- Email: [email protected]
P523 SAFETY AND EFFICACY OF AN AUTOMATED LOW FLOW ASCITES (ALFA) PUMP IN CIRRHOTIC PATIENTS WITH REFRACTORY ASCITES
POSTERS LEV predicted by algorithm correlated weakly with endoscopyassessed LEV (r = 0.296; p = 0.0001) showing, however, an average absolute interclass agreement (ICC=0.494; p = 0.0001). Conclusions: The above stepwise algorithm, combining LSM, Lok Score and extended (up to 150 kPa) SSM might represent a promising noninvasive method for LEV diagnosis in cirrhotic patients, but needs further validation.
Figure 1.
P522 TOTAL SERUM BILE ACIDS IN PATIENTS WITH HEPATOPULMONARY SYNDROME 1 T. Horvatits1 , A. Drolz1 , C. Muller ¨ , G. Fauler2 , P. Schenk1 , M. Trauner1 , V. Fuhrmann1 . 1 Dep. Internal Medicine, Div. of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, 2 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria E-mail: [email protected] Background and Aims: Hepatopulmonary syndrome (HPS) occurs in 20–30% of patients with liver cirrhosis and is associated with a >2fold increased mortality. Retention and accumulation of bile acids play a major role in damage of the liver. Common bile duct ligation (CBDL), the only available experimental model for HPS, is characterized by bile acid retention with hepatic inflammation, cholestatic hepatic injury and biliary cirrhosis. Therefore we aimed to evaluate the role of serum total bile acids (TBA) in patients with HPS. Methods: 72 patients (m/f: 57/15) with liver cirrhosis were included in this prospective study. TBA were analysed in all patients that were screened for HPS according established criteria (presence of cirrhosis, AaPO2 ≥15 mmHg & PaO2 <80 mmHg, intrapulmonary vasodilatation in contrast enhanced echocardiography). Results: Criteria of HPS were fulfilled in 12 patients (21%). TBA levels were significantly higher in patients with HPS compared to patients without HPS (median;IQR: 74;39–161 mmol/l vs. 25;12–64 mmol/l, p < 0.05). AUROC of TBA for detection of HPS was 0.79. At a cut-off of TBA ≥35 mmol/l sensitivity was 91.7%, specificity 58.3%, positive predictive value 30.6% and negative predictive value 97.2%. TBA were significantly associated with HPS (OR: 1.012, 95% CI: 1.003–1.022, p < 0.05) and remained significantly associated with S244
HPS after correction for sex, age, MELD score and bilirubin (OR: 1.013, 95% CI: 1.001–1.025, p < 0.05). Conclusions: TBA predicted presence of HPS, independently of severity of cirrhosis. Using a cut-off level of TBA ≥35 mmol/l may help to identify HPS in patients with cirrhosis. P523 SAFETY AND EFFICACY OF AN AUTOMATED LOW FLOW ASCITES (ALFA) PUMP IN CIRRHOTIC PATIENTS WITH REFRACTORY ASCITES A. De Gottardi1,2 , V. Banz3 , F. Storni3 , G. Stirnimann1,2 , N. Semmo1,2 , C. Engelmann4 , A.-C. Piguet2 , S. Whittaker5 , F. Lammert6 , T. Berg4 , S. Zeuzem7 , J. Cordoba8 , J.-F. Dufour1,2 . 1 Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, 2 Hepatology, Department of Clinical Research, University of Bern, 3 Surgery, University Clinic of Visceral Surgery and Medicine, Inselspital, Berne, Switzerland; 4 Hepatology, Universit¨ atsklinikum, Leipzig, Leipzig, Germany; 5 Sequana Medical, Zurich, Switzerland; 6 Gastroenterology, Universit¨ atsklinikum des Saarlandes, HomburgSaar, 7 Gastroenterology, Universit¨ atsklinikum Frankfurt, Frankfurt, Germany; 8 Gastroenterology, Hospital Vall d’Hebron, Barcelona, Spain E-mail: [email protected] Background and Aims: Treatment of refractory ascites includes large volume paracentesis (LVP) or transjugular intrahepatic portosystemic shunt. Transporting ascites from the peritoneal cavity into the urinary bladder could avoid the complications of these treatments. We assess here