- Email: [email protected]
P475 ADRENAL INSUFFICIENCY IN CRITICALLY ILL CIRRHOTIC PATIENTS: PREVALENCE, RISK FACTORS AND IMPACT ON MORTALITY
POSTERS P473 BACTERIAL INFECTIONS IN CIRRHOTIC PATIENTS: RISK FACTORS AND RATE OF FAILURE OF THE EMPIRICAL ANTIBIOTIC THERAPY V. Di Gregorio1 , C. Lucidi1 , V. Giannelli1 , B. Lattanzi1 , M. Giusto1 , G. Iacovone1 , M. Venditti2 , O. Riggio1 , M. Merli1 . 1 Gastroenterology, Department of Clinical Medicine, 2 Department of Infectious Disease, Sapienza Universita’ di Roma, Rome, Italy E-mail: [email protected] Background and Aims: Cirrhotic patients are very prone to bacterial infections. Because of the selective pressure carried out by the use of antibiotics and the need for frequent hospitalization, infections by multidrug-resistant pathogens are increasing. To assess prevalence and risk factors for infections by multidrugresistant bacteria in hospitalized cirrhotics. The failure of empiric antibiotic therapy was also examined. Methods: We enrolled all consecutive hospitalized cirrhotics with a microbiologically documented infection. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as MDR (Multidrug-Resistant) if they were resistant to at least three classes of antibiotics, XDR (Extensively-Drug-Resistant) if sensitive to one or two antimicrobial classes and PDR (Pandrug-Resistant) if they were resistant to all classes. Results: We considered 122 infectious episodes;15% of them were CA, 52%HA and 33%HCA. Pathogens isolated were in 51%multidrugresistant, classified as MDR in 76%, XDR in 21% and PDR in 3% of cases. Risk factors for the development of multidrug-resistant infections were the use of quinolone-prophylaxis (p = 0.01), a contact with the health-care environment (p = 0.02) and the use of antibiotics in the last month (p = 0.04). At multivariate analysis the antibiotic prophylaxis (OR 8.4, p = 0.05, CI 1.03–76) and contact with the health-care environment (OR 3.7, p = 0.04, CI 1.05–13) were selected as independent predictors. The failure of the empirical antibiotic therapy was higher according to the degree of resistance. Therapy resulted ineffective in the majority of HA and HCA infections with a great number of systemic complications. Conclusions: Infections by multidrug-resistant pathogens are a rising problem in cirrhotics, particularly in those in contact with the hospital environment. The rate of failure of the empirical antibiotic therapy is particularly relevant in HCA and HA infections, suggesting the need for new guidelines for antibiotic therapy. P474 CLINICAL OUTCOMES OF PATIENTS WITH PORTAL HYPERTENSION NOT DUE TO CIRRHOSIS: A SINGLE-CENTRE EXPERIENCE S. Gioia, E.G. Onori, C. Marzano, S. Angeloni, F. Cerini, I. Pentassuglio, S. Nardelli, M. Merli, A.F. Attili, O. Riggio. Policlinico Umberto I, Rome, Italy E-mail: [email protected] Background and Aims: The knowledge of natural history and prognostic factors of portal hypertension (PH) not due to cirrhosis is based on a limited number of studies because of the infrequency of this condition. Aim: To describe natural history of 77 patients with PH not due to cirrhosis (14 with idiopathic non cirrhotic portal hypertension and 63 with chronic portal vein thrombosis) in comparison with 84 patients with class A Child Pugh cirrhosis. Methods: The patients with non cirrhotic portal hypertension (NCPH) and those with cirrhosis, observed for the same period of time, were evaluated by clinical, laboratory, Doppler Ultrasound and endoscopy. Survival, variceal progression, variceal bleeding and portal vein thrombosis or re-thrombosis were recorded. Results: At diagnosis, splenomegaly was observed in 87% of NCPH vs 79% of cirrhotic patients (p=Ns), esophageal varices in 72% vs 70% (Ns) and variceal bleeding in 35% vs 36% (Ns). The rate of variceal progression (p < 0.001) and variceal bleeding (p = 0.01) were
significantly higher in patients with NCPH than in patients with cirrhosis (log rank test). Equally, the risk of developing a new event of portal vein thrombosis resulted higher in the NCPH patients (p = 0.001). The cumulative survival was similar (Ns).
Figure: Clinical outcomes.
