- Email: [email protected]
650 VITAMIN D AND DEPRESSION IN PATIENTS WITH CHRONIC LIVER DISEASE - A QUASI-EXPERIMENTAL INTERVENTION STUDY
POSTERS the whole spectrum of patients from mild ascites to refractory ascites were analyzed. Baseline evaluation included the assessment of quality of life by the Medical Outcomes Study Short-Form 36 (SF36) questionnaire. This questionnaire includes 36 questions divided into 8 domains, that are summarised in 2 components: physical component score (PCS) and mental component score (MCS). Results: All domain scores were significantly lower in patients with cirrhosis and ascites compared with those of the general population. In multivariate analysis, serum sodium concentration and leg edema were independent predictive factors of healthrelated quality of life in almost all individual domains. Patients with hyponatremia (<130 mEq/L) had significantly lower scores in 7 out of the 8 individual domains compared with patients without hyponatremia. Moreover, patients with hyponatremia had lower values in both PCS (31±9) and MCS (43±11) compared to patients with normal serum sodium concentration (37±9 and 46±11, respectively, p < 0.0001). Presence of leg edema was associated with significantly lower scores in PCS (32±9 vs 38±9 in patients without edema; p < 0.0001). A history of previous hepatic encephalopathy, falls, and non-alcoholic etiology of cirrhosis were also associated with an impaired health-related quality of life. Neither age, nor liver and renal function tests were significantly related to quality of life. Conclusion: Patients with cirrhosis and ascites have an important impairment in health-related quality of life. Standard liver function tests are not predictive factors of health-related quality of life. The main predictive factors of impaired health-related quality of life are hyponatremia, leg edema, non-alcoholic cirrhosis, and previous hepatic encephalopathy and falls. Impaired health-related quality of life in cirrhosis is heavily dependent on serum sodium concentration. 649 TOLL-LIKE RECEPTOR 4 D299G AND T399I POLYMORPHISMS AND BACTERIAL INFECTIONS IN PATIENTS WITH CIRRHOSIS AND ASCITES 2 G. Soriano1,2 , J.C. Nieto3,4 , E. Roman ´ 1,4 , E. Sanchez ´ , C. Guarner1 3,4 1 1 3 Argente , S. Vidal , O. Pavel , C. Romero , C. Juarez ´ , C. Guarner1,2 . 1 Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, 2 CIBERehd, Institute of Health Carlos III, 3 Department of Immunology, Hospital de la Santa Creu i Sant Pau, 4 Institut d’Investigaci´ o Biom`edica Sant Pau, Barcelona, Spain E-mail: [email protected] Background and Aim: Toll-like receptor (TLR) 4 plays a key role in the innate immune response, mainly against Gram-negative bacilli. It has been suggested that the presence of the genetic polymorphisms D299G (rs4986790) and T399I (rs4986791) of TLR4 could increase the susceptibility to develop infections in several populations. One retrospective study supports a possible association between the presence of D299G polymorphism and the predisposition to develop bacterial infections in patients with cirrhosis (Soriano, APT 2010). However, such an association has not yet been prospectively evaluated. The aim of our study was to prospectively assess the relationship between the presence of D299G or T399I TLR4 polymorphisms and the incidence of bacterial infections in cirrhotic patients with ascites. Patients and Methods: All patients with cirrhosis and ascites hospitalized from April 2006 to June 2011 were included. The presence of D299G and T399I TLR4 polymorphisms was determined by sequentiation and related to the incidence of infections during follow-up. Results: Two hundred and fifty-eight patients were included and the follow-up was 12.8±15.0 months. Twenty-eight patients (10.8%) were carriers of D299G or T399I TLR4 polymorphisms (polymorphisms group) and 230 were not (wild type group). Clinical and analytical characteristics were similar in the two groups, except for a higher incidence of previous hepatic
encephalopathy in the polymorphisms group (46.4% vs 22.2%, p = 0.009). We did not observe statistical differences between the two groups in the incidence and number of infections per patient during follow-up. The probability of developing any bacterial infection at one-year follow-up was 80% in the polymorphisms group and 70% in the wild-type group (p NS). The one-year probability of presenting infections caused by Gram-negative bacilli was (polymorphisms group versus wild type group) 54% vs 46%, infections caused by Gram-positive cocci 52% vs 43%, and spontaneous bacterial peritonitis 30% vs 36% (p NS). The one-year probability of survival was 53% in the polymorphisms group and 65% in the wild-type group (p NS). Conclusions: The presence of the genetic polymorphisms D299G and T399I of TLR4 does not seem to play a relevant role in the predisposition of patients with cirrhosis and ascites to develop bacterial infections. 650 VITAMIN D AND DEPRESSION IN PATIENTS WITH CHRONIC LIVER DISEASE – A QUASI-EXPERIMENTAL INTERVENTION STUDY C.S. Stokes1 , C. Baus2 , M. Riemenschneider2 , F. Lammert1 . 