- Email: [email protected]
P.11.11 RAPID “BREATH-PRINT” OF LIVER CIRRHOSIS BY PROTON TRANSFER REACTION TIME OF FLIGHT MASS SPECTROMETRY
S168
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
cutoff values of LSM were 20kPa (AUROC 0.80, Sensitivity 80%, Specificity 60%) to predict LD and 21 kPa (AUROC 0.73, Sensitivity 70%, Specificity 60%) to predict HCC. Conclusions: Liver stiffness measurement by TE is an accurate predictor of outcome events in patients with compensated HCV cirrhosis, particularly in patients who do not obtain a SVR after SOC.
P.11.10 SPLEEN AND LIVER STIFFNESS MEASUREMENT CAN PREDICT CLINICAL COMPLICATIONS IN COMPENSATED CIRRHOTIC PATIENTS: A PROSPECTIVE STUDY A. Colecchia ∗ ,1 , D. Mandolesi 1 , R. Schiumerini 1 , A. Colli 2 , L. Marzi 1 , M.L. Bacchi Reggiani 1 , G. Bonato 1 , M. Taddia 1 , L. Montrone 1 , E. Scaioli 1 , G. Mazzella 1 , D. Festi 1 1 Policlinico
S. Orsola-Malpighi, Bologna; 2 Ospedale Manzoni, Lecco, Italy
Background and aim: The prognosis of compensated cirrhotic patients is strongly associated with portal hypertension (PHT) development. Currently HVPG measurent represents the best predictor of clinical decompensation. Nevertheless, HVPG is an invasive procedure and not widely diffused. The evaluation of liver stiffness (LS) and more recently of spleen stiffness (SS) by Fibroscan has been shown to be correlated to HVPG degree. Aim of the present prospective study was to assess the role of LS and SS, compared to HVPG, in predicting clinical complications in compensated cirrhotic patients. Material and methods: Eighty patients with compensated cirrhosis underwent at enrollment to LS, SS, HVPG measurements and upper gastrointestinal endoscopy, and then followed-up for 2 years or until the occurrence of the first clinical decompensation [development or small to large esophageal varices, variceal bleeding, ascites, encephalopathy, hepatorenal syndrome, spleen size increasing (>2 cm), sepsis, liver transplantation and death]. The predictive values were evaluated by means of AUROC curves and by uni and multivariate analyses. Survival rates were also evaluated. Results: 38 out 80 (47.5%) patients developed the first clinical complication related to PHT and 5 out 60 (8%) developed an hepatocellular carcinoma. Four deaths and one liver transplantation were observed during the follow-up, but they always occurred after a previous complication. At univariate analysis, LS, SS, HVPG, LS-spleen diameter/platelet count score (LSPS), MELD and APRI score resulted clinical predictors of PHT-related events. At multivariate analysis only SS resulted as predictive factor (HR= 3.79, 95% CI: 1.51–9.48, p<0.004). The AUROC of HVPG, LS and SS value to predict PHT-related complication were 0.768, 0.746 and 0.850 respectively (p=ns). The best LS and SS cut-offs predicting PTH related events were 23 kPa and 56 kPa, respectively; patients with values lower than cut offs had a significant lower probability to remain free of PHT-related events (Log Rank test p<0.0026, p<0.0000 respectively). Conclusions: This study shows that in compensated cirrhotic patients both LS and SS represent good predictors of clinical decompensation, with a prognostic performance similar to HVPG. If confirmed by further studies, LS and SS could substitute invasive procedures in the overall management of compensated cirrhotic patients.