Conclusions: The natural history and the incidence of many outcomes are different between patients with portal hypertension due or not due to liver cirrhosis. The management and treatment of the patients with portal hypertension not due to cirrhosis cannot be simply based on the guide-line derived by the observation of cirrhotic patients. P475 ADRENAL INSUFFICIENCY IN CRITICALLY ILL CIRRHOTIC PATIENTS: PREVALENCE, RISK FACTORS AND IMPACT ON MORTALITY H. Nair1 , H. Nandish1 , S. Shyamsundar2 , A. Menon3 , K. Mumtaz4 , K. Harishkumar3 , B. Vallath5 . 1 Centre for Liver Diseases, 2 Division of Critical Care, 3 Endocrinology, Amrita Institute of Medical Sciences, Cochin, India; 4 Transplant Hepatology, University Health Network, Toronto, ON, Canada; 5 Digestive Diseases Institute, Amrita Institute of Medical Sciences, Cochin, India E-mail: [email protected] Background and Aims: Relative Adrenal Insufficiency (RAI) frequently poses challenges to the management of critically ill cirrhotic patients. The aim of the study was to determine the prevalence and its association with etiological background of cirrhosis and functional class. Bearing of RAI on 3 month mortality was also assessed. Methods: Critically ill cirrhotics admitted in the ICU were included. Patients with sepsis as evidenced by positive blood, urine, sputum or body fluid culture and findings in CXR were excluded. Short synacthen test was done on all. Diagnosis of adrenal insufficiency was based on guidelines by the American College of Critical Care Medicine which states random total basal cortisol ≤10 mg/dl or delta cortisol ≤9 mg/dl. Statistical analysis: Apart from prevalence of RAI, Student t test, Mann–Whitney U test were used to test significance.
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POSTERS Results: More than two thirds (73.5%) had RAI. Adrenal insufficiency was found more commonly in patients with the Child C cirrhosis (74% vs 50% in Child’s A cirrhosis; p 0.48). 90% of patients with a MELD score >25 had adrenal insufficiency compared to 67% of patients with MELD <10 (p 0.37). Three month mortality occurred in 31.6% and 41.3% of those without and with RAI but this was not statistically significant (p value 0.57) Age, gender, aetiology of cirrhosis and CRP did not show association. Conclusions: Critically ill cirrhotic patients WITHOUT SEPSIS have a high prevalence of adrenal insufficiency (73%). However the adrenal insufficiency is not associated with severity of liver disease, aetiology or CRP. P476 SHORT-TERM (28-DAY) CLINICAL COURSE AND TRANSPLANT-FREE MORTALITY IN ACUTE ON CHRONIC LIVER FAILURE (ACLF); EVIDENCE FOR REVERSIBILITY OF ACLF (A STUDY FROM THE CANONIC DATABASE) T. Gustot1 , J. Fernandez2 , E. Garcia3 , P. Gines ` 2 , R. Moreau4 , R. Jalan5 , M. Pavesi3 , F. Durand4 , P. Angeli6 , P. Caraceni7 , D. Markwardt8 , C. Alessandria9 , P. Solis Munoz ˜ 10 , W. Laleman11 , J. Trebicka12 , F. Saliba13 , S. Zeuzem14 , A. Albillos15 , L. Elkrief4 , D. Benten16 , J.L. Montero17 , M.T. Chiva17 , M. Concepcion18 , J. Cordoba19 , A. McCormick20 , R.E. Stauber21 , W. Vogel22 , A. de Gottardi23 , F. Morando6 , M. Domenicali7 , A. Gerbes8 , A. Risso9 , C. Deulofeu3 , M. Bernardi7 , V. Arroyo2 , for the Investigators of the EASL CLIF Consortium. 