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Efficacy of nutritional therapy on quality of life in liver cirrhosis with minimal hepatic encephalopathy- randomized controlled trial
POSTER PRESENTATIONS (HR 0.82, p = 0.0001) and gender (HR 1.73, p = 0.02). For HRSR, significant variables for terli included average daily con albumin (OR 0.84, p = 0.04) and treatment duration (OR 1.33, p = 0.0001). For PBO, treatment duration (OR 1.20, p = 0.0008), but not total or average daily con albumin, significantly effected HRS reversal.
further 2%. With 17% and 9%, ESBL and VRE were the most common MRB in stool samples. MRSA was mainly isolated from SST swabs (5%). In 19.2% of the 1007 cases (56.4% monomicrobial, 25.5% polybacterial, 14.5% mixed bacterial/fungal infections), patients showed signs of systemic infection (WBC > 10 g/L, CRP > 3 mg/dL; outcomes will be presented).
Conclusions: These results differ from those previously reported from meta-analyses and do not demonstrate a clear dose response relationship between con albumin and survival, either alone or with terli treatment. The interaction between albumin dose and survival and HRS reversal is complex and likely involves an interaction between treatment duration and other variables. Further studies are clearly indicated. SAT-046 Bacterial infections in cirrhosis – a retrospective analysis updating on microbiology and resistance rates T. Bucsics1, M. Emich1, E. Berger1, M.C. Nackenhorst1, P. Schwabl1, M. Mandorfer1, B. Scheiner1, M. Trauner1, A. Ferlitsch1, T. Reiberger1. 1 Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria E-mail: [email protected] Background and Aims: Bacterial infections cause severe morbidity and mortality in patients with cirrhosis. Knowledge about microbial epidemiology is essential to optimize prophylactic strategies and empiric antibiotic treatment. Methods: Retrospective analysis of all consecutive microbial results from patients with cirrhosis treated at a tertiary care center between 01/2010 and 06/2013. Results: 8621 cultures from 668 patients with cirrhosis (mean age:57.3 ± 18.8 years, sex: 65.3% male, etiology: 44.9% alcoholic, 26.6% viral, 28.5% other) were included. 3684 (42.7%) cultures yielded a positive result: Bile and skin/soft tissue (SST) swabs had the highest pathogen detection rates (not considering commensal flora; 83.1% and 80.2%, respectively), compared to 28.6% in blood, 24.2% in ascites, and 6.6% in stool samples. 59% of bacterial cultures were Grampositive and 41% Gram-negative. The percentage of Gram-positive germs was higher in patients with cirrhosis than in patients without (58.7% vs. 52.3%, p < 0.001). The most common isolated germs were as follows: bile (n = 725): enterococci (29%), streptococci (16%); blood (n = 490): staphylococci (36%), enterococci (13%); SST (n = 404): staphylococci (35%, 54% of which S. aureus); ascites (n = 397): staphylococci (37%), enterococci (23%), and E. coli in only 13%; pneumonia (n = 202): pseudomonas spp. and E. coli (14% each); urinary tract (n = 341): enterococci (32%), E. coli (31%); stool (n = 106): campylobacter spp. (35%), enterococci (19%). Multiresistant bacteria (MRB) were found in 16.9% [vancomycin resistant enterococci (VRE): 2.1%; expanded-spectrum beta-lactamase producing bacteria (ESBL): 4.7%; multiresistant staphylococcus aureus (MRSA): 0.9%; others (resistances to ≥3 antibiotic classes): 9.6%]. Fewest MRB were found in bile (8%) and patients with pneumonia (9%). 34% of cultures isolated from catheter tips were non-VRE, non-MRSA, non-ESBL MRB, and VRE were detected in
