- Email: [email protected]
[136] CHIKUNGUNYA VIRUS EPIDEMIC IN SAINT BENOIT, LA REUNION ISLAND: AN EPIDEMIOLOGIC STUDY OF A CLUSTER OF ACUTE LIVER DISEASES
POSTERS
S62
01B. LIVER TRANSPLANTATION/ SURGERY/ACUTE LIVER FAILURE B) CLINICAL
11361 CHIKUNGUNYA VIRUS EPIDEMIC IN SAINT BENOIT, LA REUNION ISLAND: AN EPIDEMIOLOGIC STUDY OF A CLUSTER OF ACUTE LIVER DISEASES A. Ahergel', W. Rakotoarivonina2, Y. Jacques-Antoine2, F. Binois2, M. Lemarine12, G. Bommelae?, T. Asselah3, J. Bernuau3. 'Heputology, Hrjtel Dieu, Clernzont Fermnd; 'Emergency department, Cliniqiie Saint Benoit, Ile de la Reunion; Heputology, H6pital Beaujon, Clichy siir Seine, France E-mail: [email protected]
'
The aim of this retrospective study is to analyse the features of a cluster of acute liver diseases that occurred during the recent epidemic of Chikungunya virus (CHIK) (an alphavirus without recognized tropism for hepatocytes) observed in Saint Benoit in 2006. From January 1st to February 28th 2006,3400 patients (pts) were evaluated at the emergency wards of the Clinique Saint Benoit (CHIK infection being clinically contemplated in 750) and serum aminotransferase (SAT) activity was measured in 895 pts, Their SAT activity was compared to that of 21 1 pts seen in the same department in January-February 2004. Chronic alcoholic intoxication (CAI) was defined by a MCV >98 ~3 and therapeutic dose of paracetamol by a daily consumption of 4 g or less of PCM. In 2006, 420 out of 895 (47%) patients had SAT higher than upper limit of normal (ULN). In 82% of the patients, AST was higher than ALT. At admission, AST values higher than 10, 20, 50, 100 ULN were found in respectively 7.3% (3 1/420), 4.0%, 2.1% and 1.0% of the patients. Theses values were not statistically different from the percentages, 5.3% (5/94), l. l% , 0%, 0%, found in the 94 patients seen during January-February 2004. In 2006, CAI was diagnosed in 65%, 45%, 12.5% of patients with AST higher than 20 ULN, 5 ULN and <5 ULN respectively (p i 0.001). During the follow-up, SAT activity was higher than 20 ULN in 24/895 pts (2.7%). Among these 24 pts, 9/12 were found to be positive for CHTK (serum RT-PCR or IgM antibody), 80% recently ingested therapeutic doses of PCM, 3/24 had chronic cardiovascular disease, 60% were chronic alcohol drinkers, 25% (6 pts) developed acute hepatic failure (AHF) and 46% ( 1 1 pts) died, including 4/6 with A H F (one with cirrhosis). In January-February 2004, no patient died from liver disease. In non selected adult pts in La Reunion Island, AHF ( I ) was observed in 25% of pts with SAT activity above 20 ULN, (2) was diagnosed in alcohol abusers older than 40 years, CHIK virus infected and having ingested PCM at therapeutic doses.
11371 RESPONSE TO PEGYLATED INTERFERON-RIBAVIRIN IN PATIENTS WITH RECURRENT HEPATITIS C IN PATIENTS UNDERGOING LIVER TRANSPLANTATION FOR MIXED (ALCOHOL-HCV) CIRRHOSIS V Aguilera', M. Berenguer' , A. Palau2, A. Rubin', M. Aguas' , S. Benlloch' , M. Prieto' . 'Hepatoga,stroenterolog~~ Unit,Hospital Unuersitario La Fe, Valenciu; 'Internal Medicine, Hospital General, Custellon, Spain E-mail: [email protected] It is unknown whether a past history of alcohol consumption pretransplantation is associated with a reduced virologic response in recurrent hepatitis C treated recipients.