1 Erasme University Hospital, Brussels, Belgium; 2 Liver Unit, Hospital Clinic, Institut d’Investigacions Biom`ediques August Pi i Sunyer (IDIBAPS) and Centro de Investigaci´ on Biom´edica en Red de Enfermedades Hep´ aticas y Digestivas (CIBEREHD), 3 Data Management Center of the EASL-CLIF Consortium, Barcelona, Spain; 4 Hˆ opital Beaujon, APHP, University Paris-Diderot, Clichy, France; 5 Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, United Kingdom; 6 University of Padova, Padova, 7 University of Bologna, Bologna, Italy; 8 Liver Center, University of Munich, Munich, Germany; 9 Ospedale San Giovanni Battista, University of Torino, Torino, Italy; 10 King’s College London School of Medicine at King’s College Hospital, London, United Kingdom; 11 University Hospital of Leuven, Leuven, Belgium; 12 University of Bonn, Bonn, Germany; 13 Hˆ opital Paul Brousse, Paris, France; 14 Medical Center, University of Frankfurt, Frankfurt, Germany; 15 Hospital Universitario Ram´ on y Cajal, Universidad de Alcal´ a, Madrid, Spain; 16 University of Hamburg, Hamburg, Germany; 17 Hospital Reina Sof´ıa, Cordoba, 18 Hospital Sant Pau, 19 Hospital Vall d’Hebron, Barcelona, Spain; 20 University College Hospital, Dublin, Ireland; 21 Medical University of Graz, Graz, 22 University of Innsbruck, Innsbruck, Austria; 23 University of Bern, Berne, Switzerland E-mail: [email protected] Background and Aims: The CANONIC data-base includes 388 patients with ACLF. Aim: Assess clinical course (CC) types, associated mortality and treatment futility in patients with ACLF. Methods: CC-Types: based on final ACLF-grade; no ACLF (resolution): CC-Type-A; ACLF-1: CC-Type-B; ACLF-2: CC-Type-C; ACLF-3: CC-Type-D. Changes in ACLF-grade: very rapid, 48 h, rapid, 3–7 days, or slow improvement or worsening. Results: Initial ACLF-grade improved, followed steady course or worsened in 49.2%, 30.4% and 20.4% of patients leading to CCtype-A, B, C and D in 42.5%, 18.0%, 15.2%, and 24.2%, respectively. CC-type correlated with initial ACLF-grade (i.e. ACLF resolution occurred in 54.5%, 34.6% and 16% of patients with ACLF-1, 2 and 3, respectively, and CC-Type-D in 12.2%, 25.7% and 68%). Changes in ACLF-grade were very rapid, rapid and slow in 40.2%, 14.7% and 14.7%. As expected CC-type correlated closely to 28-day/90day mortality (mortality in CC-type A to D: 5.8%/17.6%, 18.8%/39%, 41.7%/76% and 91.8/98.8%, respectively). ACLF-grade at day 7 after S228
diagnosis predicted 28-day mortality better than ACLF-grade at diagnosis (accuracy: 84.9% vs 65.2% p < 0.0001). 28-day mortality rate in patients with initial ACLF-3 and very rapid or rapid increase in number of organ failures (28%) was 100%. Conclusions: ACLF is extremely dynamic with different CC-types that correlate with prognosis. Resolution of ACLF is frequent in ACLF-1, relatively frequent in ACLF-2 and not exceptional in ACLF-3. ACLF-grade and number of organ failures at day 7 following diagnosis predict short-term mortality and treatment futility better than at diagnosis. Patients with ACLF-2 and ACLF-3 usually develop severe CC-types and should be managed in ICU. P477 VALUE-BASED OUTCOME INDICATORS IN LIVER CIRRHOSIS: VALIDATION IN A LARGE MULTICENTER STUDY (VBMH STUDY) S. Okolicsanyi1 , A. Ciaccio1 , M. Rota2 , M. Gentiluomo3 , M. Gemma2 , A. Grisolia4 , P.A. Cortesi2 , L. Scalone2 , L. Mantovani5 , P. Pontisso6 , P. Burra6 , L. Fabris6 , M. Mondelli7 , M. Colledan4 , S. Fagiuoli4 , M.G. Valsecchi2 , G. Cesana2 , L.S. Belli3 , M. Strazzabosco8,9 . 1 San Gerardo Hospital of Monza, 2 University of Milan-Bicocca, Monza, 3 Niguarda Hospital, Milan, 4 Papa Giovanni XXIII Hospital, Bergamo, 5 University Federico II of Naples, Naples, 6 University of Padua, Padua, 7 Fundation IRCCS Policlinico San Matteo, Pavia, 8 Universit` a di Milano-Bicocca, Monza, Italy; 9 Yale University, New Haven, CT, United States E-mail: [email protected] Background and Aims: Liver Cirrhosis (LC) is responsible for high morbidity, mortality and increasing costs. Aim of our study was to identify outcome indicators (OIs) able to measure quality and value of care in compensated (CC) and decompensated (DC) cirrhosis. Methods: A panel of experts identified a list of OIs using a modified Delphi method; seven of these OIs with the highest RAND/UCLA scores were then tested in a prospective multicenter observational study (Value Based Medicine in