- Email: [email protected]
AST Ratio and Total Protein Level Identify the Autoimmune Etiology in Patients with Fulminant Hepatitis
POSTER PRESENTATIONS FRI-352 EVALUATION AND PREDICTORS OF MORTALITY IN PATIENTS WITH LIVER ABSCESS. AN ANALYSIS OF 943 CONSECUTIVE PATIENTS A. Jindal1, A. Kumar1, S.K. Sarin1. 1Department of Hepatology, ILBS, New Delhi, India E-mail: [email protected] Background and Aims: Liver abscess (LA) is the most common inflammatory space occupying liver lesion with a highly variable presentation and if left inadequately treated, complicated LA has high morbidity and mortality. Methods: Retrospective analysis of a prospective cohort of 943 LA patients at ILBS (2009–2015) were analysed for baseline clinical/lab parameters, abscess characteristics (number, size and location), local and systemic complications, Interventions (aspiration, PCD and surgery) and predictors of mortality. Results: Among 943 patients (mean age-47.40 ± 15.66 years, M:F6.2:1), main etiologies of LA were amoebic (ALA) (80.8%), pyogenic (PLA) (6.2%), malignant (1.5%) and eosinophilic LA (0.9%) and most frequent presentation(s) was abdominal pain (83.6%), fever (82.1%) and jaundice (9.1%) (Symptom duration-12(7–20) days) 28.8% had concomitant alcoholism, 45.8% were diabetic. Right lobe (84.4%), subcapsular (63%) and multiple (57.6%) LA were common [mean diameter 6.59 ± 2.65 cm]. Patients with ALA had more frequent fever, abdominal pain and alcoholism while PLA had more jaundice and prolonged hospitalization. 32 patients (3.4%) had cirrhosis and had high mortality (HR: 20.2). 602 patients (71.2%) required intervention [single time aspiration (SA) alone10.4%, SA + PCD (42.6%), multiple aspirations (MA) + PCD-13.5%, PCD alone- 2.3%, surgery-0.6%]. Main indications for intervention were large (>5 cm) abscess, left lobe abscess, subcapsular location or abscess complicated by rupture. 26(3.1%) had ERCP (biliary rupture-16 or cholangitic abscess-10). Median duration of hospitalization was 8(5–12) days and PCD was 5(3–8) days. Overall in-hospital mortality was 1.18%. Presence of septic encephalopathy (HR: 29.2) and AKI (S.cr >2 mg/dL) (HR: 5.4) were independent predictors of mortality. Conclusions: Liver abscess should be carefully assessed especially in cirrhotics and in presence of systemic complications such as encephalopathy and acute kidney injury. Besides antibiotics, most patients require intervention with aspiration and percutaneous drainage. FRI-353 BEZAFIBRATE ALLEVIATES PRURITUS AND DECREASES SPECIFIC CIRCULATING METABOLITES IN PATIENTS WITH PRIMARY BILIARY CHOLANGITIS A. Reig1, M. Pérez-Cormenzana1, P. Sesé1, R. Mayo1, A. Castro1, A. Pares1. 1Liver Unit, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain E-mail: [email protected] Background and Aims: Pruritus is a common and distressing symptom in patients with primary biliary cholangitis (PBC), and when uncontrollable it is an indication for liver transplantation. Recent observations have reported that fibrates may improve cholestatic itching, although no specific studies have been carried out. Therefore, we have assessed the effects of fibrates on pruritus and the changes in the metabolomic profiling in patients PBC. Methods: 46 PBC patients (43 females, age 54.3 ± 1.5 years) with suboptimal biochemical response to UDCA were treated with bezafibrate (400 mg/d). Apart from clinical and biochemical changes, pruritus severity was assessed by a specific questionnaires (PBC-40 and pruritus score) and with a visual analogue scale (VAS) (form 0 to 10), at baseline and after a mean of 29 ± 4 months. Moreover in 14 patients with pruritus, samples were obtained before, during and after bezafibrate discontinuation for metabolic profiling using 3 different UPLC-MS analytical platforms.
