bluuebunny/crossref_metadata_2025 huggingface dataset:
941 Sex-Specific and Ethnicity-Specific Disparities in Successful Linkage to Care Among Chronic Hepatitis C Virus Infection Patients at a Under-Served Safety Net Hospital
Authors: Gomes Chantal , Ginzberg Dina , Liu Benny , Bhuket Taft , Wong Robert
Published: October 2019

INTRODUCTION:

Despite availability of highly effective therapies for chronic hepatitis C virus (HCV), sub-optimal linkage to care (LTC) after HCV diagnosis remains a major barrier to achieving eradication. We aim to identify sex- and ethnicity-specific disparities in HCV LTC among an ethnically diverse safety-net population.

METHODS:

We retrospectively evaluated all adults who underwent HCV antibody (Ab) testing at a single-center safety-net hospital from 2014 to 2018. Among adults with positive HCV Ab, we evaluated overall rates and trends in proportion of patients with positive HCV RNA. Rates of chronic HCV infection were compared by sex and race/ethnicity using chi-squared methods. Among patients with confirmed chronic HCV infection, we evaluated overall rates and trends in successful LTC (defined as successful completion of first medical encounter with a HCV provider following diagnosis). Comparisons of successful LTC between groups were evaluated with chi-squared testing and adjusted multivariate logistic regression models.

RESULTS:

From 2014 to 2018, 54,173 HCV Ab tests were performed, among which 7.03% were HCV Ab positive. Among patients with HCV Ab positive, prevalence of positive HCV RNA was 52.5%. From 2014 to 2018, proportion of HCV Ab positive patients with positive HCV RNA declined from 74.3% in 2014 to 44.2% in 2018. The prevalence of HCV RNA positive among HCV Ab positive patients was significantly higher in men compared to women (58.0% vs. 43.7%, P < 0.001), significantly higher in African Americans compared to whites (58.8% vs. 52.7%, P < 0.001), and significantly lower in Asians compared to whites (30.4% vs. 52.7%, P < 0.001). Overall LTC among patients with confirmed chronic HCV infection was 33.2%. Women with chronic HCV had significantly higher LTC compared to men (38.3% vs. 30.6%, P < 0.04). Compared to whites with chronic HCV, significantly higher LTC rates were observed for African Americans (33.3% vs. 27.4%, P < 0.01) and Asians (66.7% vs. 27.4%, P < 0.01). On multivariate regression, there was a trend towards lower LTC rates among men compared to women (OR 0.73, 95% CI 0.52-1.02, P = 0.06). Asians were significantly more likely to achieve successful LTC compared to whites (OR 3.80, 95% CI 1.40-10.32, P < 0.01).

CONCLUSION:

Among safety-net populations with HCV, sex-specific and ethnicity-specific disparities in successful LTC were observed. Successful LTC following HCV diagnosis was highest among women, African Americans, and Asians.
945 Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma in the U.S.: Exploring Trends Since 2001
Authors: Raed Anas , Bhagatwala Jigar , Hudgi Amit , Sherid Muhammed , Sifuentes Humberto , Sharma Amol , Sridhar Subbaramiah
Published: October 2019

INTRODUCTION:

The combined mortality from hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) is rising worldwide and expected to uptrend. We aimed to evaluate incidence trends of these two cancers over last 15 years in the US population.

METHODS:

Data was extracted from National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) for the period 2001-2015. Age-adjusted incidence and annual percent change (APC) were calculated to examine trends based on type of LC, gender, and race. SEER Stat software was used to analyze this data.

RESULTS:

There were 334,617 cases of both types of cancers from 2001 to 2015, of which 89.2% had hepatocellular carcinoma. Total of 71.4% were males, 76% Caucasians, 14.2% African Americans and 9.8% were others. There was significant uptrend in the incidence rates of these cancers for period of 2001-2015 with APC 3.6 (CI: 3.2, 4.0) (Figure 1). The rise in incidence of ICC were higher than HCC with APC of 7.1 (CI: 6.1, 8.2), 3.2 (2.6, 3.8), respectively (Table 1). Males had higher increase in HCC with APC of 3.2 (CI: 2.6, 3.8), and females had higher risk for ICC with APC 7.6 (CI: 6.4, 88.) (Table 2). Caucasians had the highest APC of combined cancers 3.9 (3.5, 4.3). The APCs were trending up for HCC & ICC among all races except in other race, that showing APC was trending down -0.5 (CI: -1.0, -0.1).

