Ensuring Competency of High-level Disinfection (HLD) Practices in Non-Central Processing Department (CPD) locations

POSTERS liver on ultrasound has a good accuracy for predicting NASH in patients with gallstones. Based on these results, we propose that gallstones patients who have preoperative evidence of both insulin resistance and fatty liver on ultrasound are considered to undergo a needle liver biopsy during cholecystectomy for early diagnosis of NASH at high-risk patients. P1035 ELF TEST IS A RELIABLE NON INVASIVE TEST FOR FIBROSIS IN NAFLD SUBJECTS L. Miele1 , T. De Michele2 , M.A. Isgro` 3 , G. Marrone1 , C. Cefalo1 , M. Biolato1,4 , G.L. Rapaccini5 , A. Gasbarrini1 , C. Zuppi2 , A. Grieco1 . 1 Internal Medicine, 2 Laboratory Medicine, Catholic University, 3 Laboratory Medicine, Catholic University of Rome, 4 Catholic University, 5 Internal Medicine, Catholic University of Rome, Rome, Italy E-mail: [email protected] Background and Aims: The identification of fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) is important for prognosis and selection of patients candidates for therapeutic interventions. The reference standard for detecting liver fibrosis is liver biopsy; however, such an invasive procedure, it can be painful and hazardous, and assessment subjective and prone to sampling error. Recently, the serum Enhanced Liver Fibrosis (ELF) Test has been developed for staging liver fibrosis in patients with chronic liver diseases. The aim of our study was to evaluate the ELF Test performance in predicting fibrosis stage in an independent adult cohort of NAFLD patients. Methods: 82 patients (mean age 46 years) with suspected NAFLD were enrolled undergoing percutaneous liver biopsy and serum sampling. Fibrosis was assessed and scored by using the modified Brunt classification (F0 = no fibrosis; F1 = perisinusoidal/periportal; F2 = perisinusoidal and portal/periportal; F3 = bridging fibrosis; F4 = cirrhosis). The ELF test was determined in all patients by means of an algorithm combining hyaluronic acid, aminoterminal propeptide of type III collagen and tissue inhibitor of metalloproteinase 1. Diagnostic accuracy was assessed determining the area under receiver operating characteristic curves (AUCs). Results: The distribution of fibrosis stages in our cohort was as follows: F0 = 7.3% (n = 6), F1 = 39.0% (n = 32), F2 = 35.4% (n = 29), F3 = 6.1% (n = 5), F4 = 12.2% (n = 10). The ELF Test had an AUC of 0.988 (95% confidence interval [CI] 0.967–1.008; P < 0.001) for distinguishing cirrhosis, 0.948 (CI 0.883–1.014; P < 0.001) for severe fibrosis, 0.682 (CI 0.568–0.797; P = 0.005) for significant fibrosis and 0.658 (CI 0.401–0.915; P = 0.200) for any fibrosis. ELF scores were significantly higher in patients with severe fibrosis/cirrhosis in respect to ones with no/mild/moderate fibrosis (median 11.26 vs. 8.53; P < 0.001). Severe fibrosis and cirrhosis were correctly identified in 91% of patients. Conclusions: In our cohort of NAFLD patients, the ELF test was able to discriminate severe fibrosis and cirrhosis with an excellent diagnostic accuracy. It may result useful for the selection of cases with more advanced fibrosis stage and for therapeutic follow-up, thus avoiding liver biopsy. P1036 OBESITY, T2DM, METABOLIC SYNDROME INFLUENCE MORTALITY IN NAFLD IN A COHORT OF MEXICAN PATIENTS L.A. Perez-Arredondo1 , P. Cordero-Perez1 , G. Alarcon-Galvan1,2 , R.F. Martinez-Macias1 , A. Silvera-Linares1 , L.E. Munoz-Espinosa1 . 1 Liver Unit Department of Internal Medicine, 2 Pathology Department, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico E-mail: [email protected] Background and Aims: The spectrum of non alcoholic fatty liver disease (NAFLD) comprises non alcoholic fatty liver (NAFL), non alcoholic steatohepatitis (NASH) and cirrhosis. Recently, it has been S736