P.11.11 RAPID “BREATH-PRINT” OF LIVER CIRRHOSIS BY PROTON TRANSFER REACTION TIME OF FLIGHT MASS SPECTROMETRY V. Lembo ∗ ,1 , E. Aprea 2 , V. Fogliano 3 , P. Vitaglione 3 , G. Mazzone 1 , L. Cappellin 2 , F. Gasperi 2 , F. Biasioli 2 , F. Morisco 1 , N. Caporaso 1 1 Gastroenterology Unit, Department of Clinical and Experimental Medicine, University of Naples “Federico II”, Naples, Italy; 2 IASMA Research and Innovation Centre, Foundation Edmund Mach, Food Quality and Nutrition Department, S. Michele a/A, Italy; 3 Department of Food Science, University of Naples “Federico II”, Portici, Italy
Background and aim: Being rapid and non-invasive, breath analysis is a promising diagnostic tool although difficulties related to data interpretation,
reproducibility and sensibility have limited its application. The aim of the present work was to investigate whether a recently realized direct injection mass spectrometric technique (Proton Transfer Reaction Time of Flight Mass Spectrometry, PTR-ToF-MS) allows the direct and noninvasive diagnosis of cirrhosis as well as the assessment of the disease severity by direct analysis of exhaled breath. Material and methods: Twelve patients (M/F 8/4, mean age 70.5, range 42–80 years) with liver cirrhosis of different etiologies and status and 14 healthy subjects (M/F 5/9, mean age 52.3, range 35–77 years) were enrolled in the study. The etiology of cirrhosis was viral in 9 (8 HCV and 1 HBV) and metabolic in 3. The Child-Pugh class was A in 6 patients, B in 3, and C in the remaining 3 patients. Real time breath analysis was performed using a buffered end-tidal (BET) on-line sampler coupled to a PTR-ToF-MS. Spectra were acquired using the data acquisition software TOF-DAQ (Tofwerk AG, Switzerland) with a mass/charge range of 10–400 Th. The data were analyzed by non-parametric ANOVA (Kruskal-Wallis test) using the Statistica 9.1 (StatSoft, USA) software. Results: Eight peaks resulted significantly different in cirrhotic patients compared to healthy controls: two related to ketones, (2-pentanone, C8ketone), two to terpenes and four to sulfur compounds. Three peaks resulted significantly different between Child-Pugh A cirrhotic patients and ChildPugh B+C cirrhotic patients and precisely: C8-ketone, a monoterpene and a NS-compound. Conclusions: Real time analysis of breath allows to distinguish cirrhotic from healthy subjects and well compensated liver disease from more advanced liver stage. The proposed method can be used to identify the stage and severity of liver disease in real time with a safe and non-invasive procedure.
P.11.12 IMPROVING PROGNOSIS OF HCC ON THE REAL-WORLD CLINICAL PRACTICE IN ITALY M. Borzio ∗ ,1 , R. Sacco 2 , L. Fanigliulo 3 , G. Parisi 4 , E. Dionigi 1 , M. Salvagnini 5 , M. Difonzo 6 , S. Vicari 7 , A. Salmi 8 , I. Desio 9 , G. Francica 10 1 U.O.C.Gastroenterologia
A.O. Melegnano, Melegnano, Italy; 2 U.O.C. Gastroenterologia Ospedale Cisanello, Pisa, Italy; 3 U.O.C. Gastroenterologia Ospedale Saliceto, Piacenza, Italy; 4 U.O.C. Medicina Ospedale Santamaria del Prato, Feltre, Italy; 5 U.O.C. Gastroenterologia Ospdale SanBortolo, Vicenza, Italy; 6 U.O.C. Gastroenterologia Ospedale SantAndrea, Roma, Italy; 7 U.O.C. Gastroenterologia Ospedale Bentivoglio, Bologna, Italy; 8 U.O. Gastroenterologia Poliambulanza, Brescia, Italy; 9 U.O. Gastroenterologia Ospedale Policlinico, Napoli, Italy; 10 UO. Medicina Ospedale S.Maria Pietà Camilliani, Casoria, Italy Background and aim: Sporadic data suggest that HCC outcome is improving over time. To address this issue we compared two independent cohorts of patients recruited on field at 10 years distance each other with the aim of assessing whether or not changes occurred on: (1) epidemiologic, etiologic and clinical characteristics, (2) characteristics of HCC at presentation and (3) whether or not outcome has improved. Material and methods: The study was carried out in two Italian multicentre cohorts of consecutive new HCCs detected in two periods: cohort 1 (C1) included 327 patients (Jan-Dec 1998) and cohort 2 (C2) 718 patients (Sept 2008-Dec 2011). HCC was diagnoses according to the current criteria at that period and HCC managed accordingly. Patients of both cohorts were stratified according to Child-Pugh and MELD score. HCC was staged according to TNM classification and BCLC system. Each centre was free in clinical decisions. Results: C1 patients were significantly older and more frequently male. Nonviral-non-alcoholic cirrhosis doubled in C2. At baseline, liver function was better and comorbidities were more frequently observed in C2. In both cohorts BCLC very early/early stages were prevalent being significantly higher in C2. BCLC stage B and C were equally distributed while patients in BCLC stage D were significantly more frequent in C1. In C2 HCCs were more frequently detected under regular US surveillance and were significantly smaller and uni/paucinodular. As a whole treatment, no matter which, was more frequently offered to C2 patients (549, 76.5% vs 171, 52.3%; p<0.001) and, in particular, in C2 significantly increased the rate
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
cutoff values of LSM were 20kPa (AUROC 0.80, Sensitivity 80%, Specificity 60%) to predict LD and 21 kPa (AUROC 0.73, Sensitivity 70%, Specificity 60%) to predict HCC. Conclusions: Liver stiffness measurement by TE is an accurate predictor of outcome events in patients with compensated HCV cirrhosis, particularly in patients who do not obtain a SVR after SOC.
