- Email: [email protected]
Age does not Impact Outcomes of Transjugular Intrahepatic Portosystemic Shunt
Table 2. Change in Nutritional Status Over Hospitalization (n=31)
Su1489 AGE DOES NOT IMPACT OUTCOMES OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT Tom D. Catron, Sherwin Chiu, Sanghun Kim, Ahmed K. Abdel Aal, Ashwani Singal Background: The Model for End-stage Liver Disease (MELD) score predicts outcomes after transjugular intrahepatic portosystemic shunt (TIPS). There is minimal data in the literature on the impact of age on post-TIPS outcomes. Aim: We examined independent impact of the patient's age on TIPS outcomes. Methods: Medical charts of patients with cirrhosis undergoing TIPS between August 2005 and September 2015 were reviewed and data on patient demographics, MELD score, TIPS indication, and 90-day mortality were collected. The study population was stratified according to the patients' age to group A with < 70 years of age and group B ≥ 70 years of age. Kaplan-Meier curves were generated comparing the two age groups on 90-day mortality. A Cox proportional hazard regression analysis model was used to examine the independent effect of patients' age on 90-day mortality, and data was reported as hazard ratios (HR) with 95% confidence interval (CI). Results: The study included 272 patients with complete records and showed hepatitis C virus (HCV) infection, non-alcoholic steatohepatitis (NASH), and alcoholic liver disease as the most common cirrhosis etiologies in 34%, 31%, and 21% of patients respectively. Patients in group B (n=29, mean age = 73±9 yrs.) compared to group A (n= 243, mean age = 54±8yrs.) differed on female sex (59 vs. 40%, P=0.015), NASH (79 vs. 38%, P=0.006), and HCV (3 vs. 37%, P=0.0003). The groups also differed respectively by frequency of Caucasian race (52% vs. 79%, P=0.002), TIPS indication of refractory ascites, recurrent bleed, emergent bleed, and hydrothorax (38, 4, 48, 10% vs. 44, 25, 22, 8% respectively, P=0.0002), and MELD scores (17±7 vs. 12±5; P<0.0001). Mortality at 90 days was similar comparing Groups A and B (17.2 vs. 19.3%, Log Rank P=0.85). Age did not predict 90 days mortality after TIPS when analyzed as a continuous variable as demonstrated in Table 1. Significant predictors of mortality were African-American race, emergent variceal bleeding vs. refractory ascites indication, and MELD score. Number of hospitalizations within 90 days after TIPS was lower for Group B patients (0.48±0.78 vs. 2.3±4.8; P=0.043). Conclusion: In a selected population, MELD score, African-American race, and emergent bleeding predict post-TIPS survival. Patient's age does not impact outcome and should not contraindicate TIPS when clinically indicated. Larger, multicenter prospective studies are required to assess the impact of the patient's age on post-TIPS survival. Table 1
Su1488
AASLD Abstracts
MOST PATIENTS WITH CIRRHOSIS COME TO THE HOSPITAL MALNOURISHED AND LEAVE EVEN WORSE Matthew T. Glover, Emily Mao, Maya Balakrishnan Background: Malnutrition is common among patients with cirrhosis and is associated with complications including ascites, hepatorenal syndrome, and hepatic encephalopathy as well as increased length of hospitalization and mortality. Illness-related anorexia and high catabolic rate make cirrhotic patients particularly vulnerable to malnutrition. Studies conducted among non-cirrhotic populations have noted that patients suffer a significant decline in nutritional status over the course of hospitalization. Whether this is the case among patients with cirrhosis is unknown. The objective of this study was to evaluate the effect of hospitalization on the nutritional status of patients with cirrhosis. Methods: This was a pilot prospective cohort study conducted among consecutive adults with cirrhosis admitted to Ben Taub General Hospital (Houston, TX). Patients' nutritional status was assessed at admission using the subjective global assessment (SGA), pre-albumin, albumin, transferrin, mid-arm circumference (MAC), triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), and hand grip dynamometry (HD). These measures were used to classify patients' admission nutritional status using standard definitions. Nutritional status was assessed again among a subset of patients at the time of hospital discharge using HD. Change in nutritional status was