performance and safety of the automated low flow ascites pump following the initial safety trial (Pioneer study). Methods: All 25 patients of this study received long-term prophylactic antibiotic treatment with fluoroquinolones. Albumin administration proportional to the volume of ascites removed was not employed. Results: Mean age was 62 years (range 51–74, men 84%), mean Child–Pugh score 8.8 and mean MELD score 13. Cirrhosis was due to alcohol (84%), HCV (12%) or NASH (4%). During a mean follow up of 149 days (range 35–558), 8 patients died (32%) and 3 underwent liver transplantation (12%). The number of LVP decreased from 2.9±2.2 to 0.3±0.4 per month (p < 0.0001) and the mean ascites volume/LVP decreased from 7.1±2.1 to 4.7±2.5 litres/LVP (p = 0.017). The mean ascites volume increased from 0.62 to 0.98 litres/day (p = 0.015) likely due to a relaxation of dietary sodium restriction. Mean serum albumin was unchanged at 28±6 g/L compared to 29±6 g/L pre-implant (p = 0.2). Creatinine showed a small increase from 118±49 to 150±88 mM (p = 0.15). Complications included migration/occlusion of the peritoneal catheter (n = 4), pump pocket infections (n = 3), pump dysfunction (n = 1), or wound dehiscence (n = 1). Conclusions: A significant decrease in the need for LVP was achieved without relevant changes of serum albumin or renal function. Complications occurred rarely, but included catheter occlusions and infections of the pump pocket. P524 COMPARISON OF DIFFERENT MODELS IN PREDICTING CLINICALLY SIGNIFICANT PORTAL HYPERTENSION INCLUDING ELF-SCORE AND vWF-Ag A. Maieron1 , S. Hametner1 , M. Ferlitsch2 , A. Etschmaier2 , R. Schoefl1 , A. Ziachehabi1 , D. Trubert-Exinger3 , A. Ferlitsch2 . 1 Gastroenterology & Hepatology, Kh D. Elisabethinen, Linz, 2 Medical University of Vienna Department of Gastroenterology & Hepatology, Vienna, 3 Institute for Laboratory Medicine, LKH St. P¨ olten, St. P¨ olten, Austria E-mail: [email protected] Background and Aims: Clinically significant portal hypertension (CSPH), defined by HVPG ≥ 10 mm/Hg causes major complications.
Journal of Hepatology 2014 vol. 60 | S215–S359
Figure 1.
P522 TOTAL SERUM BILE ACIDS IN PATIENTS WITH HEPATOPULMONARY SYNDROME 1 T. Horvatits1 , A. Drolz1 , C. Muller ¨ , G. Fauler2 , P. Schenk1 , M. Trauner1 , V. Fuhrmann1 . 1 Dep. Internal Medicine, Div. of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, 2 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria E-mail: [email protected] Background and Aims: Hepatopulmonary syndrome (HPS) occurs in 20–30% of patients with liver cirrhosis and is associated with a >2fold increased mortality. Retention and accumulation of bile acids play a major role in damage of the liver. Common bile duct ligation (CBDL), the only available experimental model for HPS, is characterized by bile acid retention with hepatic inflammation, cholestatic hepatic injury and biliary cirrhosis. Therefore we aimed to evaluate the role of serum total bile acids (TBA) in patients with HPS. Methods: 72 patients (m/f: 57/15) with liver cirrhosis were included in this prospective study. TBA were analysed in all patients that were screened for HPS according established criteria (presence of cirrhosis, AaPO2 ≥15 mmHg & PaO2 <80 mmHg, intrapulmonary vasodilatation in contrast enhanced echocardiography). Results: Criteria of HPS were fulfilled in 12 patients (21%). TBA levels were significantly higher in patients with HPS compared to patients without HPS (median;IQR: 74;39–161 mmol/l vs. 25;12–64 mmol/l, p < 0.05). AUROC of TBA for detection of HPS was 0.79. At a cut-off of TBA ≥35 mmol/l sensitivity was 91.7%, specificity 58.3%, positive predictive value 30.6% and negative predictive value 97.2%. TBA were significantly associated with HPS (OR: 1.012, 95% CI: 1.003–1.022, p < 0.05) and remained significantly associated with S244