Results: Twenty-seven patients (58.7%) experienced pruritus. Bezafibrate therapy resulted in a significant alleviation of pruritus (VAS from 4.4 ± 0.5 to 0.8 ± 0.2, < 0.001). Itch disappeared completely or partly in 17 and 7 patients, respectively. No marked changes in pruritus were reported by three patients (11%). Bezafibrate discontinuation in patients who have no pruritus or minimum pruritus under therapy, resulted in an increase or recurrence of pruritus (within 19–120 days) in all cases (mean VAS from 0.8 ± 0.3 to 5.7 ± 0.6, p < 0.001). In these patients, itching decreased or disappeared again after resuming bezafibrate therapy. Thirty-eight metabolites decreased significantly after treatment, particularly phosphatidylcholines (PC) PC(18:3/18:3), PC(18:0/20:4), PC(38:5), PC(16:0/22:6), PC(14:0/20:4), TG(56:5), and PC(15:0/22:6). The omega 6 arachidonic acid, 20:4n-6, several PC with the 20:4 fatty acyl chain esterified to them together with ChoE (20:4) were in lesser amount in the samples from patients treated with bezafibrate. Twenty-two of these metabolites increased again after bezafibrate discontinuation, mainly PC and lysophosphatidylcholines ( p < 0.001) and androsterone sulfate and related isomers ( p < 0.02). Conclusions: Bezafibrate therapy is associated with a clear relief of pruritus in patients with primary biliary cholangitis, presumably resulting from a decrease of certain circulating metabolites especially phosphatidylcholines and some sterols. FRI-354 THE ALT/AST RATIO AND TOTAL PROTEIN LEVEL IDENTIFY THE AUTOIMMUNE ETIOLOGY IN PATIENTS WITH FULMINANT HEPATITIS A. Reig1, V. Prado1, H. Uchima1, A. Mas1, A. Parés1. 1Liver Unit, Hospital Clínic, IDIBAPS; CIBERehd, University of Barcelona, Barcelona, Spain E-mail: [email protected] Background and Aims: The incidence of autoimmune hepatitis has increased in recent years, but the clinical features and course of the fulminant presentation (FAIH) is not well established. Moreover, the diagnosis of this presentation may be complex and delayed by the lack of early complete analytical and histologic procedures. This is critical for therapy and consequently prognosis and survival. Therefore, we have assessed the differential features of FAIH as compared with other etiologies of fulminant hepatitis. Methods: 77 patients (58% women; age 41 ± 2 years old) diagnosed with acute liver failure (fulminant hepatitis) between 2003 and 2013. Patients were divided according to the etiology into viral, toxic, autoimmune and miscellaneous (Wilson, associated with pregnancy, ischemic and idiopathic) etiologies. Clinical, biochemical, immunological and histological features were assessed, as well as the incidence of each etiology among three periods of similar duration. Results: 17 patients (22%) had FAIH, while toxic, viral and miscellaneous etiologies were diagnosed in 36%, 23%, and 17% of patients, respectively. The incidence of FAIH increased over the three time periods being 16%, 20% and 33% respectively. Age and female gender were similar in all etiologies except for those of viral origin (25% women, p = 0.02; age 36 ± 3 years, p < 0.05). The clinical features were comparable in all different etiologies, but the duration between the first sign of liver disease and the diagnosis of fulminant hepatitis was longer in FHAI (48 ± 16 vs 17.2 ± 7.4 days, p < 0.01). Moreover, AST/ALT ratio over 1 (OR: 5.17, 95% CI 1.6–16.8, p < 0.01) and total protein levels ≥50 g/L (OR: 6.1, 95% CI 1.6–23.5, p < 0.002) were mainly observed in patients with FAIH as compared with the other etiologies, while no significant changes were found in other liver biochemistries. The combination of these two variables (AST/ALT ratio and total protein concentration) were associated with the autoimmune etiology (OR: 12.9, 95% CI 3.6–46.4, p = 0.001). The outcome was similar among all etiologies except for FAIH patients who had better early survival (76%) although most of them (70%) were transplanted.