assessed as a difference between HD, a validated measure of malnutrition among cirrhosis patients, at admission and at discharge. Descriptive statistics were calculated and Wilcoxon rank-sum test was used to assess for significant change in HD over hospitalization. Results: 60 patients were enrolled: median age 54 years, 70% male, median MELD 18, 92% CPT B or C, 57% alcoholic cirrhosis, 40% admitted with ascites, and median hospital stay 3 days. Malnutrition was highly prevalent at admission (table 1). HD was significantly lower at time of hospital discharge compared to the time of hospital admission (median HD admission= 22.5 vs. median HD discharge=20, p=0.028) (table 2). Conclusions: This is the first report of the effect of hospitalization on the nutritional status of patients with cirrhosis. Most patients with cirrhosis were admitted to the hospital with malnutrition and then were discharged from the hospital with significantly worsened nutritional status. This was the case despite the relatively short hospital length-of-stay among the study population. Our findings support a pressing need for nutritional interventions that target hospitalized or recently discharged patients with cirrhosis in order to improve their nutritional status which in turn may improve cirrhosis related outcomes. Table 1. Baseline nutritional status at time of admission (n=60)
Table 1: Cox proportional hazard regression analysis model for predictors on 90-day mortality after TIPS
Su1490 REAL LIFE EXPERIENCE WITH OMBITASVIR/PARITAPREVIR/RITONAVIR + DASABUVIR AND RIBAVIRIN REGIMEN IN PATIENTS WITH COMPENSATED HCV CIRRHOSIS Mariana Jinga, Vasile Daniel Balaban, Florentina Ionita-Radu, Raluca Costache, Petrut Nuta, Sandica Bucurica, Andrada Popescu, Victor Stoica, Oana Vutcanu, Mihaela Milicescu, Ion Stefan, Bogdan Macadon, Alice Farcas, Florica Naftanaila, Aurelia Alexandru, Georgiana C. Robu Background Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir in association with ribavirin is the only interferon free regimen available in Romania for compensated HCV cirrhosis. Aim of our study is to reveal our experience with interferon free therapy in compensated HCV cirrhosis. Material and methods We conducted a multicenter prospective study including 90 patients with compensated (Child-Pugh A) HCV cirrhosis treated with Ombitasvir/ Paritaprevir/Ritonavir + Dasabuvir and Ribavirin regimen for 12 weeks, diagnosed clinical, biological, and by FibroMax test. Each patient had follow-up visits at four, eight, twelve and 24 weeks after treatment initiation. Biological tests included: hemoglobin, ALT, AST, platelets, total bilirubin, serum albumin, INR. We defined anemia as Hb<12 g/dl in women and Hb< 13 g/dl in men. Cytolysis was defined as values of ALT or AST > as least 2 time upper limit of normal. Hyperbilirubinemia was defined as a level of bilirubin > than 1.2 mg/dl. HCV RNA level in blood was evaluated at baseline, end of treatment (EOT) and 12 weeks after EOT. Undetectable HCV RNA was defined as a viral load <15 UI/ml, assessed by PCR. Virological response (VR) was defined as undetectable HCV RNA at EOT and sustained virological response (SRV) as undetectable HCV RNA at 12 weeks after EOT. Results 44 (49%) patients were female and 46 (51 %) were male. The mean age of patients in the study was 61 years old. All the patients had HCV genotype 1b infection. 22 patients were naive and 68 had previous antiviral therapies based on pegylated IFN-α and ribavirin. At the initiation of treatment 64 (71%) of patients had cytolysis, 38 (42%) had thrombocytopenia, 19 (21%) patients had hyperbilirubinemia and 11 (12%) patients had anemia. After four weeks of treatment it was noticed an increasing of anemia in 42 (47%) patients, and an increasing of the level bilirubinemia in 36 (40%) patients. Regarding cytolysis a decreasing was noticed, only 10% of 64 patients still having cytolysis after four weeks of treatment. One patient (1%) died after four weeks of treatment by complications of cirrhosis. 89 (99%) of patients had VR at EOT and SVR at twelve weeks after EOT. Conclusion The most common side effect among the patients in the study group was anemia (47% cases). Cytolysis disappeared after four weeks of treatment in 61% of patients. The interferon free combination treatment was safe and highly effective in compensated HCV cirrhosis.