Hepatology, VBMH). During 18 months, 1751 patients with LC were enrolled (1004 CC, 747 DC). Results: Annual rate of decompensation (OI#1), annual incidence of first variceal bleeding (OI#2) and annual incidence of HCC (OI#3) in CC were 12%, 2% for low- and 3% for high-risk varices, and 4.3% (81% diagnosed in BCLC-A stage) respectively. One-year survival for CPT score A, B, C was 96%, 81% and 59% (OI#4) respectively, and 94%, 56% when stratified for MELD cut-off of 15 (OI#5). Among DC patients, 4% of them had an episode of variceal bleeding (6 weeks survival 90%, 32% recurrence) (OI#6), 3% had spontaneous bacterial peritonitis (6 weeks survival 86%, 13% recurrence) (OI#7). Conclusions: The seven outcome indicators identified in our study performed well when tested in a large cohort of patients and represent a reference tool to implement a value-based approach to liver diseases. P478 RESOURCE USE ASSOCIATED WITH HEPATIC ENCEPHALOPATHY IN PATIENTS WITH LIVER DISEASE J.G. Orr1 , C.L. Morgan2 , S. Jenkins-Jones2 , M. Hudson1 , P. Conway3 , A. Radwan4 , C.J. Currie5 . 1 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, 2 Pharmatelligence, Cardiff, 3 Norgine Global Health Outcomes, Norgine Ltd, 4 Norgine UK, Uxbridge, 5 School of Medicine, Cardiff University, Cardiff, United Kingdom E-mail: [email protected] Background and Aims: Overt hepatic encephalopathy (HE) is associated with frequent hospitalisations which are expensive to manage and result in poor quality of life. The aim was to estimate the resource use associated with HE and hospitalisation in the UK. Methods: The Clinical Practice Research Datalink (CPRD) with linked hospital data from Health Episode Statistics (HES) was used to identify patients with a first diagnosis of liver disease between
Journal of Hepatology 2014 vol. 60 | S215–S359
significantly higher in patients with NCPH than in patients with cirrhosis (log rank test). Equally, the risk of developing a new event of portal vein thrombosis resulted higher in the NCPH patients (p = 0.001). The cumulative survival was similar (Ns).
Figure: Clinical outcomes.
Conclusions: The natural history and the incidence of many outcomes are different between patients with portal hypertension due or not due to liver cirrhosis. The management and treatment of the patients with portal hypertension not due to cirrhosis cannot be simply based on the guide-line derived by the observation of cirrhotic patients. P475 ADRENAL INSUFFICIENCY IN CRITICALLY ILL CIRRHOTIC PATIENTS: PREVALENCE, RISK FACTORS AND IMPACT ON MORTALITY H. Nair1 , H. Nandish1 , S. Shyamsundar2 , A. Menon3 , K. Mumtaz4 , K. Harishkumar3 , B. Vallath5 . 1 Centre for Liver Diseases, 2 Division of Critical Care, 3 Endocrinology, Amrita Institute of Medical Sciences, Cochin, India; 4 Transplant Hepatology, University Health Network, Toronto, ON, Canada; 5 Digestive Diseases Institute, Amrita Institute of Medical Sciences, Cochin, India E-mail: [email protected] Background and Aims: Relative Adrenal Insufficiency (RAI) frequently poses challenges to the management of critically ill cirrhotic patients. The aim of the study was to determine the prevalence and its association with etiological background of cirrhosis and functional class. Bearing of RAI on 3 month mortality was also assessed. Methods: Critically ill cirrhotics admitted in the ICU were included. Patients with sepsis as evidenced by positive blood, urine, sputum or body fluid culture and findings in CXR were excluded. Short synacthen test was done on all. Diagnosis of adrenal insufficiency was based on guidelines by the American College of Critical Care Medicine which states random total basal cortisol ≤10 mg/dl or delta cortisol ≤9 mg/dl. Statistical analysis: Apart from prevalence of RAI, Student t test, Mann–Whitney U test were used to test significance.