Aims: ( I ) To determine if virologic response to peg-interferon (pIFN) + ribavirin (RBV) is different in patients transplanted due to HCV cirrhosis or mixed cirrhosis. (2) To define treatment tolerability (dose reduction or discontinuation). (3) To identify factors associated with sustained virological response (SVR). (4) To determine the risk of rejection. Patients and Methods: Between 2002 and 2005, 47 patients with recurrent hepatitis C (HCV cirrhosis, n = 3 1, mixed cirrhosis, n = 16) and fibrosis >1 (Knodell score) in protocol liver biopsies were treated with plFN+RBV Patient and donor baseline features, immunosupression, genotype, viremia pre-treatment and at 4, 12, 24 and 48 weeks, rejection, reduction andor treatment discontinuation, erithropoietin (EPO) or filgastrim were recorded. Six-month posttherapy negative viremia defined SVR whereas on-treatment 3-month negative viremia defined early virologic response (EVR). Results: SVR: 48% in HCV-cirrhosis and 43% in mixed cirrhosis (p =ns). In the mixed group, there were more men ( 1 00% vs 6 I %, p = 0.0 I), median age at treatment was lower (50.5 vs 61 years, p=0.06) and genotype non-1 was greater (90% vs 71.5%, p=ns). The other features were similar between groups. The proportion of patients that required reduction and/or discontinuation and/or EPO/filgastrim use were similar between groups. When the analysis was performed in the two groups, none of the features were predictive of SVR. 3-month EVR (95% in SVR vs 40% in nonSVR; p = 0.001), viral load reduction > de 2 log at 3 months (95% in SVR vs 60% in non SVR; p=0.002) and EPO use (48% in SVR vs 17% in non-SVR; p =0.05) were associated with SVR. Early discontinuation of treatment (33% vs 65% p = 0.03) was inversely associated with SVR. SVR was greater in those who received a dose S O % of pIFN, RBV or both. Rejection was more common among HCV-cirrhosis patients (p = ns). Conclusions: Antiviral response to treatment in recurrent hepatitis C does not differ between groups. No pre-treatment features predict SVR. 3-month virologic response is helpful in predicting outcome.
11381 LACTATE ALONE IS NOT AN ACCURATE PREDICTOR OF POOR PROGNOSIS IN PARACETAMOL INDUCED FULMINANT LIVER FAILURE C.M. Bates, N. Kochar, J.S. Davidson, P.C. Hayes, K.J. Simpson. Scottish Liver Trunspbnt linit, Royal Infirnzury of' Edinburgh, Edinburgh, 7JK E-mail: [email protected]
Background: The Kings College Hospital (KCH) poor prognostic criteria have been used since 1989 to determine need for transplantation in patients with fulminant hepatic failure (FHF). These criteria have recently been modified to include lactate in paracetamol overdose (POD). Lactate >3.5 mmolil 24 hours post overdose or remaining >3.0mmmol/l following fluid resuscitation fulfils a separate criterion for poor prognosis and listing for super-urgent orthotopic liver transplant (OLT). Aims and Methods: We retrospectively analysed all admissions to the Scottish Liver Transplant Unit from 1/9/04 to 31/10/06 with POD. Lactate on admission and following fluid resuscitation were recorded. The sensitivity and specificity of lactate was compared with KCH criteria for poor prognosis. Results: 68 patients were admitted with POD. 3 underwent super-urgent OLT and were excluded from further analysis. The median lactate recorded on admission in 53 patients was 4.1 mmolil (range 1.1-19.53 mmol/l). 30 patients had a lactate >3.5mmol/L. 12 patients subsequently fulfilled KCH criteria (1 1 died, 1 survived). 18 patients did not fulfil KCH criteria and 17 survived. The sensitivity of admission lactate for predicting death from FHF was 92%, but specificity was only 55%. KCH criteria were 92% sensitive and 95% specific for predicting death. 2 patients within lactate 13.5 group subsequently fulfilled KCH criteria. Post fluid resuscitation lactate was recorded in 26 patients [Med. time 12 hours I0 mins (6:24-26:59)]. Within this group 15 had a lactate >3.0 [med. time 12 hours 12 mins following 1st lactate). 5 of these patients survived [med lactate 3.34 (3.03-4.67) mmol/l)] and 10 died [med lactate