Conclusions: Our results underline the increasing prevalence of Gram-positive germs and multiresistant bacteria in cirrhosis. 16.9% of pathogenic bacteria were multiresistant, and mostly not VRE, MRSA or ESBL. Only 19.2% of culture-positive cases showed elevated CRP/ WBC levels. SAT-047 Efficacy of nutritional therapy on quality of life in liver cirrhosis with minimal hepatic encephalopathy- randomized controlled trial S. Maharshi1, B.C. Sharma1,2. 1Gastroenterology, G. B. Pant Hospital, New Delhi; 2Hepatology, Institute of Liver and Biliary Sciences, New Dehi, India E-mail: [email protected] Background and Aims: Minimal hepatic encephalopathy (MHE) impairs health related quality of life (HRQOL), predicts development of overt hepatic encephalopathy (HE) and associated with poor prognosis. There are limited studies on nutritional therapy for HRQOL in patients with MHE. We assessed the effects of nutritional therapy on cognitive functions and HRQOL in patients of cirrhosis with MHE. Methods: A randomized controlled trial conducted in a tertiary care setting on patients of cirrhosis with MHE who were randomized to nutritional therapy (group A: 30–35 kcal/kg/day and 1.0–1.5 gram of vegetable protein/kg/day) and no nutritional therapy (group B: diet as patients were taking before) for 6 months. MHE was diagnosed based on psychometry hepatic encephalopathy score (PHES). HRQOL was assessed by sickness impact profile (SIP) questionnaire. Primary endpoints were improvement in HRQOL and improvement or worsening in MHE. Results: 120 patients were randomized to group-A (n = 60, age 42.1 ± 10.3 yr, 48 men) and group-B (n = 60, age 42.4 ± 9.6 yr, 47 men). There was no significant difference in baseline characteristics between the two groups. Baseline PHES (−8.12 ± 1.32 vs. −8.53 ± 1.38; p = 0.08) and SIP score (14.25 ± 5.8 vs. 15.44 ± 5.03; p = 0.85) were comparable in both the groups. Improvement in PHES (ΔPHES 3 .86 ± 3.58 vs. 0.52 ± 4.09; p = 0.001) and HRQOL (Δ SIP 3.24 ± 3.63 vs. 0.54 ± 3.58; p = 0.001) were higher in group A compared to group B. Reversal of MHE was also higher in group A (71.1% vs. 22.8%; p = 0.001). Conclusions: Nutritional therapy is associated with improvement in HRQOL and effective in treatment of MHE.
Journal of Hepatology 2017 vol. 66 | S543–S750
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further 2%. With 17% and 9%, ESBL and VRE were the most common MRB in stool samples. MRSA was mainly isolated from SST swabs (5%). In 19.2% of the 1007 cases (56.4% monomicrobial, 25.5% polybacterial, 14.5% mixed bacterial/fungal infections), patients showed signs of systemic infection (WBC > 10 g/L, CRP > 3 mg/dL; outcomes will be presented).
Conclusions: These results differ from those previously reported from meta-analyses and do not demonstrate a clear dose response relationship between con albumin and survival, either alone or with terli treatment. The interaction between albumin dose and survival and HRS reversal is complex and likely involves an interaction between treatment duration and other variables. Further studies are clearly indicated. SAT-046 Bacterial infections in cirrhosis – a retrospective analysis updating on microbiology and resistance rates T. Bucsics1, M. Emich1, E. Berger1, M.C. Nackenhorst1, P. Schwabl1, M. Mandorfer1, B. Scheiner1, M. Trauner1, A. Ferlitsch1, T. Reiberger1. 1 Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria E-mail: [email protected] Background and Aims: Bacterial infections cause severe morbidity and mortality in patients with cirrhosis. Knowledge about microbial epidemiology is essential to optimize prophylactic strategies and empiric antibiotic treatment. Methods: Retrospective analysis of all consecutive microbial results from patients with cirrhosis treated at a tertiary care center between 01/2010 and 06/2013. Results: 8621 cultures from 668 patients with cirrhosis (mean age:57.3 ± 18.8 years, sex: 65.3% male, etiology: 44.9% alcoholic, 26.6% viral, 28.5% other) were included. 