CONCLUSION:

Our data reveal alarming rise in the incidence rates, for both HCC and ICC, separately and combined. Males and females differ in the rising trends of these cancers and all races appear to harbor rise in the cancer incidence. Identifying and treating risk factors are crucial to prevent this fatal disease.
947 Lusutrombopag for Treatment of Thrombocytopenia in Patients With Chronic Liver Disease Who Are Undergoing Planned Invasive Procedures: Pooled Safety Analysis of Bleeding-Related Adverse Events
Authors: Giannini Edoardo G. , Kano Takeshi , Ochiai Toshimitsu , Bentley Roy , Shrestha Pomy
Published: October 2019

INTRODUCTION:

Thrombocytopenia is a common complication in patients with chronic liver disease. A low platelet count in chronic liver disease patients who require an invasive procedure is a serious condition that may be associated with an increased risk of bleeding during or after the procedure. Lusutrombopag is a thrombopoietin receptor agonist approved in Japan (2015) and the US (2018) for treatment of thrombocytopenia, and in the EU (2019) for severe thrombocytopenia, associated with chronic liver disease in patients undergoing a planned invasive procedure. A pooled safety analysis was performed to assess differences in bleeding events following treatment with lusutrombopag without platelet transfusion or placebo with platelet transfusion.

METHODS:

Safety data were pooled from 3 double-blind, placebo-controlled studies, in patients with thrombocytopenia associated with chronic liver disease undergoing a planned invasive procedure (Phase 2b: M0626 [Japan; JapicCTI-121944]; Phase 3: L-PLUS 1 [Japan; JapicCTI-132323], L-PLUS 2 [global; NCT02389621]). Patients enrolled in these studies were randomized to lusutrombopag 3 mg or placebo for up to 7 days prior to procedure. Platelet transfusion was administered if platelet count was < 50 × 109/L no more than 2 days prior to procedure. Patients were classified into 1 of 4 subgroups: lusutrombopag alone or +platelet transfusion or placebo alone or +platelet transfusion. This analysis focused on patients in the lusutrombopag alone and placebo + platelet transfusion subgroups. Bleeding events were summarized pre-, during, and post-procedure.

RESULTS:

Lower bleeding event rates, regardless of severity and timing of onset, were observed for lusutrombopag alone vs placebo + platelet transfusion (Table 1). Percent of patients with bleeding events was numerically higher with placebo + platelet transfusion vs lusutrombopag alone, both during (4.8% vs 3.2%) and post-procedure (7.1% vs 4.0%). Percent of patients with procedural and post-procedural bleeding events in liver-related procedures was greater in the placebo + platelet transfusion (16.1%) vs lusutrombopag alone (11.1%) arm, and a larger difference was seen with gastrointestinal-related procedures in the placebo + platelet transfusion (8.9%) vs lusutrombopag alone (2.0%) arm.

CONCLUSION:

In this pooled analysis, a trend toward lower bleeding event rates was observed with lusutrombopag alone vs placebo + platelet transfusion, regardless of type of invasive procedure.
948 Trends of Hospital Admissions and Healthcare Burden From Patients Admitted With Hepatic Encephalopathy
Authors: Siddiqui Mohammad A. , Shabbir AImun , Shabbir Nawal , Haq Khwaja F. , Jafri Syed-Mohammed
Published: October 2019

INTRODUCTION:

Hepatic encephalopathy (HE) develops in about 50% of patients with cirrhosis and is one of the features of decompensated cirrhosis. It causes substantial mortality and utilization of resources. We aimed to study the trends of admission rates and mortality rates over time of patient admitted with HE on a large national sample database.