S62
01B. LIVER TRANSPLANTATION/ SURGERY/ACUTE LIVER FAILURE B) CLINICAL
11361 CHIKUNGUNYA VIRUS EPIDEMIC IN SAINT BENOIT, LA REUNION ISLAND: AN EPIDEMIOLOGIC STUDY OF A CLUSTER OF ACUTE LIVER DISEASES A. Ahergel', W. Rakotoarivonina2, Y. Jacques-Antoine2, F. Binois2, M. Lemarine12, G. Bommelae?, T. Asselah3, J. Bernuau3. 'Heputology, Hrjtel Dieu, Clernzont Fermnd; 'Emergency department, Cliniqiie Saint Benoit, Ile de la Reunion; Heputology, H6pital Beaujon, Clichy siir Seine, France E-mail: [email protected]
'
The aim of this retrospective study is to analyse the features of a cluster of acute liver diseases that occurred during the recent epidemic of Chikungunya virus (CHIK) (an alphavirus without recognized tropism for hepatocytes) observed in Saint Benoit in 2006. From January 1st to February 28th 2006,3400 patients (pts) were evaluated at the emergency wards of the Clinique Saint Benoit (CHIK infection being clinically contemplated in 750) and serum aminotransferase (SAT) activity was measured in 895 pts, Their SAT activity was compared to that of 21 1 pts seen in the same department in January-February 2004. Chronic alcoholic intoxication (CAI) was defined by a MCV >98 ~3 and therapeutic dose of paracetamol by a daily consumption of 4 g or less of PCM. In 2006, 420 out of 895 (47%) patients had SAT higher than upper limit of normal (ULN). In 82% of the patients, AST was higher than ALT. At admission, AST values higher than 10, 20, 50, 100 ULN were found in respectively 7.3% (3 1/420), 4.0%, 2.1% and 1.0% of the patients. Theses values were not statistically different from the percentages, 5.3% (5/94), l. l% , 0%, 0%, found in the 94 patients seen during January-February 2004. In 2006, CAI was diagnosed in 65%, 45%, 12.5% of patients with AST higher than 20 ULN, 5 ULN and <5 ULN respectively (p i 0.001). During the follow-up, SAT activity was higher than 20 ULN in 24/895 pts (2.7%). Among these 24 pts, 9/12 were found to be positive for CHTK (serum RT-PCR or IgM antibody), 80% recently ingested therapeutic doses of PCM, 3/24 had chronic cardiovascular disease, 60% were chronic alcohol drinkers, 25% (6 pts) developed acute hepatic failure (AHF) and 46% ( 1 1 pts) died, including 4/6 with A H F (one with cirrhosis). In January-February 2004, no patient died from liver disease. In non selected adult pts in La Reunion Island, AHF ( I ) was observed in 25% of pts with SAT activity above 20 ULN, (2) was diagnosed in alcohol abusers older than 40 years, CHIK virus infected and having ingested PCM at therapeutic doses.
11371 RESPONSE TO PEGYLATED INTERFERON-RIBAVIRIN IN PATIENTS WITH RECURRENT HEPATITIS C IN PATIENTS UNDERGOING LIVER TRANSPLANTATION FOR MIXED (ALCOHOL-HCV) CIRRHOSIS V Aguilera', M. Berenguer' , A. Palau2, A. Rubin', M. Aguas' , S. Benlloch' , M. Prieto' . 'Hepatoga,stroenterolog~~ Unit,Hospital Unuersitario La Fe, Valenciu; 'Internal Medicine, Hospital General, Custellon, Spain E-mail: [email protected] It is unknown whether a past history of alcohol consumption pretransplantation is associated with a reduced virologic response in recurrent hepatitis C treated recipients.