Journal of Hepatology 2014 vol. 60 | S215–S359
S227
POSTERS Results: More than two thirds (73.5%) had RAI. Adrenal insufficiency was found more commonly in patients with the Child C cirrhosis (74% vs 50% in Child’s A cirrhosis; p 0.48). 90% of patients with a MELD score >25 had adrenal insufficiency compared to 67% of patients with MELD <10 (p 0.37). Three month mortality occurred in 31.6% and 41.3% of those without and with RAI but this was not statistically significant (p value 0.57) Age, gender, aetiology of cirrhosis and CRP did not show association. Conclusions: Critically ill cirrhotic patients WITHOUT SEPSIS have a high prevalence of adrenal insufficiency (73%). However the adrenal insufficiency is not associated with severity of liver disease, aetiology or CRP. P476 SHORT-TERM (28-DAY) CLINICAL COURSE AND TRANSPLANT-FREE MORTALITY IN ACUTE ON CHRONIC LIVER FAILURE (ACLF); EVIDENCE FOR REVERSIBILITY OF ACLF (A STUDY FROM THE CANONIC DATABASE) T. Gustot1 , J. Fernandez2 , E. Garcia3 , P. Gines ` 2 , R. Moreau4 , R. Jalan5 , M. Pavesi3 , F. Durand4 , P. Angeli6 , P. Caraceni7 , D. Markwardt8 , C. Alessandria9 , P. Solis Munoz ˜ 10 , W. Laleman11 , J. Trebicka12 , F. Saliba13 , S. Zeuzem14 , A. Albillos15 , L. Elkrief4 , D. Benten16 , J.L. Montero17 , M.T. Chiva17 , M. Concepcion18 , J. Cordoba19 , A. McCormick20 , R.E. Stauber21 , W. Vogel22 , A. de Gottardi23 , F. Morando6 , M. Domenicali7 , A. Gerbes8 , A. Risso9 , C. Deulofeu3 , M. Bernardi7 , V. Arroyo2 , for the Investigators of the EASL CLIF Consortium. 1 Erasme University Hospital, Brussels, Belgium; 2 Liver Unit, Hospital Clinic, Institut d’Investigacions Biom`ediques August Pi i Sunyer (IDIBAPS) and Centro de Investigaci´ on Biom´edica en Red de Enfermedades Hep´ aticas y Digestivas (CIBEREHD), 3 Data Management Center of the EASL-CLIF Consortium, Barcelona, Spain; 4 Hˆ opital Beaujon, APHP, University Paris-Diderot, Clichy, France; 5 Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, United Kingdom; 6 University of Padova, Padova, 7 University of Bologna, Bologna, Italy; 8 Liver Center, University of Munich, Munich, Germany; 9 Ospedale San Giovanni Battista, University of Torino, Torino, Italy; 10 King’s College London School of Medicine at King’s College Hospital, London, United Kingdom; 11 University Hospital of Leuven, Leuven, Belgium; 12 University of Bonn, Bonn, Germany; 13 Hˆ opital Paul Brousse, Paris, France; 14 Medical Center, University of Frankfurt, Frankfurt, Germany; 15 Hospital Universitario Ram´ on y Cajal, Universidad de Alcal´ a, Madrid, Spain; 16 University of Hamburg, Hamburg, Germany; 17 Hospital Reina Sof´ıa, Cordoba, 18 Hospital Sant Pau, 19 Hospital Vall d’Hebron, Barcelona, Spain; 20 University College Hospital, Dublin, Ireland; 21 Medical University of Graz, Graz, 22 University of Innsbruck, Innsbruck, Austria; 23 University of Bern, Berne, Switzerland E-mail: [email protected] Background and Aims: The CANONIC data-base includes 388 patients with ACLF. Aim: Assess clinical course (CC) types, associated mortality and treatment futility in patients with ACLF. Methods: CC-Types: based on final ACLF-grade; no ACLF (resolution): CC-Type-A; ACLF-1: CC-Type-B; ACLF-2: CC-Type-C; ACLF-3: CC-Type-D. Changes in ACLF-grade: very rapid, 48 h, rapid, 3–7 days, or slow improvement or worsening. Results: Initial ACLF-grade improved, followed steady course or worsened in 49.2%, 30.4% and 20.4% of patients leading to CCtype-A, B, C and D in 42.5%, 18.0%, 15.2%, and 24.2%, respectively. CC-type correlated with initial ACLF-grade (i.e. ACLF resolution occurred in 54.5%, 34.6% and 16% of patients with ACLF-1, 2 and 3, respectively, and CC-Type-D in 12.2%, 25.7% and 68%). Changes in ACLF-grade were very rapid, rapid and slow in 40.2%, 14.7% and 14.7%. As expected CC-type correlated closely to 28-day/90day mortality (mortality in CC-type A to D: 5.8%/17.6%, 18.8%/39%, 41.7%/76% and 91.8/98.8%, respectively). ACLF-grade at day 7 after S228
