- Email: [email protected]
The hidden burden of hepatitis C related advanced liver disease in the community
POSTER PRESENTATIONS values >5%/h, reaching a HR of 1.6 (95% CI 0.3; 7.9) with PDRpeak of 15%/h and a HR of 1 with a PDRpeak of 24%/h. Patients with PDRpeak values <24%/h could be stratified according to risk (Figure); however, risk stratification could not be performed using LB fibrosis scores (ranging of HR 0.67 to 1.18).
group there are significant numbers of patients at high risk of decompensation. On-going alcohol use is associated with a significantly higher FS score. While these patients may have significant comorbidities, including addiction, which limits access to specialist hospital services, it is important to overcome these challenges if we are to make an impact on HCV-related mortality. SAT-486 Attenuation coefficient measurement as novel real time ultrasound alternative to CAP (fibroscan) O. Dynnyk1, N. Marunchyn2, N. Kobyliak2, O. Fedusenko3, V. Gurianov2. 1 Bogomolets Institute of Physiology of the Ukrainian National Academy of Sciences; 2Bogomolets National Medical University; 3Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine E-mail: [email protected]
Conclusions: The MBT is a safe non-invasive tool to assess hepatic metabolic function. MBT performed at the point of care can predict risk of LRD or need for LTX in patients with CLD, regardless of etiology. Serial monitoring of MBT is a promising tool to address the unmet need for predicting the risk of deterioration in patients with CLD. SAT-485 The hidden burden of hepatitis C related advanced liver disease in the community N. Iqbal1, C. Murphy2, T. McHugh2, A. Singleton3, S. Keating3, D. Crowley4, H. Gallagher5, F. Savage6, J. Maloney7, J. Lambert8, S. Stewart1. 1Gastroenterology & Hepatology, Mater Misericordiae University Hospital; 2Research & Addiction Service, Catherine McAuley Education & Research Centre Nelson Street, Dublin 7; 3National Drug Treatment Centre, Trinity Court; 4HSE Methadone Clinic, The Thompson Centre; 5HSE Methadone Clinic, Domville House, Ballymun, Dublin; 6HSE Methadone Clinic, HSE Addiction Services, Bray, Co Wicklow; 7HSE Methadone Clinic, HSE Addiction Services Patrick St Clinic, Dun Laoghaire; 8Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland E-mail: [email protected] Background and Aims: In Ireland there are large numbers of hepatitis C (HCV) positive patients receiving methadone substitution therapy in drug treatment centre (DTCs) who do not attend specialist hepatology services. Most of these patients have never had their liver disease staged. Fibroscan™ (FS) is an excellent, point of care, noninvasive tool for measuring liver stiffness which correlates closely with hepatic fibrosis. The clinically relevant cut-offs are 8.5 kPa, which allows access to direct acting antivirals (DAAs) in Ireland, 25 kPa which has a 90% positive predictive value for clinically significant portal hypertension and 35 kPa which associates with a 10–20% risk of decompensation per year. Aims: To use FS to risk stratify patients receiving methadone substitution therapy in Dublin DTCs. To determine the impact of active alcohol consumption on FS score. Methods: We performed FS on sequential clients receiving methadone substitution therapy in the six larger Dublin DTCs regardless of their HCV status. Clients were also asked regarding alcohol intake and grouped into two categories – abstinent or not abstinent. Results: A total of 618 consecutive patients (75% male, mean age 38 ± 7.2) were assessed. HCV status was known in 91% (561) of patients with 70% (391) being HCV +ve. The mean FS score was higher in the HCV +ve patients than the HCV –ve (11.0 kPa ± 12.4 v 5.6 kPa ± 4.0; p = 0.001). In the HCV +ve group, patients that drank alcohol (35%) had a higher score than those that were abstinent (13.2 kPa ± 16.4 v 9.7 kPa ± 9.9; p = 0.02). There were 128 (33% of total cohort) HCV +ve patients with FS ≥8.5 kPa, 34 (9%) with FS ≥25 kPa and 21 (5%) with FS ≥35 kPa. Conclusions: This community based study has identified a large number of HCV positive patients that do not attend specialist hepatology services yet qualify for DAA treatment. Within this