Aims: ( I ) To determine if virologic response to peg-interferon (pIFN) + ribavirin (RBV) is different in patients transplanted due to HCV cirrhosis or mixed cirrhosis. (2) To define treatment tolerability (dose reduction or discontinuation). (3) To identify factors associated with sustained virological response (SVR). (4) To determine the risk of rejection. Patients and Methods: Between 2002 and 2005, 47 patients with recurrent hepatitis C (HCV cirrhosis, n = 3 1, mixed cirrhosis, n = 16) and fibrosis >1 (Knodell score) in protocol liver biopsies were treated with plFN+RBV Patient and donor baseline features, immunosupression, genotype, viremia pre-treatment and at 4, 12, 24 and 48 weeks, rejection, reduction andor treatment discontinuation, erithropoietin (EPO) or filgastrim were recorded. Six-month posttherapy negative viremia defined SVR whereas on-treatment 3-month negative viremia defined early virologic response (EVR). Results: SVR: 48% in HCV-cirrhosis and 43% in mixed cirrhosis (p =ns). In the mixed group, there were more men ( 1 00% vs 6 I %, p = 0.0 I), median age at treatment was lower (50.5 vs 61 years, p=0.06) and genotype non-1 was greater (90% vs 71.5%, p=ns). The other features were similar between groups. The proportion of patients that required reduction and/or discontinuation and/or EPO/filgastrim use were similar between groups. When the analysis was performed in the two groups, none of the features were predictive of SVR. 3-month EVR (95% in SVR vs 40% in nonSVR; p = 0.001), viral load reduction > de 2 log at 3 months (95% in SVR vs 60% in non SVR; p=0.002) and EPO use (48% in SVR vs 17% in non-SVR; p =0.05) were associated with SVR. Early discontinuation of treatment (33% vs 65% p = 0.03) was inversely associated with SVR. SVR was greater in those who received a dose S O % of pIFN, RBV or both. Rejection was more common among HCV-cirrhosis patients (p = ns). Conclusions: Antiviral response to treatment in recurrent hepatitis C does not differ between groups. No pre-treatment features predict SVR. 3-month virologic response is helpful in predicting outcome.
11381 LACTATE ALONE IS NOT AN ACCURATE PREDICTOR OF POOR PROGNOSIS IN PARACETAMOL INDUCED FULMINANT LIVER FAILURE C.M. Bates, N. Kochar, J.S. Davidson, P.C. Hayes, K.J. Simpson. Scottish Liver Trunspbnt linit, Royal Infirnzury of' Edinburgh, Edinburgh, 7JK E-mail: [email protected]
Background: The Kings College Hospital (KCH) poor prognostic criteria have been used since 1989 to determine need for transplantation in patients with fulminant hepatic failure (FHF). These criteria have recently been modified to include lactate in paracetamol overdose (POD). Lactate >3.5 mmolil 24 hours post overdose or remaining >3.0mmmol/l following fluid resuscitation fulfils a separate criterion for poor prognosis and listing for super-urgent orthotopic liver transplant (OLT). Aims and Methods: We retrospectively analysed all admissions to the Scottish Liver Transplant Unit from 1/9/04 to 31/10/06 with POD. Lactate on admission and following fluid resuscitation were recorded. The sensitivity and specificity of lactate was compared with KCH criteria for poor prognosis. Results: 68 patients were admitted with POD. 3 underwent super-urgent OLT and were excluded from further analysis. The median lactate recorded on admission in 53 patients was 4.1 mmolil (range 1.1-19.53 mmol/l). 30 patients had a lactate >3.5mmol/L. 12 patients subsequently fulfilled KCH criteria (1 1 died, 1 survived). 18 patients did not fulfil KCH criteria and 17 survived. The sensitivity of admission lactate for predicting death from FHF was 92%, but specificity was only 55%. KCH criteria were 92% sensitive and 95% specific for predicting death. 2 patients within lactate 13.5 group subsequently fulfilled KCH criteria. Post fluid resuscitation lactate was recorded in 26 patients [Med. time 12 hours I0 mins (6:24-26:59)]. Within this group 15 had a lactate >3.0 [med. time 12 hours 12 mins following 1st lactate). 5 of these patients survived [med lactate 3.34 (3.03-4.67) mmol/l)] and 10 died [med lactate