P.11.10 SPLEEN AND LIVER STIFFNESS MEASUREMENT CAN PREDICT CLINICAL COMPLICATIONS IN COMPENSATED CIRRHOTIC PATIENTS: A PROSPECTIVE STUDY A. Colecchia ∗ ,1 , D. Mandolesi 1 , R. Schiumerini 1 , A. Colli 2 , L. Marzi 1 , M.L. Bacchi Reggiani 1 , G. Bonato 1 , M. Taddia 1 , L. Montrone 1 , E. Scaioli 1 , G. Mazzella 1 , D. Festi 1 1 Policlinico
S. Orsola-Malpighi, Bologna; 2 Ospedale Manzoni, Lecco, Italy
Background and aim: The prognosis of compensated cirrhotic patients is strongly associated with portal hypertension (PHT) development. Currently HVPG measurent represents the best predictor of clinical decompensation. Nevertheless, HVPG is an invasive procedure and not widely diffused. The evaluation of liver stiffness (LS) and more recently of spleen stiffness (SS) by Fibroscan has been shown to be correlated to HVPG degree. Aim of the present prospective study was to assess the role of LS and SS, compared to HVPG, in predicting clinical complications in compensated cirrhotic patients. Material and methods: Eighty patients with compensated cirrhosis underwent at enrollment to LS, SS, HVPG measurements and upper gastrointestinal endoscopy, and then followed-up for 2 years or until the occurrence of the first clinical decompensation [development or small to large esophageal varices, variceal bleeding, ascites, encephalopathy, hepatorenal syndrome, spleen size increasing (>2 cm), sepsis, liver transplantation and death]. The predictive values were evaluated by means of AUROC curves and by uni and multivariate analyses. Survival rates were also evaluated. Results: 38 out 80 (47.5%) patients developed the first clinical complication related to PHT and 5 out 60 (8%) developed an hepatocellular carcinoma. Four deaths and one liver transplantation were observed during the follow-up, but they always occurred after a previous complication. At univariate analysis, LS, SS, HVPG, LS-spleen diameter/platelet count score (LSPS), MELD and APRI score resulted clinical predictors of PHT-related events. At multivariate analysis only SS resulted as predictive factor (HR= 3.79, 95% CI: 1.51–9.48, p<0.004). The AUROC of HVPG, LS and SS value to predict PHT-related complication were 0.768, 0.746 and 0.850 respectively (p=ns). The best LS and SS cut-offs predicting PTH related events were 23 kPa and 56 kPa, respectively; patients with values lower than cut offs had a significant lower probability to remain free of PHT-related events (Log Rank test p<0.0026, p<0.0000 respectively). Conclusions: This study shows that in compensated cirrhotic patients both LS and SS represent good predictors of clinical decompensation, with a prognostic performance similar to HVPG. If confirmed by further studies, LS and SS could substitute invasive procedures in the overall management of compensated cirrhotic patients.
