The natural history of covert hepatic encephalopathy in cirrhotic patients in a tertiary care hospital

POSTER PRESENTATIONS were: male sex n = 92 (82.9%), mean age 56.21 ± 12 years, etiology (alcohol n = 70.63,1%; HCV n = 10.1 (11%). Portal thrombosis prevalence n = 3 (2.7%). Primary prophylaxis n = 88 (79.3%), secondary prophylaxis n = 22 (20.7%). We found no statistically significant differences in MELD, platelet count and bilirubin, but all patients with PT had ascites and esophageal varices (Chi 2p = 0.123 and p = 0.05, respectively). We didń t find any differences in the baseline cardiopulmonary parameters, but it was significative in the liver measurements: IVCP (non-PT 11.9 ± 4.67 mmHg vs. PT 18.33 ± 4.9 mmHg p = 0.023); FHVP (nonPT 11.9 ± 4, 8 mmHg vs. PT 14.16 ± 6.04 mmHg p = 0.434), WHVP (nonPT 30.69 ± 6.25 mmHg vs. PT 40.33 ± 1.25 mmHg p = 0.009) and HVPG (nonPT 18.7 ± 4.06 mmHg vs. TP 26.16 ± 4.9 mmHg p = 0.002. These differences were maintained in post betablocker measurements: IVCP (nonPT 11.59 ± 4.6 mmHg vs. PT 17.33 ± 4.16 mmHg p = 0.036); FHVP (non PT 12.69 ± 4.32 mmHg vs. PT 16.66 ± 4.6 mmHg p = 0.12); WHVP (nonPT 28.56 ± 7.06 mmHg vs. PT 40.0 ± 1.0 mmHg); HVPG (non PT 15.88 ± 4.92 mmHg vs. PT 23.33 ± 3.7 mmHg p = 0.011). Conclusions: The prevalence of portal thrombosis in our cohort of patients is close to 3%, and its presence is associated with a higher degree of portal hypertension (without influence on the response to acute beta blockers), esophageal varices and ascites. THU-026 The natural history of covert hepatic encephalopathy in cirrhotic patients in a tertiary care hospital A. Wang1, A. Peng1, X. Zheng2, B. Li1, J. Hong1, N. Gan1, X. Zhu1. 1 Gastroenterology and Hepatology; 2Pharmacy, First Affiliated Hospital of Nanchang University, Nanchang, China E-mail: [email protected] Background and Aims: The natural history of covert hepatic encephalopathy (CHE) in cirrhotic patients without medication interference has not been explored. The aim of this study was to explore the natural history of CHE and identify predictors for exacerbation and resolution of CHE. Methods: Consecutive outpatient cirrhotic patients in a tertiary care hospital were enrolled and administered neuropsychometric tests for CHE diagnosis. They were followed up for 12 months. Time to the first cirrhosis-related complication(s) requiring hospitalization including overt HE (OHE), resolution of CHE and death/transplant were compared between CHE and no-CHE. Predictors for exacerbation and resolution of CHE were also analyzed. Results: A total of 366 patients (age: 47.2 ± 8.6 yrs, male: 73.0%) were enrolled. CHE was identified in 35.8% of patients. CHE had higher rates of mortality and incidence of complication(s) requiring hospitalization including OHE than no-CHE patients. Finally, 17.6% of CHE developed OHE, 42.0% suffered persistent CHE, and 19.8% of

CHE spontaneously resolved. Only serum albumin <28 g/L (HR 5.22) was the predictor for developing OHE while blood creatinine >133 μmol/L (HR 4.75) for mortality for CHE patients. Patients with Child-Pugh B/C (HR 0.084) and OHE history (HR 0.15) were predictors for spontaneous resolution of CHE.Cox analysis of predictors for developing OHE, developing the first cirrhosisrelated complication(s) requiring hospitalization and mortality in CHE patients. Predictor(s) For developing OHE Albumin <28 g/L For developing the Cr > 133 μmol/L first cirrhosis-related complications MELD score >20 PLT <80*109/L For mortality Cr >133 μmol/L

β 1.65 1.24

HR

95%CI

5.22 1.22–22.32 3.46 1.46–8.20

P 0.03 0.005

2.31 10.12 4.14–24.74 <0.001 2.52 2.44 1.69–6.60 0.013 1.51 4.75 1.10–20.44 0.036

Conclusions: CHE is associated with increased risk of complications and mortality in clinically stable cirrhosis. CHE could aggravate, persist or resolve without medication interference. Triage of patients based on predictors for exacerbation and resolution make CHE management cost-effective. THU-027 Long-term prognosis following acute-on-chronic liver failure E.L. Yoon1, T.Y. Kim2, D.S. Song3, H.Y. Kim3, C.W. Kim3, Y.K. Jung4, D.H. Sinn5, J.Y. Jang6, M.Y. Kim7, S.W. Jeong6, S.G. Kim8, E. Choi9, K.T. Suk10, D.J. Kim10 and Korean Acute-on-Chronic Liver Failure (KACLiF) Study Group. 1Internal Medicine, Sanggye Paik Hospital, Inje University; 2Institute of Medical Science, Hanyang University; 3Internal Medicine, The Catholic University of Korea, Seoul; 4Internal Medicine, Korea University, Ansan; 5Internal Medicine, Samsung Medical Center; 6 Internal Medicine, Soonchunhyang University, Seoul; 7Internal Medicine, Yonsei University Wonju College of Medicine, Wonju; 8Internal Medicine, Soonchunhyang University, Bucheon; 9Institue of Livestyle Medicine, Yonsei University Wonju College of Medicine, Wonju; 10 Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea E-mail: [email protected] Background and Aims: The long-term prognosis of patients who survive acute-on-chronic liver failure (ACLF) is not known. We aimed to investigate the long-term outcomes following ACLF. Methods: A cohort of 1177 patients from the Korean Acute-onChronic Liver Failure (KACLiF) study who had survived for more than 3 months following acute deterioration of liver function was

Figure: (abstract: THU-026) Journal of Hepatology 2017 vol. 66 | S95–S332

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