*Standard definitions for malnutrition were used to classify patients: TSF, MAC, MAMC<5th percentile of reference population; HD>2SD below mean for reference population; prealbumin<10mg/dL. Table 2. Change in Nutritional Status Over Hospitalization (n=31)
AASLD Abstracts
S-1148
Su1489 AGE DOES NOT IMPACT OUTCOMES OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT Tom D. Catron, Sherwin Chiu, Sanghun Kim, Ahmed K. Abdel Aal, Ashwani Singal Background: The Model for End-stage Liver Disease (MELD) score predicts outcomes after transjugular intrahepatic portosystemic shunt (TIPS). There is minimal data in the literature on the impact of age on post-TIPS outcomes. Aim: We examined independent impact of the patient's age on TIPS outcomes. Methods: Medical charts of patients with cirrhosis undergoing TIPS between August 2005 and September 2015 were reviewed and data on patient demographics, MELD score, TIPS indication, and 90-day mortality were collected. The study population was stratified according to the patients' age to group A with < 70 years of age and group B ≥ 70 years of age. Kaplan-Meier curves were generated comparing the two age groups on 90-day mortality. A Cox proportional hazard regression analysis model was used to examine the independent effect of patients' age on 90-day mortality, and data was reported as hazard ratios (HR) with 95% confidence interval (CI). Results: The study included 272 patients with complete records and showed hepatitis C virus (HCV) infection, non-alcoholic steatohepatitis (NASH), and alcoholic liver disease as the most common cirrhosis etiologies in 34%, 31%, and 21% of patients respectively. Patients in group B (n=29, mean age = 73±9 yrs.) compared to group A (n= 243, mean age = 54±8yrs.) differed on female sex (59 vs. 40%, P=0.015), NASH (79 vs. 38%, P=0.006), and HCV (3 vs. 37%, P=0.0003). The groups also differed respectively by frequency of Caucasian race (52% vs. 79%, P=0.002), TIPS indication of refractory ascites, recurrent bleed, emergent bleed, and hydrothorax (38, 4, 48, 10% vs. 44, 25, 22, 8% respectively, P=0.0002), and MELD scores (17±7 vs. 12±5; P<0.0001). Mortality at 90 days was similar comparing Groups A and B (17.2 vs. 19.3%, Log Rank P=0.85). Age did not predict 90 days mortality after TIPS when analyzed as a continuous variable as demonstrated in Table 1. Significant predictors of mortality were African-American race, emergent variceal bleeding vs. refractory ascites indication, and MELD score. Number of hospitalizations within 90 days after TIPS was lower for Group B patients (0.48±0.78 vs. 2.3±4.8; P=0.043). Conclusion: In a selected population, MELD score, African-American race, and emergent bleeding predict post-TIPS survival. Patient's age does not impact outcome and should not contraindicate TIPS when clinically indicated. Larger, multicenter prospective studies are required to assess the impact of the patient's age on post-TIPS survival. Table 1
Su1488
AASLD Abstracts
MOST PATIENTS WITH CIRRHOSIS COME TO THE HOSPITAL MALNOURISHED AND LEAVE EVEN WORSE Matthew T. Glover, Emily Mao, Maya Balakrishnan Background: Malnutrition is common among patients with cirrhosis and is associated with complications including ascites, hepatorenal syndrome, and hepatic encephalopathy as well as increased length of hospitalization and mortality. Illness-related anorexia and high catabolic rate make cirrhotic patients particularly vulnerable to malnutrition. Studies conducted among non-cirrhotic populations have noted that patients suffer a significant decline in nutritional status over the course of hospitalization. Whether this is the case among patients with cirrhosis is unknown. The objective of this study was to evaluate the effect of hospitalization on the nutritional status of patients with cirrhosis. Methods: This was a pilot prospective cohort study conducted among consecutive adults with cirrhosis admitted to Ben Taub General Hospital (Houston, TX). Patients' nutritional status was assessed at admission using the subjective global assessment (SGA), pre-albumin, albumin, transferrin, mid-arm circumference (MAC), triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), and hand grip dynamometry (HD). These measures were used to classify patients' admission nutritional status using standard definitions. Nutritional status was assessed again among a subset of patients at the time of hospital discharge using HD. Change in nutritional status was assessed as a difference between HD, a validated measure of malnutrition among cirrhosis