METHODS:

The National Inpatient Sample database which is collected as part of Agency for Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized. Individuals aged over 18 were included. The hospitalizations with primary diagnosis of HE were captured by ICD-9 codes. Data on patient age, length of stay, cost of hospitalization and inpatient mortality was extracted. Descriptive statistics were then run using the online software at HCUPnet.

RESULTS:

The total number of patient with HE presenting to the ED has an upward trend, year after year, increasing from 42687 ED visits in 2006 to 57578 in 2014. Total number of these patient being admitted to the same hospital has also steadily increased from 37966 in 2006 to 49079 in 2014. The length of stay has ranged from 5.2 days to 5.5 days over these years. The increasing mean cost of hospital stay, from 28797 in 2006 to 40669 in 2014, has further added to the health care burden. The percentage of deaths during these hospitalizations from HE has declined from 7.4% in 2006 to 4.6% in 2014.

CONCLUSION:

In-patient admissions with HE represent a significant health care burden given increasing cost of hospitalization. Though the trend of mortality rate is decreasing over time, efforts need to be under taken to optimize outpatient care to avoid admissions.
960 Revised Lille Score for Predicting 90 Days Mortality in Severe Alcoholic Hepatitis
Authors: Majeed Muhammad , Agrawal Rohit , Attar Bashar M. , Wang Yuchen , Vohra Ishaan , Haque Zohaib , Gandhi Seema
Published: October 2019

INTRODUCTION:

Iron is an essential micronutrient which circulates bound to transferrin for tissue distribution. Liver is the main site for transferrin synthesis and its dysfunction can alter iron homeostasis resulting in oxidative stress. Recent studies showed that transferrin saturation is an independent predictor of mortality in patients with decompensated cirrhosis. We aim to evaluate the prognostic efficacy of transferrin saturation and revised Lille score to predict 90-days mortality in patients with severe alcoholic hepatitis.

METHODS:

We retrospectively reviewed the electronic medical records of patients diagnosed with severe alcoholic hepatitis (SAH) who received prednisolone therapy. Demographic and biochemical data at diagnosis and day 4 was collected. Univariate logistic regression for all variables included in Lille score along with ferritin and transferrin percent was performed. A revised Lille score was created based on results of univariate analysis. The efficacy of revised Lille score was then tested against Lille score on day 4 with receiver operating characteristics (ROC) analysis and Kaplan-Meier survival analysis by dichotomization per optimal cut-offs.

RESULTS:

In our cohort of 80 patients with SAH, 12(13.3%) patients died within 90 days. Apart from all parameters included in the Lille score, transferrin saturation was identified as an independent predictor of 90-days mortality on univariate analysis (Table 1). Revised Lille score was generated by the formula mentioned below. The ROC analysis for the prediction of 90-day mortality of Day 4 revised Lille score revealed a higher AUC of 0.8419 in comparison to Day 4 Lille score that had a lower AUC of 0.6985 (Table 1). With the optimal cut-off value of 5, the revised Lille score sub-classified patients into low and high-risk (HR = 21.05, P < 0.004) groups (Figure 2). Revised Lille score = 2.15 × Lille score + 0.06 × Transferrin saturation

CONCLUSION:

In conclusion, revised Lille score at fourth day can be utilized to predict mortality at 90 days. When using a cut-off of 5, patients can be subclassified into low and high-risk groups with a sensitivity and specificity of 97.95% and 35.48 respectively. We propose that revised Lille score should be compared with Lille score in predicting outcomes in SAH. Moreover, patients with elevated transferrin saturation have a high mortality.
961 Striatal GABA Levels in Liver Cirrhosis Patients: Preliminary Results
Authors: Zupan Gasper , Stefanovic Sebastian , Jerovsek Marjanca Turk , Stabuc Borut , Oeltzschner Georg , Ropele Stefan , Vovk Andrej , Suput Dusan
Published: October 2019

INTRODUCTION:

Liver cirrhosis (LC) is a worldwide public health problemthat represents an important cause of death in adults. One of the complications of LC is hepatic encephalopathy (HE). HE is sometimes challenging to detect as it can present as subtle cognitive impairment. Alterations of gamma-aminobutyric acid (GABA) levels in various brain regions were demonstrated in HE (1–3), however, changes of GABA levels in the striatum, a critical element of the motor, reward and executive systems, have not been yet reported. This pilot study focuses on the detection of GABA in the striata in LC patients with various degrees of cognitive impairment.