Background and Aims: The presence of fat droplets in the hepatocytes (micro- or macrovesicular hepatic steatosis) under condition of chronic diffuse liver disease (CDLD) increases the attenuation of ultrasound (US). A group of Ukrainian scientists proposed an original algorithm for real-time US attenuation measurement (attenuation coefficient measurement – ACM – patent UA №2014 111234) Methods: From total of 3,274 patients who underwent to comprehensive abdominal US (2015–2016) in our clinic, 949 have been diagnosed with fatty liver according to Hamaguchi criteria. All these patient we provide Attenuation coefficient measurement (ACM) (dB/ cm) measurement on SoneusP7 device (Ultrasign, Ukraine), with a 1– 6 MHz convex transducer in the right and left lobes. For diagnostic accuracy assessment (used CT as standard) and comparison with CAP measured by Fibroscan (Echosens, France) we included 142 patients for subanalysis. Evaluation of diagnostic accuracy of ACM performed using ROC-analysis. Results: Depending on the stage of steatosis according to B-mode median, 25 and 75 quartiles for ACM were as follows: control group 1.57 (1,32–1,85); S1–1,86 (1,78–2,11); S2 – 2,26 (2,20–2,49) and respectively for S3 – 2,7 (2,40–2,82) dB/cm. ACM value increase parallel the hepatic steatosis progression ( p < 0.001), which was also accompanied with presence of very strong correlation between these parameters (r = 0,814, p < 0.001). In patient with NAFLD the association between maximum value of ACM and duration of T2DM and triglycerides (model 1, multiple correlation coefficient = 0.55; R2 = 0.26; p = 0,004) and ALT (model 2, multiple correlation coefficient = 0.55; R2 = 0.25; p = 0,005) were observed. After adjustment by the duration of T2DM the level of triglycerides (r = 0.44, p = 0.012) and activity of ALT (r = 0.44, p = 0.012) significantly correlated with ACM. The AUROC of ACM for steatosis diagnosis was 0,925 (95% CI 0.877– 0.973). The optimal cutoff point was >2.27 dB/cm, with sensitivity, specificity, PPV and NPV respectively 91.5, 77.3, 84.6 and 83.8%. ACM value also significantly correlated with CAP (r = 0,630, p < 0.001). Conclusions: The ACM as novel real time ultrasound approach can be used for noninvasive hepatic steatosis diagnosis, allows clinicians to follow up disease progression and response to treatment. SAT-487 How to combine blood test and elastography to stage liver fibrosis in chronic hepatitis C? P. Cales1, J. Boursier1, V. de Ledinghen2, I. Hubert1, F. Oberti1. 1 Hepatology, University Hospital, Angers; 2Liver-Gastroenterology, Segalen University, Bordeaux, France E-mail: [email protected] Background and Aims: In chronic hepatitis C, the EASL-ALEH recommends performing transient elastography and a blood test to diagnose significant fibrosis; test concordance confirms diagnosis. Our aim was to validate this rule and evaluate whether combining the blood markers of the blood test and transient elastography (constitutive tests) into a single combined test, as suggested by AASLD-IDSA recommendations, improves accuracy, especially with a new classification metric.
Journal of Hepatology 2017 vol. 66 | S543–S750
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group there are significant numbers of patients at high risk of decompensation. On-going alcohol use is associated with a significantly higher FS score. While these patients may have significant comorbidities, including addiction, which limits access to specialist hospital services, it is important to overcome these challenges if we are to make an impact on HCV-related mortality. SAT-486 Attenuation coefficient measurement as novel real time ultrasound alternative to CAP (fibroscan) O. Dynnyk1, N. Marunchyn2, N. Kobyliak2, O. Fedusenko3, V. Gurianov2. 1 Bogomolets Institute of Physiology of the Ukrainian National Academy of Sciences; 2Bogomolets National Medical University; 3Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine E-mail: [email protected]
Conclusions: The MBT is a safe non-invasive tool to assess hepatic metabolic function. MBT performed at the point of care can predict risk of LRD or need for LTX in patients with CLD, regardless of etiology. Serial monitoring of MBT is a promising tool to address the unmet need for predicting the risk of deterioration in patients with CLD. SAT-485 The hidden burden of hepatitis C related advanced liver disease in the community N. Iqbal1, C. Murphy2, T. McHugh2, A. Singleton3, S. Keating3, D. Crowley4, H. Gallagher5, F. Savage6, J. Maloney7, J. Lambert8, S. Stewart1. 1Gastroenterology & Hepatology, Mater Misericordiae University Hospital; 2Research & Addiction Service, Catherine McAuley Education & Research Centre Nelson Street, Dublin 7; 3National Drug Treatment Centre, Trinity Court; 4HSE Methadone Clinic, The Thompson Centre; 5HSE Methadone Clinic, Domville House, Ballymun, Dublin; 6HSE Methadone Clinic, HSE Addiction Services, Bray, Co Wicklow; 7HSE Methadone Clinic, HSE Addiction Services Patrick St Clinic, Dun Laoghaire; 8Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland E-mail: [email protected] Background and Aims: In Ireland there are large numbers of hepatitis C (HCV) positive patients receiving methadone substitution therapy in drug treatment centre (DTCs) who do not attend specialist hepatology services. Most of these patients have never had their