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POSTER PRESENTATIONS Conclusions: Autoimmune etiology is frequently observed in patients with fulminant hepatitis with increasing incidence. A new and simple biochemical index identifies patients with the autoimmune condition, and it may be useful for early treatment. FRI-364 COLONIZATION OF GERM-FREE MICE WITH A HUMAN MICROBIOTA INDUCES FXR SIGNALING A. Wahlström1, P. Kovatcheva-Datchary1, M. Ståhlman1, H.-U. Marschall1, F. Bäckhed1,2. 1Department of Molecular and Clinical Medicine, Sahlgrenska University Hostpital, Gothenburg University, Gothenburg, Sweden; 2Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Receptology and Enteroendocrinology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark E-mail: [email protected] Background and Aims: The gut microbiota influences the development and progression of metabolic diseases, partly by metabolism of bile acids and modified signaling through the farnesoid X receptor (FXR). Mice that are colonized with a human microbiota can be used to study the effect of human bacteria on metabolic functions, and in this study we aim to determine how the human gut microbiota metabolizes murine bile acids and affects FXR signaling in colonized mice. Methods: We colonized germ-free mice with fresh caecal content from a mouse donor or pre-frozen or fresh faeces from a human donor. We analyzed the gut microbiota and bile acid composition and expression of FXR target genes in ileum and liver. Results: Caecal microbiota composition differed between mice colonized with mouse and human microbiota and the freezing process also affected microbiota composition in the humanized mice. Human and mouse microbiota reduced total bile acid levels similarly but the humanized mice produced less secondary bile acids. The human microbiota was able to induce expression of FXR target genes Fgf15 and Shp in ileum and reduce expression of Cyp7a1 in the liver. Colonization with frozen human faeces resulted in higher ratio between FXR agonistic and FXR antagonistic bile acids and higher expression of the FXR target genes compared with fresh human faeces. Conclusions: We show that a human microbiota can change bile acid composition and induce FXR signaling in colonized mice, but the levels of secondary bile acids produced are lower than in mice colonized with a mouse microbiota. FRI-365 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY INDUCED CHOLANGITIS: CLINICAL CHARACTERISTICS, SEVERITY INDICATORS AND PROGNOSIS A. Peixoto1, M. Silva1, J. Santos-Antunes1, E. Rodrigues-Pinto1, P. Pereira1, G. Macedo1. 1Gastroenterology, Centro Hospitalar De São João, Porto, Portugal E-mail: [email protected] Background and Aims: Cholangitis does not often occur after endoscopic retrograde cholangiopancreatography (ERCP), but it can be a serious complication of this procedure. However, its clinical features, management and outcomes are poorly characterized in the literature. We aim to evaluate clinical features, treatment, evolution and outcomes of cases of post-ERCP cholangitis in a tertiary referral center. Methods: Retrospective analysis of cases of ERCP induced cholangitis diagnosed between January 2013 and December 2014. Results: From a total of 487 ERCP performed in two years, 24 patients developed cholangitis after the procedure (4.9%). The majority of patients were female (n = 13, 54%), with a median age of 60 years-old. The diagnosis was made after a median period of two days, with a mortality of 29.2% (n = 7). The median days of hospitalization was
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7 days, being the majority of patients from the outpatient clinic (n = 17, 70.8%). 42% of patients had already undergone ERCP with sphincterotomy and 30% were under antibiotic therapy or had received antibiotics in the previous three months. The main reasons for the procedure were choledocholitiasis (n = 9, 37.5%), obstructive jaundice (n = 7, 29.2%) and evaluation of dilated bile ducts (n = 4, 16.7%). A dominant stricture was present in 37.5% of cases (n = 9) and one or more biliary stents were placed in 11 patients (46%). Two patients were considered to have a failed ERCP. Fever (n = 18, 75%), abdominal pain (n = 12, 50%) and jaundice (n = 10, 42%) were the main clinical manifestations, however Charcot’s triad was only present in 3 patients (12.5%). 