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The Clinical Impact of Hepatitis B Virus Infection on Hepatocellular Carcinoma and Mortality in Alcoholic Cirrhosis
the annual mortality rate was 9.5%. The cumulative mortality rate was significantly higher in the alcoholic cirrhotic patients with than those without HBV infection (70% vs 67% at 10 years, P=0.002). The cumulative mortality rate was higher in the abstinent than nonabstinent patients with the 10-year mortality rate being 46% and 72% in the abstinent and non-abstinent patients, respectively. Multivariate regression analyses revealed that HBV infection significantly increased the risk of HCC (odds ratio=3.4) and mortality (odds ratio= 1.9) in alcoholic cirrhotic patients. Predictors of increased mortality were low serum albumin and varices in alcoholic cirrhotic patients. Serum HBV DNA increased the risk of HCC in alcoholic cirrhotic patients with HBV infection. Besides, continuously high HBV DNA (≥ 104 copies/mL) increased the risk of HCC in alcoholic cirrhotic patients with HBV infection. Conclusions: Concomitant HBV increased the risk of HCC and mortality in alcoholic cirrhotic patients. Treatment of HBV seems to decrease the risk of HCC and mortality in alcoholic cirrhotic patients. Abstinence increased the risk of HCC but decreased the risk of mortality. Continuously high HBV DNA increased the risk of HCC. Maintaining continuously low HBV DNA with oral antiviral therapy may be useful in preventing HCC occurrence in alcoholic cirrhotic patients with HBV infection. Tu1932 A Review of Primary Care Referrals to a General Hepatology Clinic - Is Alcohol a Major Cause of Liver Disease in Outpatients? Audrey Dillon, Vogue Murphy, Liam Mahoney, Suzanne Norris Introduction: Alcohol is a major factor in liver disease. In Ireland, alcohol related hospital discharges increased by 147% from 1995 to 2004 . There is little information on the patient profile of outpatient hepatology services internationally. Aims & Background: The prevalence of alcohol related chronic liver disease in primary care (PC) referrals to Irish hepatology outpatients is unknown. Method: A chart review of all PC referrals to a general hepatology clinic in 2008 was carried out to identify alcohol intake, investigations and final diagnosis. Results: Of the 296 new patients seen in 2008, 113 (38%) were referred from GPs. 93 (82.3%) charts were examined. The main reasons for referral were investigation of abnormal liver functions tests (54.8%); management of new diagnosis of viral hepatitis (28%) and investigation of abnormal iron indices, or family history of haemochromatosis (5.4%). PC referral letters mentioned alcohol intake in 33% of cases and at outpatients, intake was quantified at less than 14 units per week in 68 (75%) cases. 13 patients had no identifiable abnormality on clinical review. The overall diagnoses were 22 (28%) non alcohol related fatty liver disease (NAFLD) cases; 30 (38%) cases of hepatitis C; 13 (16%) alcohol liver disease cases; 5 (6%) hepatitis B cases with 4 (5%) cases of haemochromatosis. Of those investigated for abnormal liver function, 21 (41%) patients were diagnosed with NAFLD. Viral hepatitis and NALFD were more common than alcohol, however, those with alcohol liver related disease are more likely to attend emergency than outpatient services. The high rate of NAFLD is concerning and suggests a need to increase screening and services.