diagnosis predicted 28-day mortality better than ACLF-grade at diagnosis (accuracy: 84.9% vs 65.2% p < 0.0001). 28-day mortality rate in patients with initial ACLF-3 and very rapid or rapid increase in number of organ failures (28%) was 100%. Conclusions: ACLF is extremely dynamic with different CC-types that correlate with prognosis. Resolution of ACLF is frequent in ACLF-1, relatively frequent in ACLF-2 and not exceptional in ACLF-3. ACLF-grade and number of organ failures at day 7 following diagnosis predict short-term mortality and treatment futility better than at diagnosis. Patients with ACLF-2 and ACLF-3 usually develop severe CC-types and should be managed in ICU. P477 VALUE-BASED OUTCOME INDICATORS IN LIVER CIRRHOSIS: VALIDATION IN A LARGE MULTICENTER STUDY (VBMH STUDY) S. Okolicsanyi1 , A. Ciaccio1 , M. Rota2 , M. Gentiluomo3 , M. Gemma2 , A. Grisolia4 , P.A. Cortesi2 , L. Scalone2 , L. Mantovani5 , P. Pontisso6 , P. Burra6 , L. Fabris6 , M. Mondelli7 , M. Colledan4 , S. Fagiuoli4 , M.G. Valsecchi2 , G. Cesana2 , L.S. Belli3 , M. Strazzabosco8,9 . 1 San Gerardo Hospital of Monza, 2 University of Milan-Bicocca, Monza, 3 Niguarda Hospital, Milan, 4 Papa Giovanni XXIII Hospital, Bergamo, 5 University Federico II of Naples, Naples, 6 University of Padua, Padua, 7 Fundation IRCCS Policlinico San Matteo, Pavia, 8 Universit` a di Milano-Bicocca, Monza, Italy; 9 Yale University, New Haven, CT, United States E-mail: [email protected] Background and Aims: Liver Cirrhosis (LC) is responsible for high morbidity, mortality and increasing costs. Aim of our study was to identify outcome indicators (OIs) able to measure quality and value of care in compensated (CC) and decompensated (DC) cirrhosis. Methods: A panel of experts identified a list of OIs using a modified Delphi method; seven of these OIs with the highest RAND/UCLA scores were then tested in a prospective multicenter observational study (Value Based Medicine in Hepatology, VBMH). During 18 months, 1751 patients with LC were enrolled (1004 CC, 747 DC). Results: Annual rate of decompensation (OI#1), annual incidence of first variceal bleeding (OI#2) and annual incidence of HCC (OI#3) in CC were 12%, 2% for low- and 3% for high-risk varices, and 4.3% (81% diagnosed in BCLC-A stage) respectively. One-year survival for CPT score A, B, C was 96%, 81% and 59% (OI#4) respectively, and 94%, 56% when stratified for MELD cut-off of 15 (OI#5). Among DC patients, 4% of them had an episode of variceal bleeding (6 weeks survival 90%, 32% recurrence) (OI#6), 3% had spontaneous bacterial peritonitis (6 weeks survival 86%, 13% recurrence) (OI#7). Conclusions: The seven outcome indicators identified in our study performed well when tested in a large cohort of patients and represent a reference tool to implement a value-based approach to liver diseases. P478 RESOURCE USE ASSOCIATED WITH HEPATIC ENCEPHALOPATHY IN PATIENTS WITH LIVER DISEASE J.G. Orr1 , C.L. Morgan2 , S. Jenkins-Jones2 , M. Hudson1 , P. Conway3 , A. Radwan4 , C.J. Currie5 . 1 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, 2 Pharmatelligence, Cardiff, 3 Norgine Global Health Outcomes, Norgine Ltd, 4 Norgine UK, Uxbridge, 5 School of Medicine, Cardiff University, Cardiff, United Kingdom E-mail: [email protected] Background and Aims: Overt hepatic encephalopathy (HE) is associated with frequent hospitalisations which are expensive to manage and result in poor quality of life. The aim was to estimate the resource use associated with HE and hospitalisation in the UK. Methods: The Clinical Practice Research Datalink (CPRD) with linked hospital data from Health Episode Statistics (HES) was used to identify patients with a first diagnosis of liver disease between
Journal of Hepatology 2014 vol. 60 | S215–S359