirrhotic patients without SBP. When both cases and controls are taken together PPI use was noted in 63% in Child C cirrhotic patients. The risk estimate showed a significant association between PPI use and SBP in Child C cirrhotic patients (P = 0.023, OR = 2.627, 95% CI = 1.133–6.091). Out of the 63 patients with PPI use 26 had appropriate indication for PPI therapy. Conclusion: PPI use is high in Child C patients even without appropriate indications. PPI use is associated with SBP in Child C cirrhotic patients. Corresponding author: Sijil K.S. Email: [email protected]
SURVIVAL OF PATIENTS WITH CIRRHOSIS FOLLOWING FIRST EPISODE OF DECOMPENSATION Yamuna Pillai, H. Abhilash, Devang Tank, K. S. Sijil, Premaletha Narayanan, K. R. Vinayakumar Department of Medical Gastroenterology, Medical College Trivandrum, Kerala, India Background: Hepatic decompensation is a crucial turning point in cirrhosis with over 50% risk of complications or death within a relatively short period. Acute-on-chronic liver failure (ACLF) has high mortality of about 50–90%. Despite the magnitude of the problem, there is scarcity of data from our country that assessed the outcome of patients with cirrhosis since the onset of decompensation according to its clinical features.
S40
22ND ANNUAL CONFERENCE – 2014
Objective: 1) To assess transplant free survival rates of patients with cirrhosis after first episode of decompensation 2) To study the difference between survival rates of patients with cirrhosis according to first episode of decompensation 3) To assess impact of ACLF in overall survival of cirrhosis patients. Methods: Retrospective inception cohort study conducted in Department of Medical Gastroenterology, Medical College, Thiruvananthapuram in patients presenting with first episode of decompensation between 2008–2012. Decompensated cirrhosis defined as clinically evident complications of portal hypertension (ascites, variceal hemorrhage, hepatic encephalopathy) and ACLF by APASL guidelines. Exclusion criteria 1) Patients with HCC at study entry 2) Unwilling to participate 3) Death due to causes unrelated to cirrhosis 4) Patients with inadequate data. Follow up period censored at either death or lost to follow-up. Survival analysis was done by Kaplan Meier curve for each exposure variable such as ascites, variceal bleed, hepatic encephalopathy and ACLF. Effect on survival was assessed by log rank test. Results: Of 490 cirrhotic patients, 155 fulfilled the study criteria (143 males; mean age 52.7 11.47). Etiology was alcohol in 93.5%. Ascites found in 91 (59.45%), variceal bleed in 63 (40.9%), hepatic encephalopathy (HE) in 15 (9.7%) and ACLF in 21 (13.5%). Follow-up for mean period of 14.4 months. Overall survival after decompensation was 70.3%, 49.1% and 34.7% at 1 year, 2 years and 3 years respectively. The cumulative survival of patients with ascites at first presentation was 56.4%, 40.3%, 16% at 1 year, 2 years and 3 years respectively compared to 87%, 59.7%, 56.3% in variceal bleeding (P = 0.000). HE found to have 1 year survival of 54.5%, median survival 13 months (P = 0.055). ACLF (1 year survival = 46%, median survival = 10months) was found to have significantly lesser survival with P = 0.005. Conclusions: (1) Overall survival after decompensation was 70.3%, 49.1% and 34.7% at 1 year, 2 years and 3 years respectively (2) Survival of decompensated cirrhotic patients with ascites at first episode of decompensation was significantly low compared to variceal bleed (3) ACLF is associated with worst prognosis with median survival of 10 months after index presentation. Corresponding author: Yamuna Pillai. Email: [email protected]
RISK FACTORS OF CELLULITIS IN CIRRHOSIS AND ROLE OF ANTIBIOTICS IN PREVENTING RECURRENCE E. H. Rooby, P. V. Mashhood, Deni Joseph, G. Chethan, George Peter, N. Premalatha, K. R. Vinayakumar Department of Medical Gastroenterology, Medical College Trivandrum, Kerala, India © 2014, INASL