HPS after correction for sex, age, MELD score and bilirubin (OR: 1.013, 95% CI: 1.001–1.025, p < 0.05). Conclusions: TBA predicted presence of HPS, independently of severity of cirrhosis. Using a cut-off level of TBA ≥35 mmol/l may help to identify HPS in patients with cirrhosis. P523 SAFETY AND EFFICACY OF AN AUTOMATED LOW FLOW ASCITES (ALFA) PUMP IN CIRRHOTIC PATIENTS WITH REFRACTORY ASCITES A. De Gottardi1,2 , V. Banz3 , F. Storni3 , G. Stirnimann1,2 , N. Semmo1,2 , C. Engelmann4 , A.-C. Piguet2 , S. Whittaker5 , F. Lammert6 , T. Berg4 , S. Zeuzem7 , J. Cordoba8 , J.-F. Dufour1,2 . 1 Hepatology, University Clinic of Visceral Surgery and Medicine, Inselspital, 2 Hepatology, Department of Clinical Research, University of Bern, 3 Surgery, University Clinic of Visceral Surgery and Medicine, Inselspital, Berne, Switzerland; 4 Hepatology, Universit¨ atsklinikum, Leipzig, Leipzig, Germany; 5 Sequana Medical, Zurich, Switzerland; 6 Gastroenterology, Universit¨ atsklinikum des Saarlandes, HomburgSaar, 7 Gastroenterology, Universit¨ atsklinikum Frankfurt, Frankfurt, Germany; 8 Gastroenterology, Hospital Vall d’Hebron, Barcelona, Spain E-mail: [email protected] Background and Aims: Treatment of refractory ascites includes large volume paracentesis (LVP) or transjugular intrahepatic portosystemic shunt. Transporting ascites from the peritoneal cavity into the urinary bladder could avoid the complications of these treatments. We assess here performance and safety of the automated low flow ascites pump following the initial safety trial (Pioneer study). Methods: All 25 patients of this study received long-term prophylactic antibiotic treatment with fluoroquinolones. Albumin administration proportional to the volume of ascites removed was not employed. Results: Mean age was 62 years (range 51–74, men 84%), mean Child–Pugh score 8.8 and mean MELD score 13. Cirrhosis was due to alcohol (84%), HCV (12%) or NASH (4%). During a mean follow up of 149 days (range 35–558), 8 patients died (32%) and 3 underwent liver transplantation (12%). The number of LVP decreased from 2.9±2.2 to 0.3±0.4 per month (p < 0.0001) and the mean ascites volume/LVP decreased from 7.1±2.1 to 4.7±2.5 litres/LVP (p = 0.017). The mean ascites volume increased from 0.62 to 0.98 litres/day (p = 0.015) likely due to a relaxation of dietary sodium restriction. Mean serum albumin was unchanged at 28±6 g/L compared to 29±6 g/L pre-implant (p = 0.2). Creatinine showed a small increase from 118±49 to 150±88 mM (p = 0.15). Complications included migration/occlusion of the peritoneal catheter (n = 4), pump pocket infections (n = 3), pump dysfunction (n = 1), or wound dehiscence (n = 1). Conclusions: A significant decrease in the need for LVP was achieved without relevant changes of serum albumin or renal function. Complications occurred rarely, but included catheter occlusions and infections of the pump pocket. P524 COMPARISON OF DIFFERENT MODELS IN PREDICTING CLINICALLY SIGNIFICANT PORTAL HYPERTENSION INCLUDING ELF-SCORE AND vWF-Ag A. Maieron1 , S. Hametner1 , M. Ferlitsch2 , A. Etschmaier2 , R. Schoefl1 , A. Ziachehabi1 , D. Trubert-Exinger3 , A. Ferlitsch2 . 1 Gastroenterology & Hepatology, Kh D. Elisabethinen, Linz, 2 Medical University of Vienna Department of Gastroenterology & Hepatology, Vienna, 3 Institute for Laboratory Medicine, LKH St. P¨ olten, St. P¨ olten, Austria E-mail: [email protected] Background and Aims: Clinically significant portal hypertension (CSPH), defined by HVPG ≥ 10 mm/Hg causes major complications.
Journal of Hepatology 2014 vol. 60 | S215–S359