P.11.11 RAPID “BREATH-PRINT” OF LIVER CIRRHOSIS BY PROTON TRANSFER REACTION TIME OF FLIGHT MASS SPECTROMETRY V. Lembo ∗ ,1 , E. Aprea 2 , V. Fogliano 3 , P. Vitaglione 3 , G. Mazzone 1 , L. Cappellin 2 , F. Gasperi 2 , F. Biasioli 2 , F. Morisco 1 , N. Caporaso 1 1 Gastroenterology Unit, Department of Clinical and Experimental Medicine, University of Naples “Federico II”, Naples, Italy; 2 IASMA Research and Innovation Centre, Foundation Edmund Mach, Food Quality and Nutrition Department, S. Michele a/A, Italy; 3 Department of Food Science, University of Naples “Federico II”, Portici, Italy
Background and aim: Being rapid and non-invasive, breath analysis is a promising diagnostic tool although difficulties related to data interpretation,
reproducibility and sensibility have limited its application. The aim of the present work was to investigate whether a recently realized direct injection mass spectrometric technique (Proton Transfer Reaction Time of Flight Mass Spectrometry, PTR-ToF-MS) allows the direct and noninvasive diagnosis of cirrhosis as well as the assessment of the disease severity by direct analysis of exhaled breath. Material and methods: Twelve patients (M/F 8/4, mean age 70.5, range 42–80 years) with liver cirrhosis of different etiologies and status and 14 healthy subjects (M/F 5/9, mean age 52.3, range 35–77 years) were enrolled in the study. The etiology of cirrhosis was viral in 9 (8 HCV and 1 HBV) and metabolic in 3. The Child-Pugh class was A in 6 patients, B in 3, and C in the remaining 3 patients. Real time breath analysis was performed using a buffered end-tidal (BET) on-line sampler coupled to a PTR-ToF-MS. Spectra were acquired using the data acquisition software TOF-DAQ (Tofwerk AG, Switzerland) with a mass/charge range of 10–400 Th. The data were analyzed by non-parametric ANOVA (Kruskal-Wallis test) using the Statistica 9.1 (StatSoft, USA) software. Results: Eight peaks resulted significantly different in cirrhotic patients compared to healthy controls: two related to ketones, (2-pentanone, C8ketone), two to terpenes and four to sulfur compounds. Three peaks resulted significantly different between Child-Pugh A cirrhotic patients and ChildPugh B+C cirrhotic patients and precisely: C8-ketone, a monoterpene and a NS-compound. Conclusions: Real time analysis of breath allows to distinguish cirrhotic from healthy subjects and well compensated liver disease from more advanced liver stage. The proposed method can be used to identify the stage and severity of liver disease in real time with a safe and non-invasive procedure.
P.11.12 IMPROVING PROGNOSIS OF HCC ON THE REAL-WORLD CLINICAL PRACTICE IN ITALY M. Borzio ∗ ,1 , R. Sacco 2 , L. Fanigliulo 3 , G. Parisi 4 , E. Dionigi 1 , M. Salvagnini 5 , M. Difonzo 6 , S. Vicari 7 , A. Salmi 8 , I. Desio 9 , G. Francica 10 1 U.O.C.Gastroenterologia
A.O. Melegnano, Melegnano, Italy; 2 U.O.C. Gastroenterologia Ospedale Cisanello, Pisa, Italy; 3 U.O.C. Gastroenterologia Ospedale Saliceto, Piacenza, Italy; 4 U.O.C. Medicina Ospedale Santamaria del Prato, Feltre, Italy; 5 U.O.C. Gastroenterologia Ospdale SanBortolo, Vicenza, Italy; 6 U.O.C. Gastroenterologia Ospedale SantAndrea, Roma, Italy; 7 U.O.C. Gastroenterologia Ospedale Bentivoglio, Bologna, Italy; 8 U.O. Gastroenterologia Poliambulanza, Brescia, Italy; 9 U.O. Gastroenterologia Ospedale Policlinico, Napoli, Italy; 10 UO. Medicina Ospedale S.Maria Pietà Camilliani, Casoria, Italy Background and aim: Sporadic data suggest that HCC outcome is improving over time. To address this issue we compared two independent cohorts of patients recruited on field at 10 years distance each other with the aim of assessing whether or not changes occurred on: (1) epidemiologic, etiologic and clinical characteristics, (2) characteristics of HCC at presentation and (3) whether or not outcome has improved. Material and methods: The study was carried out in two Italian multicentre cohorts of consecutive new HCCs detected in two periods: cohort 1 (C1) included 327 patients (Jan-Dec 1998) and cohort 2 (C2) 718 patients (Sept 2008-Dec 2011). HCC was diagnoses according to the current criteria at that period and HCC managed accordingly. Patients of both cohorts were stratified according to Child-Pugh and MELD score. HCC was staged according to TNM classification and BCLC system. Each centre was free in clinical decisions. Results: C1 patients were significantly older and more frequently male. Nonviral-non-alcoholic cirrhosis doubled in C2. At baseline, liver function was better and comorbidities were more frequently observed in C2. In both cohorts BCLC very early/early stages were prevalent being significantly higher in C2. BCLC stage B and C were equally distributed while patients in BCLC stage D were significantly more frequent in C1. In C2 HCCs were more frequently detected under regular US surveillance and were significantly smaller and uni/paucinodular. As a whole treatment, no matter which, was more frequently offered to C2 patients (549, 76.5% vs 171, 52.3%; p<0.001) and, in particular, in C2 significantly increased the rate