1 Department of Medicine II, 2 Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany E-mail: [email protected] Background: Patients with chronic liver disease (CLD) frequently exhibit vitamin D deficiency [1]. Vitamin D has been implicated in depression, and serum 25-hydroxyvitamin D levels often correlate inversely with depressive symptoms [2]. Vitamin D receptors (VDR) are confirmed to be involved in depression pathophysiology in brain [3]. We investigate the potential of vitamin D supplementation in ameliorating depressive symptoms in CLD. Methods: Currently 39 CLD patients have been recruited (51% male, age 37–75 years). Patients are allocated to the intervention or control group when serum 25-hydroxyvitamin D levels are <30 ng/ml, and ≥30 ng/ml, respectively. The intervention group receives 20,000 IU 25-hydroxyvitamin D/week for six months. Patients are followed up at 3, 6 and 12 months to assess depression severity using the validated Beck Depression Inventory (BDI), and to measure serum 25-hydroxyvitamin D levels via chemiluminescence immunoassay. Results: In total, 69% of patients have serum 25-hydroxyvitamin D levels <30 ng/ml (mean 23.6±11.3 ng/ml) and 62% (n = 24) have depressive symptoms. A non-significant (p = 0.191) inverse correlation between 25-hydroxyvitamin D and depressive symptoms is present in this cohort; when restricting the analysis to patients with mild/severe depression this inverse association was significant (rs = −0.675, p = 0.008). Preliminary results show reduced severity of depressive symptoms in CLD patients (n = 6) after three months of vitamin D supplementation (median BDI score 4; range 0–26) compared to baseline (median 11; range 0–22). The BDI score in the control group increased slightly at 3 months (median 9, range 0–22) compared to baseline (median 7; range 1–12). Conclusions: A high proportion of CLD patients display vitamin D deficiency, which is significantly inversely associated with depression. Preliminary evidence indicates potential benefits of vitamin D supplementation in ameliorating depressive symptoms in patients with CLD. This ongoing study will further substantiate whether vitamin D therapy mitigates depression, which is frequently co-morbid in this patient group. Reference(s) [1] Arteh, et al. Dig Dis Sci 2010. [2] Ganji, et al. Int Arch Med 2010. [3] Eyles, et al. J Chem Neuroanat 2005.
Journal of Hepatology 2012 vol. 56 | S225–S388
S257
encephalopathy in the polymorphisms group (46.4% vs 22.2%, p = 0.009). We did not observe statistical differences between the two groups in the incidence and number of infections per patient during follow-up. The probability of developing any bacterial infection at one-year follow-up was 80% in the polymorphisms group and 70% in the wild-type group (p NS). The one-year probability of presenting infections caused by Gram-negative bacilli was (polymorphisms group versus wild type group) 54% vs 46%, infections caused by Gram-positive cocci 52% vs 43%, and spontaneous bacterial peritonitis 30% vs 36% (p NS). The one-year probability of survival was 53% in the polymorphisms group and 65% in the wild-type group (p NS). Conclusions: The presence of the genetic polymorphisms D299G and T399I of TLR4 does not seem to play a relevant role in the predisposition of patients with cirrhosis and ascites to develop bacterial infections. 650 VITAMIN D AND DEPRESSION IN PATIENTS WITH CHRONIC LIVER DISEASE – A QUASI-EXPERIMENTAL INTERVENTION STUDY C.S. Stokes1 , C. Baus2 , M. Riemenschneider2 , F. Lammert1 . 1 Department of Medicine II, 2 Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany E-mail: [email protected] Background: Patients with chronic liver disease (CLD) frequently exhibit vitamin D deficiency [1]. Vitamin D has been implicated in depression, and serum 25-hydroxyvitamin D levels often correlate inversely with depressive symptoms [2]. Vitamin D receptors (VDR) are confirmed to be involved in depression pathophysiology in brain [3]. We investigate the potential of vitamin D supplementation in ameliorating depressive symptoms in CLD. Methods: Currently 39 CLD patients have been recruited (51% male, age 37–75 years). Patients are allocated to the intervention or control group when serum 25-hydroxyvitamin D levels are <30 ng/ml, and ≥30 ng/ml, respectively. The intervention group receives 20,000 IU 25-hydroxyvitamin D/week for six months. Patients are followed up at 3, 6 and 12 months to assess depression severity using the validated Beck Depression Inventory (BDI), and to measure serum 25-hydroxyvitamin D levels via chemiluminescence immunoassay. Results: In total, 69% of patients have serum 25-hydroxyvitamin D levels <30 ng/ml (mean 23.6±11.3 ng/ml) and 62% (n = 24) have depressive symptoms. A non-significant (p = 0.191) inverse correlation between 25-hydroxyvitamin D and depressive symptoms is present in this cohort; when restricting the analysis to patients with mild/severe depression this inverse association was significant (rs = −0.675, p = 0.008). Preliminary results show reduced severity of depressive symptoms in CLD patients (n = 6) after three months of vitamin D supplementation (median BDI score 4; range 0–26) compared to baseline (median 11; range 0–22). The BDI score in the control group increased slightly at 3 months (median 9, range 0–22) compared to baseline (median 7; range 1–12). Conclusions: A high proportion of CLD patients display vitamin D deficiency, which is significantly inversely associated with depression. Preliminary evidence indicates potential benefits of vitamin D supplementation in ameliorating depressive symptoms in patients with CLD. This ongoing study will further substantiate whether vitamin D therapy mitigates depression, which is frequently co-morbid in this patient group. Reference(s) [1] Arteh, et al. Dig Dis Sci 2010. [2] Ganji, et al. Int Arch Med 2010. [3] Eyles, et al. J Chem Neuroanat 2005.
Journal of Hepatology 2012 vol. 56 | S225–S388
S257