patients, at admission and at discharge. Descriptive statistics were calculated and Wilcoxon rank-sum test was used to assess for significant change in HD over hospitalization. Results: 60 patients were enrolled: median age 54 years, 70% male, median MELD 18, 92% CPT B or C, 57% alcoholic cirrhosis, 40% admitted with ascites, and median hospital stay 3 days. Malnutrition was highly prevalent at admission (table 1). HD was significantly lower at time of hospital discharge compared to the time of hospital admission (median HD admission= 22.5 vs. median HD discharge=20, p=0.028) (table 2). Conclusions: This is the first report of the effect of hospitalization on the nutritional status of patients with cirrhosis. Most patients with cirrhosis were admitted to the hospital with malnutrition and then were discharged from the hospital with significantly worsened nutritional status. This was the case despite the relatively short hospital length-of-stay among the study population. Our findings support a pressing need for nutritional interventions that target hospitalized or recently discharged patients with cirrhosis in order to improve their nutritional status which in turn may improve cirrhosis related outcomes. Table 1. Baseline nutritional status at time of admission (n=60)
Table 1: Cox proportional hazard regression analysis model for predictors on 90-day mortality after TIPS
Su1490 REAL LIFE EXPERIENCE WITH OMBITASVIR/PARITAPREVIR/RITONAVIR + DASABUVIR AND RIBAVIRIN REGIMEN IN PATIENTS WITH COMPENSATED HCV CIRRHOSIS Mariana Jinga, Vasile Daniel Balaban, Florentina Ionita-Radu, Raluca Costache, Petrut Nuta, Sandica Bucurica, Andrada Popescu, Victor Stoica, Oana Vutcanu, Mihaela Milicescu, Ion Stefan, Bogdan Macadon, Alice Farcas, Florica Naftanaila, Aurelia Alexandru, Georgiana C. Robu Background Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir in association with ribavirin is the only interferon free regimen available in Romania for compensated HCV cirrhosis. Aim of our study is to reveal our experience with interferon free therapy in compensated HCV cirrhosis. Material and methods We conducted a multicenter prospective study including 90 patients with compensated (Child-Pugh A) HCV cirrhosis treated with Ombitasvir/ Paritaprevir/Ritonavir + Dasabuvir and Ribavirin regimen for 12 weeks, diagnosed clinical, biological, and by FibroMax test. Each patient had follow-up visits at four, eight, twelve and 24 weeks after treatment initiation. Biological tests included: hemoglobin, ALT, AST, platelets, total bilirubin, serum albumin, INR. We defined anemia as Hb<12 g/dl in women and Hb< 13 g/dl in men. Cytolysis was defined as values of ALT or AST > as least 2 time upper limit of normal. Hyperbilirubinemia was defined as a level of bilirubin > than 1.2 mg/dl. HCV RNA level in blood was evaluated at baseline, end of treatment (EOT) and 12 weeks after EOT. Undetectable HCV RNA was defined as a viral load <15 UI/ml, assessed by PCR. Virological response (VR) was defined as undetectable HCV RNA at EOT and sustained virological response (SRV) as undetectable HCV RNA at 12 weeks after EOT. Results 44 (49%) patients were female and 46 (51 %) were male. The mean age of patients in the study was 61 years old. All the patients had HCV genotype 1b infection. 22 patients were naive and 68 had previous antiviral therapies based on pegylated IFN-α and ribavirin. At the initiation of treatment 64 (71%) of patients had cytolysis, 38 (42%) had thrombocytopenia, 19 (21%) patients had hyperbilirubinemia and 11 (12%) patients had anemia. After four weeks of treatment it was noticed an increasing of anemia in 42 (47%) patients, and an increasing of the level bilirubinemia in 36 (40%) patients. Regarding cytolysis a decreasing was noticed, only 10% of 64 patients still having cytolysis after four weeks of treatment. One patient (1%) died after four weeks of treatment by complications of cirrhosis. 89 (99%) of patients had VR at EOT and SVR at twelve weeks after EOT. Conclusion The most common side effect among the patients in the study group was anemia (47% cases). Cytolysis disappeared after four weeks of treatment in 61% of patients. The interferon free combination treatment was safe and highly effective in compensated HCV cirrhosis.
*Standard definitions for malnutrition were used to classify patients: TSF, MAC, MAMC<5th percentile of reference population; HD>2SD below mean for reference population; prealbumin<10mg/dL. Table 2. Change in Nutritional Status Over Hospitalization (n=31)
AASLD Abstracts
S-1148