3684 (42.7%) cultures yielded a positive result: Bile and skin/soft tissue (SST) swabs had the highest pathogen detection rates (not considering commensal flora; 83.1% and 80.2%, respectively), compared to 28.6% in blood, 24.2% in ascites, and 6.6% in stool samples. 59% of bacterial cultures were Grampositive and 41% Gram-negative. The percentage of Gram-positive germs was higher in patients with cirrhosis than in patients without (58.7% vs. 52.3%, p < 0.001). The most common isolated germs were as follows: bile (n = 725): enterococci (29%), streptococci (16%); blood (n = 490): staphylococci (36%), enterococci (13%); SST (n = 404): staphylococci (35%, 54% of which S. aureus); ascites (n = 397): staphylococci (37%), enterococci (23%), and E. coli in only 13%; pneumonia (n = 202): pseudomonas spp. and E. coli (14% each); urinary tract (n = 341): enterococci (32%), E. coli (31%); stool (n = 106): campylobacter spp. (35%), enterococci (19%). Multiresistant bacteria (MRB) were found in 16.9% [vancomycin resistant enterococci (VRE): 2.1%; expanded-spectrum beta-lactamase producing bacteria (ESBL): 4.7%; multiresistant staphylococcus aureus (MRSA): 0.9%; others (resistances to ≥3 antibiotic classes): 9.6%]. Fewest MRB were found in bile (8%) and patients with pneumonia (9%). 34% of cultures isolated from catheter tips were non-VRE, non-MRSA, non-ESBL MRB, and VRE were detected in
Conclusions: Our results underline the increasing prevalence of Gram-positive germs and multiresistant bacteria in cirrhosis. 16.9% of pathogenic bacteria were multiresistant, and mostly not VRE, MRSA or ESBL. Only 19.2% of culture-positive cases showed elevated CRP/ WBC levels. SAT-047 Efficacy of nutritional therapy on quality of life in liver cirrhosis with minimal hepatic encephalopathy- randomized controlled trial S. Maharshi1, B.C. Sharma1,2. 1Gastroenterology, G. B. Pant Hospital, New Delhi; 2Hepatology, Institute of Liver and Biliary Sciences, New Dehi, India E-mail: [email protected] Background and Aims: Minimal hepatic encephalopathy (MHE) impairs health related quality of life (HRQOL), predicts development of overt hepatic encephalopathy (HE) and associated with poor prognosis. There are limited studies on nutritional therapy for HRQOL in patients with MHE. We assessed the effects of nutritional therapy on cognitive functions and HRQOL in patients of cirrhosis with MHE. Methods: A randomized controlled trial conducted in a tertiary care setting on patients of cirrhosis with MHE who were randomized to nutritional therapy (group A: 30–35 kcal/kg/day and 1.0–1.5 gram of vegetable protein/kg/day) and no nutritional therapy (group B: diet as patients were taking before) for 6 months. MHE was diagnosed based on psychometry hepatic encephalopathy score (PHES). HRQOL was assessed by sickness impact profile (SIP) questionnaire. Primary endpoints were improvement in HRQOL and improvement or worsening in MHE. Results: 120 patients were randomized to group-A (n = 60, age 42.1 ± 10.3 yr, 48 men) and group-B (n = 60, age 42.4 ± 9.6 yr, 47 men). There was no significant difference in baseline characteristics between the two groups. Baseline PHES (−8.12 ± 1.32 vs. −8.53 ± 1.38; p = 0.08) and SIP score (14.25 ± 5.8 vs. 15.44 ± 5.03; p = 0.85) were comparable in both the groups. Improvement in PHES (ΔPHES 3 .86 ± 3.58 vs. 0.52 ± 4.09; p = 0.001) and HRQOL (Δ SIP 3.24 ± 3.63 vs. 0.54 ± 3.58; p = 0.001) were higher in group A compared to group B. Reversal of MHE was also higher in group A (71.1% vs. 22.8%; p = 0.001). Conclusions: Nutritional therapy is associated with improvement in HRQOL and effective in treatment of MHE.
Journal of Hepatology 2017 vol. 66 | S543–S750
S577