liver disease staged. Fibroscan™ (FS) is an excellent, point of care, noninvasive tool for measuring liver stiffness which correlates closely with hepatic fibrosis. The clinically relevant cut-offs are 8.5 kPa, which allows access to direct acting antivirals (DAAs) in Ireland, 25 kPa which has a 90% positive predictive value for clinically significant portal hypertension and 35 kPa which associates with a 10–20% risk of decompensation per year. Aims: To use FS to risk stratify patients receiving methadone substitution therapy in Dublin DTCs. To determine the impact of active alcohol consumption on FS score. Methods: We performed FS on sequential clients receiving methadone substitution therapy in the six larger Dublin DTCs regardless of their HCV status. Clients were also asked regarding alcohol intake and grouped into two categories – abstinent or not abstinent. Results: A total of 618 consecutive patients (75% male, mean age 38 ± 7.2) were assessed. HCV status was known in 91% (561) of patients with 70% (391) being HCV +ve. The mean FS score was higher in the HCV +ve patients than the HCV –ve (11.0 kPa ± 12.4 v 5.6 kPa ± 4.0; p = 0.001). In the HCV +ve group, patients that drank alcohol (35%) had a higher score than those that were abstinent (13.2 kPa ± 16.4 v 9.7 kPa ± 9.9; p = 0.02). There were 128 (33% of total cohort) HCV +ve patients with FS ≥8.5 kPa, 34 (9%) with FS ≥25 kPa and 21 (5%) with FS ≥35 kPa. Conclusions: This community based study has identified a large number of HCV positive patients that do not attend specialist hepatology services yet qualify for DAA treatment. Within this
Background and Aims: The presence of fat droplets in the hepatocytes (micro- or macrovesicular hepatic steatosis) under condition of chronic diffuse liver disease (CDLD) increases the attenuation of ultrasound (US). A group of Ukrainian scientists proposed an original algorithm for real-time US attenuation measurement (attenuation coefficient measurement – ACM – patent UA №2014 111234) Methods: From total of 3,274 patients who underwent to comprehensive abdominal US (2015–2016) in our clinic, 949 have been diagnosed with fatty liver according to Hamaguchi criteria. All these patient we provide Attenuation coefficient measurement (ACM) (dB/ cm) measurement on SoneusP7 device (Ultrasign, Ukraine), with a 1– 6 MHz convex transducer in the right and left lobes. For diagnostic accuracy assessment (used CT as standard) and comparison with CAP measured by Fibroscan (Echosens, France) we included 142 patients for subanalysis. Evaluation of diagnostic accuracy of ACM performed using ROC-analysis. Results: Depending on the stage of steatosis according to B-mode median, 25 and 75 quartiles for ACM were as follows: control group 1.57 (1,32–1,85); S1–1,86 (1,78–2,11); S2 – 2,26 (2,20–2,49) and respectively for S3 – 2,7 (2,40–2,82) dB/cm. ACM value increase parallel the hepatic steatosis progression ( p < 0.001), which was also accompanied with presence of very strong correlation between these parameters (r = 0,814, p < 0.001). In patient with NAFLD the association between maximum value of ACM and duration of T2DM and triglycerides (model 1, multiple correlation coefficient = 0.55; R2 = 0.26; p = 0,004) and ALT (model 2, multiple correlation coefficient = 0.55; R2 = 0.25; p = 0,005) were observed. After adjustment by the duration of T2DM the level of triglycerides (r = 0.44, p = 0.012) and activity of ALT (r = 0.44, p = 0.012) significantly correlated with ACM. The AUROC of ACM for steatosis diagnosis was 0,925 (95% CI 0.877– 0.973). The optimal cutoff point was >2.27 dB/cm, with sensitivity, specificity, PPV and NPV respectively 91.5, 77.3, 84.6 and 83.8%. ACM value also significantly correlated with CAP (r = 0,630, p < 0.001). Conclusions: The ACM as novel real time ultrasound approach can be used for noninvasive hepatic steatosis diagnosis, allows clinicians to follow up disease progression and response to treatment. SAT-487 How to combine blood test and elastography to stage liver fibrosis in chronic hepatitis C? P. Cales1, J. Boursier1, V. de Ledinghen2, I. Hubert1, F. Oberti1. 1 Hepatology, University Hospital, Angers; 2Liver-Gastroenterology, Segalen University, Bordeaux, France E-mail: [email protected] Background and Aims: In chronic hepatitis C, the EASL-ALEH recommends performing transient elastography and a blood test to diagnose significant fibrosis; test concordance confirms diagnosis. Our aim was to validate this rule and evaluate whether combining the blood markers of the blood test and transient elastography (constitutive tests) into a single combined test, as suggested by AASLD-IDSA recommendations, improves accuracy, especially with a new classification metric.
Journal of Hepatology 2017 vol. 66 | S543–S750
S669