Prospective Analysis of Early Hospital Readmissions in Patients with Decompensated Cirrhosis and its Impact on Mortality

POSTER PRESENTATIONS 33). MAP decreased progressively from PS1 to PS5 while CI increased progressively from PS1-to PS4 but decreased in PS5 (Figure A). MELD and HVPG increased progressively from PS1 to PS5 (Figure B). Oneyear mortality was minimal in compensated patients (4 deaths, 2.7%) while it was 28% in decompensated patients. In a Cox regression model including age, CI, LVD, MAP, MELD, HVPG, serum albumin, cardiovascular comorbidities, and ongoing treatment with diuretics or beta-blockers, only CI <3.2 L/min/m2 (HR 0.2; 0.1–0.5), LVD (HR 3.5; 1.1–12.0) and MELD > 12 (HR 4.7; 1.3–16.4) were significant independent predictors of death in decompensated cirrhosis. Conclusions: Systemic hemodynamic alterations occur as early as PS2 (compensated cirrhosis with HVPG ≥10, no varices) and, in decompensated patients, a relative decrease in CI and the presence of LVD are, together with MELD, the most important predictors of oneyear mortality. THU-348 PROSPECTIVE ANALYSIS OF EARLY HOSPITAL READMISSIONS IN PATIENTS WITH DECOMPENSATED CIRRHOSIS AND ITS IMPACT ON MORTALITY L. Franco1, J. Ferrusquía1, S. Antón2, A. Ríos2, C.A. Navascués1, J. de la Vega2, L. Gonzalez-Dieguez1, M. Varela1, V. Cadahía1, M. Rodriguez1. 1 Liver Unit, Hospital Universitario Central de Asturias, Oviedo; 2 Gastroenterology Department, Hospital San Agustin, Avilés, Spain E-mail: [email protected] Background and Aims: Early hospital readmissions in patients with decompensated cirrhosis are frequent, increase health care cost and some of them might be potentially avoidable. Nevertheless, their role as a prognostic factor in medium and long-term mortality is unknown. Aims: To assess the influence on mortality of early hospital readmissions, defined as those occurring within 30 days of discharge, in a cohort of patients who have had an index hospital admission for decompensated cirrhosis. Methods: We included 254 patients with decompensated liver cirrhosis who were discharged between Oct/12 and Sep/14. Patients were followed up after discharge for one year. The influence of eight different variables on 1-year survival following discharge was analysed. Results: 76% of patients were men and the mean age was 62.8 ± 11.8 years old. The most common aetiologies of liver cirrhosis were alcohol-related liver disease (74%) and HCV infection (13%). The most common causes of admission were ascites (29%) and variceal bleeding (22%). 59 (23%) patients were readmitted within 30 days of discharge, and 80 (31.5%) died in the first year after discharge. The estimated cumulative 12-months survival probability was significantly higher in patients who were not readmitted than in patients who were (72.5% vs. 30.5%; p < 0.001). Other variables associated with lower survival in the univariate analysis were: Age >60 years ( p = 0.01), HCV as the aetiology of the cirrhosis ( p = 0.03), Child-Pugh score at discharge >8 ( p < 0.001), MELD score at discharge >17 ( p < 0.001) and Charlson comorbidity index at discharge >6 ( p < 0.001). The gender and the cause of the index admission were not correlated with survival ( p = 0.67 y p = 0.09 respectively). In the multivariate analysis, the variables associated with lower survival were: Early hospital readmissions (OR 3.88; ICc 95%:2.39–6.32; p < 0.001), MELD score at discharge >17 (OR 2.88; IC 95%:1.74–4,76; p < 0.001),\ Charlson comorbidity index at discharge >6 (OR 2.21; IC 95%:1.22–3.99; p = 0.009), HCV as the cause of cirrhosis (OR 2.10; IC 95%: 1.13–3.92; p = 0.019) and age >60 years (OR 1.69; IC95%:1.002– 2.85; p = 0.04). Conclusions: Early readmissions in patients with decompensated cirrhosis are frequent and are associated with a higher mortality independently of other factors known to be related to a poorer outcome. Different strategies and health care programs should be implemented in high risk cirrhotic patients in order to prevent early hospital readmissions.

THU-349 HBV ASSOCIATED CIRRHOTIC PATIENTS MEETING APASL ACUTEON-CHRONIC LIVER FAILURE CRITERIA HAVE HETEROGENEOUS OUTCOME AND SHORT TERM SURVIVAL RATE H. Li1, L.-Y. Chen1, Q. Xie2, N.-N. Zhang1, S. Yin1, S.-J. Wang1. 1 Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; 2Department of Infectious Disease, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China E-mail: [email protected] Background and Aims: Multiple organ failure (MOF) and submassive hepatic necrosis (SMHN) and are clinical and pathological characteristics separately for HBV associated acute-on-chronic liver failure (ACLF) patients. However, if APASL diagnostic criteria (TB > 5 mg/dL, INR > 1.5) could accurately distinguish ACLF patients from HBV associated cirrhotic patients with acute decompensation (AD) is still controversy. The aim of the current study is to identify whether APASL criteria recruited HBV associated cirrhotic patients belong to a homogenous cohort or not. Methods: 1511 consecutive hospitalized HBV associated cirrhotic patients with AD from two medical centers between 2005 and 2010 in Shanghai, China were included. Among them 280 (19%) patients underwent liver transplantation (LT). MOF (meeting any of ACLF grade I, II or III according to CLIF-OFs), short-term mortality and LT patients’ pathological feature were used to evaluate the population.

Results: According to APASL criteria for ACLF, 37.5% (567/1511) patients met at enrollment and 5.2% (78/1511) developed to meet it within 28-days. Among all above 645 patients, 67.3% (434/645) had MOF at admission or developed within 28-days. However, 32.7% (211/ 645) patients had not suffered MOF within 28-days after enrollment. The 28 and 90-day mortality of APASL MOF patients were 36.4% and 45.9% respectively. APASL non-MOF patients had a 28 and 90-day mortality of 3.8% and 8% respectively ( p < 0.001 vs APASL MOF). APASL patients with MOF displayed more accelerated deterioration of

Journal of Hepatology 2016 vol. 64 | S213–S424

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