91.7% of patients (n = 22) were treated with antibiotics within the first 24 hours in 86% of cases. Half of the patients had positive blood cultures (E. coli in 75%). Only one patient was submitted to ERCP after diagnosis. The duration of hospitalization ( p = 0.001) and higher levels of gamma-glutamyl transferase ( p = 0.04), alkaline phosphatase ( p = 0.03) and bilirubin ( p = 0.02) at the time of diagnosis were significantly associated with mortality. Conclusions: In our experience post-ERCP cholangitis developed in about 5% of cases, with a not negligible mortality of nearly 30%, despite antibiotic therapy institution. Fever was the main present clinical sign, often in the absence of other manifestations. Analytical factors can help identify the most serious cases that could benefit from a more aggressive approach. FRI-366 ENVIRONMENTAL RISK FACTORS AND SOCIOECONOMIC DISPARITY IN HISPANIC VERSUS NON-HISPANIC PATIENTS WITH PBC A. Rabiee1, N.A. Pena polanco2, A.F. De La Vara2, K.R. Bhamidimarri3, C. Levy3. 1Gastroenterology; 2Internal Medicine; 3Hepatology, University of Miami, Miami, United States E-mail: [email protected] Background and Aims: We have previously shown that Hispanics with PBC have increased prevalence of overlap syndrome, reduced response to UDCA and increased risk of portal hypertension complications compared to non-Hispanics. In the current study, we aimed to compare the demographics, comorbidities, environmental risk factors and socioeconomic status of Hispanic and non-Hispanic patients with PBC. Methods: We identified 265 patients with diagnosis of PBC who had been seen at University of Miami/Jackson Memorial Hospital from January 1998 through January 2013, of whom 41 were unavailable (10 deceased, 5 unwilling, 26 incorrect address). A questionnaire-based survey, available in English and Spanish, was developed evaluating patients’ demographics, comorbid conditions, environmental risk factors and socioeconomic status. Patients were contacted via phone call or mail. Odds ratio and 95% confidence intervals were calculated to measure association between exposure and outcome. Results: Ninety-six patients with PBC (43%) completed the questionnaire, 38 Hispanics (37 F, 1 M) and 58 non-Hispanics (54 F, 4 M). Male patients were excluded from data analysis. Age at diagnosis, race and years lived in the US were not statistically different between the two groups, since most patients (84% of Hispanics and 100% of non Hispanics) have lived in the US for more than 15 years. 91.7% of Hispanics were diagnosed after year 2000, as compared to 42.6% of non-Hispanics. Comorbidities and environmental risk factors are presented in Figure 1. No significant difference in environmental risk factors and comorbidities was observed between the two groups. 64% of Hispanics had a household income less than $50,000, as compared to 16% of non Hispanic patients. There was a trend towards higher levels of education and employment in non Hispanics compared to Hispanics, however this did not reach statistical significance. Healthcare insurance was significantly higher in non Hispanics compared to Hispanics (98.1% vs 86.5%, OR = 0.1 CI: 0–0.9).
Journal of Hepatology 2016 vol. 64 | S425–S630
Results: Twenty-seven patients (58.7%) experienced pruritus. Bezafibrate therapy resulted in a significant alleviation of pruritus (VAS from 4.4 ± 0.5 to 0.8 ± 0.2, < 0.001). Itch disappeared completely or partly in 17 and 7 patients, respectively. No marked changes in pruritus were reported by three patients (11%). Bezafibrate discontinuation in patients who have no pruritus or minimum pruritus under therapy, resulted in an increase or recurrence of pruritus (within 19–120 days) in all cases (mean VAS from 0.8 ± 0.3 to 5.7 ± 0.6, p < 0.001). In these patients, itching decreased or disappeared again after resuming bezafibrate therapy. Thirty-eight metabolites decreased significantly after treatment, particularly phosphatidylcholines (PC) PC(18:3/18:3), PC(18:0/20:4), PC(38:5), PC(16:0/22:6), PC(14:0/20:4), TG(56:5), and PC(15:0/22:6). The omega 6 arachidonic acid, 20:4n-6, several PC with the 20:4 fatty acyl chain esterified to them together with ChoE (20:4) were in lesser amount in the samples from patients treated with bezafibrate. Twenty-two of these metabolites increased again after bezafibrate discontinuation, mainly PC and lysophosphatidylcholines ( p < 0.001) and androsterone sulfate and related isomers ( p < 0.02). Conclusions: Bezafibrate therapy is associated with a clear relief of pruritus in patients with primary biliary cholangitis, presumably resulting from a decrease of certain circulating metabolites especially phosphatidylcholines and some sterols. FRI-354 THE ALT/AST RATIO AND TOTAL PROTEIN LEVEL IDENTIFY THE AUTOIMMUNE ETIOLOGY IN PATIENTS WITH FULMINANT HEPATITIS A. Reig1, V. Prado1, H. Uchima1, A. Mas1, A. Parés1. 