P538 ADHERENCE TO QUALITY OF CARE INDICATORS FOR CIRRHOSIS RELATED ASCITES IS ASSOCIATED WITH IMPROVED PATIENT OUTCOMES

POSTERS quantified the relationship between liver size and survival but is hampered by subjectivity. The current study aimed to improve the existing model. Methods: A retrospective-prospective cohort study was performed on patients with cirrhosis. The censor point used was date of patient death or liver transplant (LT) from CT date. Time points were measured from the date of the CT scan to censor point or last clinic appointment. The enhanced Liverpool to Abdomen Area Ratio (eLAAR) was derived using a software package (Carestream). eLAAR was calculated using the formula (Liver area [cm2 ]/ Abdominal area [cm2 ]) × 100. Results: 101 patients were identified, 66% male, median age 52 (44–60 years). The LAAR score detected progression to death/LT in our cohort at 1 year (p = 0.02) and at 5 years (p = 0.03). The intraclass correlation coefficient between 2 operators was 0.94 (95% CI 0.89–0.97). Using an optimal eLAAR cut-off of 32, eLAAR could predict death at 1 and 5 years from diagnosis, p = 0.03 [OR 2.51 (1.08–2.51)] and p = 0.002 (R 3.98, 95% CI 1.5–10.4). Survival curves were constructed and the log rank test showed that eLAAR was able to predict death at 1 year (Log rank 5.3, p = 0.02) and 5 years (Log-rank 9.7, p = 0.002). Conclusions: The eLAAR score offers a new paradigm to identify patients with poor prognostic criteria on cross-sectional imaging who may benefit from liver transplantation. P538 ADHERENCE TO QUALITY OF CARE INDICATORS FOR CIRRHOSIS RELATED ASCITES IS ASSOCIATED WITH IMPROVED PATIENT OUTCOMES S. Le1 , T. Spelman2 , N. Heerasing3 , C.P. Chong4 , J. Lim5 , T. He5 , L. Sahhar5 , P. Ha5 , W. Sievert6 . 1 Gastroenterology and Hepatology, Monash Health, Monash University, 2 Burnet Institute, Melbourne, 3 Gastroenterology and Hepatology, Geelong Hospital, Geelong, 4 General Medicine, Monash Health, Monash University, 5 Monash University, 6 Monash Health, Monash University, Melbourne, VIC, Australia E-mail: [email protected] Background and Aims: Cirrhotic ascites is associated with significant morbidity and reduced health-related quality of life. We evaluated whether adherence to quality indicators (QI) of care for ascites affected readmission rates and mortality. Methods: 302 cirrhotic patients were admitted for new onset ascites between 2000 and 2012. Patient histories were interrogated for demographic and clinical data plus adherence to each of the eight Delphi panel-derived QIs for ascites management. The association between adherence to each QI and 30-day readmission and 90-day mortality were compared on multivariate Poisson and logistic regression analysis. Results: Median admission MELD score was 14 (IQR 11–19). 71% of patients were readmitted within 90 days and 41% within 30 days of index admission. The risk of 30-day cirrhosis related readmission reduced significantly if an abdominal paracentesis occurred within 30 days of ascites diagnosis (QI 1: Incidence Rate Ratio (IRR): 0.409, P = 0.004, 95% CI: 0.224–0.747) or during index hospitalization (QI 2: IRR: 0.567, P = 0.006, 95% CI: 0.379–0.850). Baseline serum bilirubin >25 mmol/L increased the risk of 30-day cirrhosis-related readmission (IRR: 1.508, P = 0.033, 95% CI 1.034–2.199). 18.5% of patients died within 90 days of index admission (median interval to death was 139 days; IQR: 37–562 days). Older age (OR: 1.03, P = 0.029) and MELD-Na (OR: 1.06, P = 0.05) independently predicted 90-day mortality. Discharge diuretic prescription (QI 8: OR: 0.28, P = 0.014) was independently associated with a 72% reduction in 90-day mortality. Conclusions: Early paracentesis in new onset cirrhotic ascites lowers 30-day readmission rates. Early initiation of diuretic therapy

lowers 90-day mortality. Adherence to these QIs should be prioritized in the management of cirrhotic ascites. P539 EFFICACY OF RIFAMIXIN-A ALONE COMPARED TO RIFAMIXIN-A AND AN INULIN-TYPE PREBIOTIC IN LIVER ENCEPHALOPATHY L. Toma, E.L. Iliescu, C. Orban, A. Tanase. Fundeni Clinical Institute, Bucharest, Romania E-mail: [email protected] Background and Aims: Liver encephalopathy is a frequent complication of liver failure with an important impact on quality of life. We aim to compare the efficacy of Rifamixin-a alone and Rifamixin-a and an inulin-type prebiotic (ITP) in down staging liver encephalopathy and reducing the number and length of hospital admissions. Methods: We performed a prospective study on 206 patients with cirrhosis and liver encephalopathy. 106 patients were given 1200 mg/day Rifamixin-a and 100 patients were given 1200 mg Rifamixin-a and 10 g/day of ITP for 90 days. We compared the patients’ results in psychometric tests, EEG expression of liver encephalopathy and the serum levels of ammonia. Results: 61% of the patients included in the study were male, the mean age was 55.4 years (25–75), MELD scores were under 25 and the venous ammonia level over 50 mmol/l. 62% of the patients had significant cognitive alterations. Combined therapy lead to a faster, more important lowering in the ammonia levels that Rifaximin-a alone (p value <0.02) and an improvement in EEG waves. Also, patients’ results in the number connection, line tracing, serial dotting and digit symbol tests improved in the combined therapy group (p value <0.001). Both the mean hospital stay and the frequency of admission were approximately 2 times lower in the combined therapy group. Conclusions: Rifamixin-a and ITP have better results than Rifamixin-a alone in the management of liver encephalopathy in cirrhosis. One must also take into account the subsequent cost reduction for hospitalisation in patients with this chronic and resource-consumpting disease. P540 HEMODYNAMIC CHANGES IN CIRRHOTIC PATIENTS FOLLOWING TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) INSERTION: A MATCHED ANALYSIS K.A. Forde1 , R.C. McLean2 , M. Rivera3 , O. Tanapanpanit1 , M. Soulen4 , K.R. Reddy1 . 1 Gastroenterology, 2 Cardiology, University of Pennsylvania, Philadelphia, PA, 3 Wesleyan University, Middletown, CT, 4 Radiology, University of Pennsylvania, Philadelphia, PA, United States E-mail: [email protected] Background and Aims: Cirrhotic cardiomyopathy, characterized by preserved left ventricular systolic function, diastolic dysfunction, and arrhythmias, may be unmasked by a physiologic stressor such as insertion of a transjugular intrahepatic portosystemic shunt (TIPS). Such physiologic changes may affect liver transplant (LT) candidacy. We sought to characterize the hemodynamic changes associated with TIPS. Methods: Patients in our retrospective cohort study undergoing TIPS insertion were matched for age, gender, etiology of liver disease and model of end stage liver disease score with patients who were evaluated for LT. Demographics, comorbidities, laboratory data and cardiac parameters were compared. Results: Between January 2001 and December 2012, 168 patients with cirrhosis who underwent TIPS placement (Group A) were matched to 168 cirrhotic patients not undergoing TIPS placement (Group B). In Group A, the indications for TIPS placement included portal hypertensive bleeding (41.7%), refractory ascites (56.0%), and hydrothorax (9.8%). Prior to TIPS, median hepatic venous pressure

Journal of Hepatology 2014 vol. 60 | S215–S359

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