205 HCV INFECTION AND ADVANCED LIVER CIRRHOSIS WERE ASSOCIATED INSULIN RESISTANCE

POSTERS 204 SAFETY, EFFICACY AND PREDICTORS OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT IN REFRACTORY HEPATIC HYDROTHORAX R. Yellapu1 , A. Goldstein2 , S. Anondo3 , T. Schiano1 . 1 Liver Diseases, 2 Internal Medicine, 3 Radiology, Mount Sinai Medical Center, New York, NY, USA E-mail: [email protected] Background and Aims: Hepatic hydrothorax is an uncommon complication of portal hypertension. We sought to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in these patients with symptomatic and refractory hepatic hydrothorax. Methods: Twenty four patients who underwent TIPS, between January 2001 and December 2009 for refractory hydrothorax were studied. Clinical, laboratory and procedural data were noted. Outcomes were recorded as responders or non-responders. Data patterns were examined by Chi-square test, t-test and Kaplan– Meier analysis. Results: Patients included 14 men and ten women; Child–Pugh class B, 16 patients; Child–Pugh class C, 8 patients. The mean age at TIPS creation was 60.4 years (s.d. 9.4). Mean pre-TIPS creatinine was 0.9 (s.d. 0.3) and mean model for end stage liver disease (MELD) score was 15.3 (s.d. 4.9). The mean pre- and post-TIPS portosystemic gradients were 17.7 (s.d. 5.2) mmHg and 7.4 (2.6) mmHg. There was technical success in all patients. In 19 patients covered stents were used and in 5 patients bare stents were used. Data was incomplete in one patient. Clinical response after TIPS was seen in 73.9% (17/23) patients. Median survival of the study group was 295 days (range 10–1280). The short term survival rates at 30 and 90 days were 95.6% and 82.6% respectively. The long term survival rates both at 1 and 3 years is 73.9%. Univariate and multivariate analysis showed clinical response (P = 0.01, HR 2.7 [95% CI 1.4–5.8]) was significantly and independently associated with overall survival. The 30 day mortality rate was 4.3%. Post TIPS new onset or worsening of encephalopathy was seen in 40 % of patients. Conclusion: TIPS is a relatively safe and effective method of controlling refractory hepatic hydrothorax. Clinical response after TIPS is associated with longer survival. Early mortality after TIPS may be minimized by proper selection of patients with low MELD and near normal renal functions. 205 HCV INFECTION AND ADVANCED LIVER CIRRHOSIS WERE ASSOCIATED INSULIN RESISTANCE Y.L. He1 , Z. Yan1 , K. Wang1 , T.Y. Chen2 , M. Liu2 , F. Ye2 , S.L. Zhang2 , S.M. Lin2 , Y.R. Zhao1 . 1 Hepatology Institution, Xian, 2 Infectious Diseases Department, XiAn JiaoTong University, Xian City, China E-mail: [email protected] Background and Aims: Several clinical studies have suggested a possible link between chronic hepatitis caused by hepatitis B virus (HBV)/Hepatitis C virus (HCV) and diabetes mellitus. We investigated the association between clinical data and glucose intolerance in HBV/HCV infected patients. Methods: A total 28 HCV infected patients and 61 HBV infected patients were recruited into this study. We evaluated insulin resistance (homeostasis model assessment of insulin resistance [HOMA-R]) and beta-cell function (homeostasis model assessment of beta0cell function [HOMA-b]) in a fasting state and after an oral 75 g glucose (whole-body insulin sensitivity index [WBISI]) and D-insulin 30/D-glucose 30). HBV/HCV infected patients divided into three sub-groups (chronic hepatitis [CH], liver cirrhosis with child-Pugh C stage [LC-C] and liver cirrhosis with child-Pugh B [LC-B]) according clinical data including biochemical parameter, CT scanning and gasrtoscopy. Serum virus load were quantified by real-time PCR. S88

Results: Multivariate analysis shows HCV infection and advanced liver cirrhosis the two keys independent factors associated with insulin resistance. HOMA-R was significant higher in HCV infected patients when compared with HBV infected patients. When patients were divided into CH, LC-C and LC-B sub-groups, HCV infected patients with child-Pugh stage C sub-group has the highest HOMA-R with 7.21.

Comparison of HOMA-R between CH, LC-B and LC-C subgroups. Conclusions: Our findings suggest that HCV infection and the advanced liver cirrhosis are associated insulin resistance. 206 REPRODUCIBILITY AND RELIABILITY OF THE HEPATIC VENOUS PRESSURE GRADIENT (HVPG) MEASUREMENT IN PATIENTS WITH CIRRHOSIS IS HIGHER USING THE BALLOON COMPARED TO THE STRAIGHT CATHETER A. Zipprich, M. Winkler, T. Seufferlein, M.M. Dollinger. First Department of Internal Medicine, Martin-Luther-University Halle, Halle, Germany E-mail: [email protected] HVPG (i.e. the difference between wedge hepatic [WHVP] and free hepatic venous pressure [FHVP]) is used as an estimation of portal pressure and of great importance in the management of patients with cirrhosis. Reduction of HVPG is correlated with a reduced risk of development of portal hypertension related complications, mainly variceal bleeding. Two different methods are available (straight and balloon catheter) and although the balloon catheter is considered more reproducible and reliable these two procedures were never compared directly. The aim of the study was to compare the two methods for HVPG assessment regarding reproducibility and reliability. Methods: In 47 patients with cirrhosis (alcoholic cirrhosis: n = 28; HVPG [mean±SD]: 14.7±7.2 mmHg) repeated measurements of HVPG was done using the straight (3 times) and the balloon catheter (3 times) during the same procedure to investigate the reproducibility. In another 29 patients (alcoholic cirrhosis: n = 25; WHVP [mean±SD]: 29.89±7.9 mmHg; portal pressure: 30.4±7.1 mmHg), WHVP was measured using the straight or the balloon catheter followed by a direct measurement of the portal pressure during TIPS insertion to investigate the reliability. For all measurements, variation coefficient and intraclass correlation coefficient were calculated.

Journal of Hepatology 2010 vol. 52 | S59–S182