618 GLOMERULAR FILTRATION RATE PERFORMS BETTER COMPARED TO MELD SCORE IN PATIENTS WITH DECOMPENSATED CIRRHOSIS

POSTERS urine culture results. However, urinary cultures help identifying polyresistant strains associated with high mortality. 617 QFRACTURE OR PHYSICAL EXAMINATION AS SCREENING TOOLS FOR OSTEOPENIA/OSTEOPOROSIS IN A LIVER CLINIC E. Ceriani, C. Smirne, C. Lanza, C. Ferrari, F. Caldera, R. Molinari, F. Corliano, ` R. Minisini, M. Pirisi. Universit` a del Piemonte Orientale, Novara, Italy E-mail: [email protected] Background and Aims: To propose dual energy x-ray absorptiometry (DXA) to all patients with a liver disease, a recognized osteoporosis risk factor, would be costly. We aimed to verify if items incorporated in an artificial intelligence algorithm and/or simple physical examination (PE) maneuvers may identify a subgroup of patients with liver disease with high prevalence of osteopenia/osteoporosis. Methods: A consecutive series of 261 patients were evaluated in a tertiary level liver clinic. Based on inclusion (age >18 years, active liver disease, and informed consent) and exclusion criteria (known osteoporosis), 150 patients (88 M, 62 F; mean age 59.6±12.7 years) were enrolled: 102 had viral hepatitis B or C, 29 alcohol-related disease, and 19 other causes of chronic liver disease. All were proposed the Qfracture algorithm (www.qfracture.org) and 5 PE maneuvers (i.e., weight less <51 kg, tooth count <20, rib-pelvis distance <2 finger breadths, wall-occiput distance >0 cm, selfreported humped back). DXA was requested to the 69/150 (46%) patients who had a fracture risk ≥10% at Qfracture and/or ≥1 positive physical maneuver, and was performed by 56/69 patients (81%). Results: The 10 years fracture risk categories estimated by Qfracture were: ≤10% (N = 118), 10–25% (N = 28), >25% (N = 4). Sixty-seven patients were positive at ≥1 PE maneuver; the maneuver most commonly positive (62/67, 92.5%) was tooth count <20, which had a positive association with the Qfracture fracture risk (p < 0.001). The Qfracture fracture risk increased proportionally to the number of positive maneuvers (p < 0.001). Based on DXA, 12/56 patients (21.4%) had normal bone density, 32/56 (57.1%) osteopenia, 12/56 (21.4%) osteoporosis. Among a set of demographic and clinical variables, serum albumin was the only parameter significantly associated with bone density categories (p = 0.041). The degree of agreement (weighted kappa) between Qfracture risk and T-scores was 0.225 (95% CI 0.043–0.408) (i.e., fair). In contrast, there was no agreement between PE maneuvers and T-scores. Conclusions: Qfracture selects a subgroup of patients with liver disease with high prevalence of osteopenia/osteoporosis. In the agreement with the DXA categories, the Qfracture algorithm is superior to PE, and may be well suited for osteoporosis screening in this patient population. 618 GLOMERULAR FILTRATION RATE PERFORMS BETTER COMPARED TO MELD SCORE IN PATIENTS WITH DECOMPENSATED CIRRHOSIS E. Cholongitas, G. Arsos, J. Goulis, T. Nakouti, J. Kouvelis, J. Tsechelidis, C. Birtsou, K. Karakatsanis, E. Akriviadis. Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece E-mail: [email protected] Background: Although serum creatinine is included in the model for end stage liver disease (MELD) score, it is an inaccurate marker of renal function, i.e. of glomerular filtration rate (GFR) in patients with decompensated cirrhosis. Aim: To investigate the impact of MELD score and GFR as determinants of survival in patients with decompensated cirrhosis. Methods: All consecutive patients with decompensated cirrhosis and without hepatocellular carcinoma, who admitted in our Department and had complete demographic, clinical and laboratory