1Liver Unit, Hospital Clínic, IDIBAPS; CIBERehd, University of Barcelona, Barcelona, Spain E-mail: [email protected] Background and Aims: The incidence of autoimmune hepatitis has increased in recent years, but the clinical features and course of the fulminant presentation (FAIH) is not well established. Moreover, the diagnosis of this presentation may be complex and delayed by the lack of early complete analytical and histologic procedures. This is critical for therapy and consequently prognosis and survival. Therefore, we have assessed the differential features of FAIH as compared with other etiologies of fulminant hepatitis. Methods: 77 patients (58% women; age 41 ± 2 years old) diagnosed with acute liver failure (fulminant hepatitis) between 2003 and 2013. Patients were divided according to the etiology into viral, toxic, autoimmune and miscellaneous (Wilson, associated with pregnancy, ischemic and idiopathic) etiologies. Clinical, biochemical, immunological and histological features were assessed, as well as the incidence of each etiology among three periods of similar duration. Results: 17 patients (22%) had FAIH, while toxic, viral and miscellaneous etiologies were diagnosed in 36%, 23%, and 17% of patients, respectively. The incidence of FAIH increased over the three time periods being 16%, 20% and 33% respectively. Age and female gender were similar in all etiologies except for those of viral origin (25% women, p = 0.02; age 36 ± 3 years, p < 0.05). The clinical features were comparable in all different etiologies, but the duration between the first sign of liver disease and the diagnosis of fulminant hepatitis was longer in FHAI (48 ± 16 vs 17.2 ± 7.4 days, p < 0.01). Moreover, AST/ALT ratio over 1 (OR: 5.17, 95% CI 1.6–16.8, p < 0.01) and total protein levels ≥50 g/L (OR: 6.1, 95% CI 1.6–23.5, p < 0.002) were mainly observed in patients with FAIH as compared with the other etiologies, while no significant changes were found in other liver biochemistries. The combination of these two variables (AST/ALT ratio and total protein concentration) were associated with the autoimmune etiology (OR: 12.9, 95% CI 3.6–46.4, p = 0.001). The outcome was similar among all etiologies except for FAIH patients who had better early survival (76%) although most of them (70%) were transplanted.
Journal of Hepatology 2016 vol. 64 | S425–S630
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POSTER PRESENTATIONS Conclusions: Autoimmune etiology is frequently observed in patients with fulminant hepatitis with increasing incidence. A new and simple biochemical index identifies patients with the autoimmune condition, and it may be useful for early treatment. FRI-364 COLONIZATION OF GERM-FREE MICE WITH A HUMAN MICROBIOTA INDUCES FXR SIGNALING A. Wahlström1, P. Kovatcheva-Datchary1, M. Ståhlman1, H.-U. Marschall1, F. Bäckhed1,2. 1Department of Molecular and Clinical Medicine, Sahlgrenska University Hostpital, Gothenburg University, Gothenburg, Sweden; 2Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Receptology and Enteroendocrinology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark E-mail: [email protected] Background and Aims: The gut microbiota influences the development and progression of metabolic diseases, partly by metabolism of bile acids and modified signaling through the farnesoid X receptor (FXR). Mice that are colonized with a human microbiota can be used to study the effect of human bacteria on metabolic functions, and in this study we aim to determine how the human gut microbiota metabolizes murine bile acids and affects FXR signaling in colonized mice. Methods: We colonized germ-free mice with fresh caecal content from a mouse donor or pre-frozen or fresh faeces from a human donor. We analyzed the gut microbiota and bile acid composition and expression of FXR target genes in ileum and liver. Results: Caecal microbiota composition differed between mice colonized with mouse and human microbiota and the freezing process also affected microbiota composition in the humanized mice. Human and mouse microbiota reduced total bile acid levels similarly but the humanized mice produced less secondary bile acids. The human microbiota was able to induce expression of FXR target genes Fgf15 and Shp in ileum and reduce expression of Cyp7a1 in the liver. Colonization with frozen human faeces resulted in higher ratio between FXR agonistic and FXR antagonistic bile acids and higher expression of the FXR target genes compared with fresh human faeces. Conclusions: We show that a human microbiota can change bile acid composition and induce FXR signaling in colonized mice, but the levels of secondary bile acids produced are lower than in mice colonized with a mouse microbiota. FRI-365 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY INDUCED CHOLANGITIS: CLINICAL CHARACTERISTICS, SEVERITY INDICATORS AND PROGNOSIS A. Peixoto1, M. Silva1, J. Santos-Antunes1, E. Rodrigues-Pinto1, P. Pereira1, G. Macedo1. 