AASLD Abstracts
Tu1930 Roles of Alcohol Consumption and Body Mass Index in Fatty Liver in Japanese Men and Women Akio Moriya, Yoshiaki Iwasaki, Souhei Ohguchi, Eizo Kayashima, Tadahiko Mitsumune, Hideaki Taniguchi, Fusao Ikeda, Kazuhide Yamamoto Background & Aims: Excessive alcohol consumption causes alcoholic fatty liver disease and excessive nutrition causes non-alcoholic fatty liver disease. However, a number of studies have reported an inverse association between moderate alcohol consumption and fatty liver; we have also described the inverse correlation between drinking frequency and prevalence of fatty liver. We aimed to determine the association among fatty liver, alcohol consumption, and nutrition, using body mass index (BMI) as a surrogate for nutrition. Methods: We obtained the clinical and laboratory data from 6,273 Japanese subjects who underwent ultrasonography as a part of systematic health checkups at Junpukai Health Maintenance Center in 2006, excluded individuals with concurrent liver disease and/or any missing components of data, and analyzed 4,158 men and 1,450 women (median age 49 year old). We stratified drinking frequency into 4 categories (non-drinker, drinking on 1-3 days/week, drinking on 4-6 days/week, and daily drinking) and BMI into 4 categories (<18.5 kg/m2 [underweight], 18.5-25 kg/m2 [normal range], 25-30 kg/m2 [overweight], and ≥30 kg/m2 [obese]) and performed logistic regression analysis and Cochran-Armitage test for trend. Results: In men, 32% had fatty liver; 73% reported habitual drinking (drinking at least once a week). The presence of fatty liver was inversely associated with habitual drinking (adjusted odds ratio, 0.71; 95% CI, 0.60-0.84). The prevalence of fatty liver in each BMI category was 0.63% (1/160) in underweight, 21% (590/2,802) in normal range, 60% (633/1,053) in overweight, and 78% (111/143) in obese subjects. The prevalence of fatty liver in each drinking frequency (non-drinker, drinking on 1-3 days/week, drinking 4-6 days/week, and daily drinking) was 0%, 0%, 0%, and 1.4% in underweight; 25%, 21%, 22%, and 18% in normal range; 65%, 63%, 60%, and 54% in overweight; 80%, 76%, 86%, and 70% in obese subjects, respectively. Trend toward an inverse association between drinking frequency and prevalence of fatty liver was observed in normal range (P < 0.001) and in overweight subjects (P = 0.003). In women, 14% had fatty liver; 31% reported habitual drinking. The presence of fatty liver was inversely associated with habitual drinking (odds ratio, 0.63; 95% CI, 0.45-0.89), but it was not significant after adjustment for other confounders. The prevalence of fatty liver in each BMI category was 0% (0/181) in underweight, 9.4% (100/1,065) in normal range, 48% (81/170) in overweight, and 82% (28/34) in obese subjects. No significant trend toward an association between drinking frequency and prevalence of fatty liver was observed in each BMI category. Conclusions: The frequency of alcohol consumption was inversely correlated to the prevalence of fatty liver in normal range and overweight men. Tu1931 The Clinical Impact of Hepatitis B Virus Infection on Hepatocellular Carcinoma and Mortality in Alcoholic Cirrhosis Chih-Wen Lin, Daw-Shyong Perng, Chia-Chang Hsu, Lein-Ray Mo, Gin-Ho Lo, Sien-Sing Yang Background: Hepatocellular carcinoma (HCC) is one of the most common cancers and causes of mortality worldwide. Hepatitis B virus (HBV) is an important factor in HCC and mortality. Alcoholic cirrhosis is also definite risk factor of HCC and is a condition with high mortality in western country. However, the risk factors of HCC and mortality in alcoholic cirrhosis has not been well studied. Aims: This study aims to investigate the clinical impact of HBV and the risk predictors on HCC and mortality in alcoholic cirrhotic patients. In addition, this study will examine the association between serum HBV DNA and HCC development and mortality in alcoholic cirrhotic patients with HBV infection. Both aspects of the study will focus on Taiwan. Methods: We retrospectively collected patients diagnosed of alcoholic cirrhosis between 2000 and 2005 and then followed those patients until 2010. A total of 200 alcoholic cirrhotic patients (33% with HBV) were enrolled. Results: The study included 83% men and 17% women with the mean age of 48 years. The average daily amount and duration of alcohol intake was 183 g and 18 years. The annual HCC rate was 2.8%. The cumulative HCC rate was significantly higher in the alcoholic cirrhotic patients with than those without HBV infection (55% vs 24% at 10 years, P=0.001). The cumulative HCC rate was higher in the abstinent than non-abstinent patients with the 10-year HCC rate being 43% and 16% in the abstinent and non-abstinent patients, respectively. Moreover,
AASLD Abstracts
S-990