data including measured GFR. The latter was evaluated using Cr-EDTA. In addition, we assessed independent factors associated with outcome by multiple logistic regression analysis. Their discriminative ability was evaluated by using the area under a receiver operating characteristic (AUROC) curve. Results: We evaluated 104 consecutive patients (75 men, age 55±12 years) with non-HCC decompensated cirrhosis (viral: 46%, alcohol: 23%). At the end of follow up period [median time 7 (range: 2–14) months], 87 patients (84%) – (group 1) were alive, and 17 (16%) (group 2) either died without liver transplantation (LT) (10%) or underwent LT (6%). At baseline, group 1 patients, compared to group 2 patients, had significantly lower INR (1.4±0.5 vs 2.0±0.7), serum bilirubin (3.6±1.2 vs 11±2.5 mg/dL), creatinine (1.0±0.3 vs 1.4±0.4), Child-Pugh score (8±2 vs 13±3) and MELD score (13±4 vs 21±5), while they had higher serum sodium (137±5 vs 131±7 mEq/L) and GFR (76±25 mL/min vs 52±22 mL/min) (p < 0.001 for all comparisons). In multivariate analysis, GFR was the only independent factor significantly associated with the outcome (OR: 0.95, 95%C.I.: 0.92–0.98, p = 0.0027). In addition, GFR had significantly better discriminative ability, compared to the MELD score (AUROC: 0.80 vs 0.74, p = 0.04). The best cut off point for GFR was 55 mL/min giving a sensitivity 63%, specificity 82%, PPV 91% and NPV 46%. The findings were similar when the patients who underwent LT were excluded (AUROC: 0.82, best cut off point 50 mL/min with sensitivity 64%, specificity 88%, PPV 94% and NPV 47%). Conclusions: In our cohort of patients with decompensated cirrhosis, GFR was the only independent factor associated with the outcome and with superior performance compared to the MELD score. 51

619 COPEPTIN; AN INDEPENDENT PROGNOSTIC FACTOR IN CIRRHOSIS? M.J. Coenraad, B.J. de Rooij, L. Verbruggen, B. van Hoek, J.J. van der Reijden, H.W. Verspaget. Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands E-mail: [email protected] Background and Aims: MELD score is widely accepted as a prognostic score and used for organ allocation. Portal hypertension without elevated creatinin concentration is not accounted for in the MELD score. We hypothesized that arginine vasopressin (AVP) might be an independent prognostic factor in cirrhosis. However, AVP is an instable molecule with a short half-life, whereas copeptin, a cleavage product of the C-terminal part of the AVP precursor, has a long half-life and is not bound to platelets in the circulation. The aim of this study was to assess the relationship between plasma copeptin level and renal function, as a potential marker of portal hypertension in cirrhotic patients. Methods: In 31 patients with cirrhosis, listed for liver transplantation, plasma copeptin measurements were performed twice with a mean time interval of 5±3 months, using a commercially available assay in the chemiluminescence/coated tube format (B.R.A.H.M.S. GmbH, Henningsdorf, Germany). Results: Median plasma copeptin concentration was 20.7 pmol/l (range 10.3–30.3) (sample 1) and 27.7 pmol/l (17.1–43.8) (sample 2) (Normal value healthy subjects: 4.8 pmol/l). There was a significant correlation of copeptin with serum creatinin concentration (sample 1: r = 0.38, p = 0.03, sample 2: r = 0.41, p = 0.02) and with MELD score (sample 1: r = 0.42, p < 0.001 sample 2: r = 0.51, p < 0.001). There was a significant negative correlation with MDRD (sample 1: r = −0.43, p < 0.001, sample 2: r = −0.44, p < 0.001). As expected, there was a strong correlation between creatinin and MDRD (sample 1: r = −0.896, sample 2: r = −0.924, p < 0.001) and between creatinin and MELD score (sample 1: r = 0.648, sample 2: r = 0.746, p < 0.001). A significant increase in serum creatinin was however not associated with a significant change in plasma

Journal of Hepatology 2012 vol. 56 | S225–S388

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