1Gastroenterology, Centro Hospitalar De São João, Porto, Portugal E-mail: [email protected] Background and Aims: Cholangitis does not often occur after endoscopic retrograde cholangiopancreatography (ERCP), but it can be a serious complication of this procedure. However, its clinical features, management and outcomes are poorly characterized in the literature. We aim to evaluate clinical features, treatment, evolution and outcomes of cases of post-ERCP cholangitis in a tertiary referral center. Methods: Retrospective analysis of cases of ERCP induced cholangitis diagnosed between January 2013 and December 2014. Results: From a total of 487 ERCP performed in two years, 24 patients developed cholangitis after the procedure (4.9%). The majority of patients were female (n = 13, 54%), with a median age of 60 years-old. The diagnosis was made after a median period of two days, with a mortality of 29.2% (n = 7). The median days of hospitalization was
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7 days, being the majority of patients from the outpatient clinic (n = 17, 70.8%). 42% of patients had already undergone ERCP with sphincterotomy and 30% were under antibiotic therapy or had received antibiotics in the previous three months. The main reasons for the procedure were choledocholitiasis (n = 9, 37.5%), obstructive jaundice (n = 7, 29.2%) and evaluation of dilated bile ducts (n = 4, 16.7%). A dominant stricture was present in 37.5% of cases (n = 9) and one or more biliary stents were placed in 11 patients (46%). Two patients were considered to have a failed ERCP. Fever (n = 18, 75%), abdominal pain (n = 12, 50%) and jaundice (n = 10, 42%) were the main clinical manifestations, however Charcot’s triad was only present in 3 patients (12.5%). 91.7% of patients (n = 22) were treated with antibiotics within the first 24 hours in 86% of cases. Half of the patients had positive blood cultures (E. coli in 75%). Only one patient was submitted to ERCP after diagnosis. The duration of hospitalization ( p = 0.001) and higher levels of gamma-glutamyl transferase ( p = 0.04), alkaline phosphatase ( p = 0.03) and bilirubin ( p = 0.02) at the time of diagnosis were significantly associated with mortality. Conclusions: In our experience post-ERCP cholangitis developed in about 5% of cases, with a not negligible mortality of nearly 30%, despite antibiotic therapy institution. Fever was the main present clinical sign, often in the absence of other manifestations. Analytical factors can help identify the most serious cases that could benefit from a more aggressive approach. FRI-366 ENVIRONMENTAL RISK FACTORS AND SOCIOECONOMIC DISPARITY IN HISPANIC VERSUS NON-HISPANIC PATIENTS WITH PBC A. Rabiee1, N.A. Pena polanco2, A.F. De La Vara2, K.R. Bhamidimarri3, C. Levy3. 1Gastroenterology; 2Internal Medicine; 3Hepatology, University of Miami, Miami, United States E-mail: [email protected] Background and Aims: We have previously shown that Hispanics with PBC have increased prevalence of overlap syndrome, reduced response to UDCA and increased risk of portal hypertension complications compared to non-Hispanics. In the current study, we aimed to compare the demographics, comorbidities, environmental risk factors and socioeconomic status of Hispanic and non-Hispanic patients with PBC. Methods: We identified 265 patients with diagnosis of PBC who had been seen at University of Miami/Jackson Memorial Hospital from January 1998 through January 2013, of whom 41 were unavailable (10 deceased, 5 unwilling, 26 incorrect address). A questionnaire-based survey, available in English and Spanish, was developed evaluating patients’ demographics, comorbid conditions, environmental risk factors and socioeconomic status. Patients were contacted via phone call or mail. Odds ratio and 95% confidence intervals were calculated to measure association between exposure and outcome. Results: Ninety-six patients with PBC (43%) completed the questionnaire, 38 Hispanics (37 F, 1 M) and 58 non-Hispanics (54 F, 4 M). Male patients were excluded from data analysis. Age at diagnosis, race and years lived in the US were not statistically different between the two groups, since most patients (84% of Hispanics and 100% of non Hispanics) have lived in the US for more than 15 years. 91.7% of Hispanics were diagnosed after year 2000, as compared to 42.6% of non-Hispanics. Comorbidities and environmental risk factors are presented in Figure 1. No significant difference in environmental risk factors and comorbidities was observed between the two groups. 64% of Hispanics had a household income less than $50,000, as compared to 16% of non Hispanic patients. There was a trend towards higher levels of education and employment in non Hispanics compared to Hispanics, however this did not reach statistical significance. Healthcare insurance was significantly higher in non Hispanics compared to Hispanics (98.1% vs 86.5%, OR = 0.1 CI: 0–0.9).
Journal of Hepatology 2016 vol. 64 | S425–S630