AASLD Abstracts
Tu1930 Roles of Alcohol Consumption and Body Mass Index in Fatty Liver in Japanese Men and Women Akio Moriya, Yoshiaki Iwasaki, Souhei Ohguchi, Eizo Kayashima, Tadahiko Mitsumune, Hideaki Taniguchi, Fusao Ikeda, Kazuhide Yamamoto Background & Aims: Excessive alcohol consumption causes alcoholic fatty liver disease and excessive nutrition causes non-alcoholic fatty liver disease. However, a number of studies have reported an inverse association between moderate alcohol consumption and fatty liver; we have also described the inverse correlation between drinking frequency and prevalence of fatty liver. We aimed to determine the association among fatty liver, alcohol consumption, and nutrition, using body mass index (BMI) as a surrogate for nutrition. Methods: We obtained the clinical and laboratory data from 6,273 Japanese subjects who underwent ultrasonography as a part of systematic health checkups at Junpukai Health Maintenance Center in 2006, excluded individuals with concurrent liver disease and/or any missing components of data, and analyzed 4,158 men and 1,450 women (median age 49 year old). We stratified drinking frequency into 4 categories (non-drinker, drinking on 1-3 days/week, drinking on 4-6 days/week, and daily drinking) and BMI into 4 categories (<18.5 kg/m2 [underweight], 18.5-25 kg/m2 [normal range], 25-30 kg/m2 [overweight], and ≥30 kg/m2 [obese]) and performed logistic regression analysis and Cochran-Armitage test for trend. Results: In men, 32% had fatty liver; 73% reported habitual drinking (drinking at least once a week). The presence of fatty liver was inversely associated with habitual drinking (adjusted odds ratio, 0.71; 95% CI, 0.60-0.84). The prevalence of fatty liver in each BMI category was 0.63% (1/160) in underweight, 21% (590/2,802) in normal range, 60% (633/1,053) in overweight, and 78% (111/143) in obese subjects. The prevalence of fatty liver in each drinking frequency (non-drinker, drinking on 1-3 days/week, drinking 4-6 days/week, and daily drinking) was 0%, 0%, 0%, and 1.4% in underweight; 25%, 21%, 22%, and 18% in normal range; 65%, 63%, 60%, and 54% in overweight; 80%, 76%, 86%, and 70% in obese subjects, respectively. Trend toward an inverse association between drinking frequency and prevalence of fatty liver was observed in normal range (P < 0.001) and in overweight subjects (P = 0.003). In women, 14% had fatty liver; 31% reported habitual drinking. The presence of fatty liver was inversely associated with habitual drinking (odds ratio, 0.63; 95% CI, 0.45-0.89), but it was not significant after adjustment for other confounders. The prevalence of fatty liver in each BMI category was 0% (0/181) in underweight, 9.4% (100/1,065) in normal range, 48% (81/170) in overweight, and 82% (28/34) in obese subjects. No significant trend toward an association between drinking frequency and prevalence of fatty liver was observed in each BMI category. Conclusions: The frequency of alcohol consumption was inversely correlated to the prevalence of fatty liver in normal range and overweight men. Tu1931 The Clinical Impact of Hepatitis B Virus Infection on Hepatocellular Carcinoma and Mortality in Alcoholic Cirrhosis Chih-Wen Lin, Daw-Shyong Perng, Chia-Chang Hsu, Lein-Ray Mo, Gin-Ho Lo, Sien-Sing Yang Background: Hepatocellular carcinoma (HCC) is one of the most common cancers and causes of mortality worldwide. Hepatitis B virus (HBV) is an important factor in HCC and mortality. Alcoholic cirrhosis is also definite risk factor of HCC and is a condition with high mortality in western country. However, the risk factors of HCC and mortality in alcoholic cirrhosis has not been well studied. Aims: This study aims to investigate the clinical impact of HBV and the risk predictors on HCC and mortality in alcoholic cirrhotic patients. In addition, this study will examine the association between serum HBV DNA and HCC development and mortality in alcoholic cirrhotic patients with HBV infection. Both aspects of the study will focus on Taiwan. Methods: We retrospectively collected patients diagnosed of alcoholic cirrhosis between 2000 and 2005 and then followed those patients until 2010. A total of 200 alcoholic cirrhotic patients (33% with HBV) were enrolled. Results: The study included 83% men and 17% women with the mean age of 48 years. The average daily amount and duration of alcohol intake was 183 g and 18 years. The annual HCC rate was 2.8%. The cumulative HCC rate was significantly higher in the alcoholic cirrhotic patients with than those without HBV infection (55% vs 24% at 10 years, P=0.001). The cumulative HCC rate was higher in the abstinent than non-abstinent patients with the 10-year HCC rate being 43% and 16% in the abstinent and non-abstinent patients, respectively. Moreover,
AASLD Abstracts
S-990