positioning as one of the most frequent causes of chronic liver disease (CLD). Mexico has the second highest worldwide prevalence of obesity and type 2 diabetes mellitus (T2DM) is present in 14% of general population. The aim of this study was to evaluate the influence that metabolic factors had in the natural history of NAFLD in Mexican patients. Methods: NAFLD diagnosis was made in patients who drank <30 g/day on males, <20 g/day on females. Other etiologies of CLD were ruled out. Demographic, anthropometric, biochemical, US data and comorbidities were registered. All patients had liver biopsy and/or FibroMax. Group 1 (G1): 41 NAFL patients and group 2 (G2): 80 NASH patients. Comorbidities were compared between admission and last visit. Kaplan–Meier curves (KM) were calculated evaluating the development of cirrhosis, its complications and mortality or liver transplant (LT). Results: During follow-up obesity decreased in both groups, however HBP increased significantly in G1 as T2DM, HBP, dyslipidemia and metabolic syndrome (MS) increased in G2 (Table). Forty patients had cirrhosis initially, and in G2 four patients developed it. Cirrhosis was diagnosed in 44/121 (36%) patients. Twelve out of 121 (10%) patients died/LT, 11 of them were cirrhotic. Causes of death: liver related 9/12 (75%), cardiovascular causes 2/12 (17%) and infection 1/12 (8%). KM curves demonstrated that patients with obesity (p = 0.041), T2DM (p = 0.002) and metabolic syndrome (p = 0.001) had higher mortality/LT. The development of cirrhosis during follow-up was not influenced by comorbidities. Table: Progression of comorbidities in NAFL and NASH Comorbidity

Obesity T2DM HBP Dyslipidemia MS

Group 1 (n = 41)

Group 2 (n = 80)

Admission

Last visit

P

Admission

Last visit

P

18 11 8 32 11

15 14 14 35 14

0.687 0.250 0.031 0.250 0.250

45 34 31 56 42

40 48 38 66 46

0.210 <0.001 0.016 0.002 <0.001

Conclusions: Patients with NASH developed more comorbidities than patients with NAFL in the long term follow-up. Patients with obesity, T2DM and MS had higher mortality/LT. However the development of cirrhosis during follow-up was not influenced by comorbidities. The most common cause of death in NAFLD was liver related. P1037 INFLUENCE OF PREDICTOR VARIABLES ON FIBROMAX RESULTS N. Sargsyants1 , A. Melkonyan2 , Y. Kazanchyan2 . 1 Infectious Diseases, Armenicum Clinical Center, 2 Promtest, “Promtest” Diagnostic Laboratory, Yerevan, Armenia E-mail: [email protected] Background and Aims: Among the noninvasive alternatives to liver biopsy in patients at risk of chronic liver diseases, several studies have demonstrated the predictive value of FibroMax (BioPredictive, France). FibroMax includes 5 tests: FibroTest (quantitative assessment of fibrosis), ActiTest (quantitative assessment of necroinflammatory activity in chronic viral hepatitis C and B), SteatoTest (quantitative assessment of steatosis), NashTest (categorical diagnosis of nonalcoholic steatohepatitis) and AshTest (quantitative assessment of alcoholic steatohepatitis). The aim of the study is evaluation of predictor variables influence of Fibromax results. Methods: 80 patients were involved in the study (86% male), 21–68 years old (42.4±10.2). Statistic analysis was done by SPSS 11.0. Multiple regression was used for estimation of independent or predictor variables (gender, age, BMI, fasting glucose, triglycerides, cholesterol, AST, ALT and GGT) influence on

Journal of Hepatology 2015 vol. 62 | S263–S864