METHODS:

Six patients (2 females, mean age: 59.6 ± 8.4) with clinically diagnosed LC (all due to alcohol overconsumption) and seven (6 females, mean age: 53.9 ± 9.3) healthy subjects (HC) were included in this study. T1- and T2-weighted images were acquired to place two 35 × 25 × 25 mm voxels for MEGA-PRESS (4) MR spectroscopy in the left and right striatum. Data processing and quantitative analysis was performed in Gannet 3.0 (www.gabamrs.com). GABA levels were calculated with respect to the tissue water signal and corrected for tissue composition. Stroop test scores, psychometric hepatic encephalopathy score (PHES), Mini-Mental State Exam (MMSE) scores and venous blood ammonia levels were determined on the day of MR scanning.

RESULTS:

In left striatum, mean GABA levels were 3.5 ± 1.0 i.u. and 5.3 ± 0.8 i.u. in LC and HC group, respectively (P < 0.05). In right striatum, mean GABA levels were 4.8 ± 1.4 i.u. and 4.6 ± 0.81 i.u. in LC and HC group, respectively (P > 0.05). A negative correlation between the overall time needed for PHES completion and GABA levels in left striatum was demonstrated (r = -0.7, P < 0.05). No statistically significant correlations between response time of Stroop test, ammonia and GABA levels were noted for either voxel. MMSE did not significantly differ between groups.

CONCLUSION:

In this pilot study, decreased left striatal GABA levels were demonstrated in LC vs. HC group. This study was limited with number of enrolled subjects: continuation of this study and further stratification of patients in subgroups (accordingly to cognitive impairment) could potentially result in a model of predicting development of cognitive impairment in LC before presence of evident clinical signs.
963 Treatment Failure With Daclatasvir Plus Sofosbuvir With or Without Ribavirin in Treatment Naïve Patients With Chronic Hepatitis C Without Cirrhosis
Authors: Afzal Muhammad , Tarar Shahida Husain , Ali Shah Syed Muhammad , Butt Zamir , Ajmal Muhammad , Younis Irfan , Talat Syed Usama , Akhtar Hina , Ali Javeria
Published: October 2019

INTRODUCTION:

Chronic hepatitis C treatment has been transformed by advent of DAAs. Pakistan is one of worst affected country with hepatitis C with recent suggested prevalence of 4.9%. Current AASLD guidelines recommend treatment with daily sofosbuvir plus daclatasvir with or without addition of weight based ribavirin. However this regimen is not first line recommendation. These drugs are available free of cost in government run setups. However it has raised questions about treatment failure with them and need for other DAAs.

METHODS:

This cross-sectional study is being conducted at ABSTH Gujrat from Oct. 2018 after approval of IRB and informed consent of patients using non-probability consecutive sampling. No genotyping is being done. Cirrhosis is considered when abdominal ultrasound shows coarse echotexture of liver as either Shear Wave Elastography or Fibroscan are not available. Treatment naive chronic hepatitis C patients without cirrhosis are being included. Patients on PCR testing having viral load of <400000 IU/L are being considered to have low viral load and are being given 12 weeks regimen of daclatasvir plus sofosbuvir. Patients with having viral load of >400000 IU/L are being considered to have high viral load and are being prescribed 24 weeks regimen of daclatasvir plus sofosbuvir with weight based ribavirin. ETR and SVR24 at 24 weeks are being noted. Patients who fail to achieve SVR24 after achieving ETR are being declared as treatment failure. Data analysis is being done using SPSS 20.0.

RESULTS:

1073 patients have been included this study till now. Mean age is 46.01 + 11.50 years. 712(66.4%) are female and 361(33.6%) are male. 729(67.9%) patients with low viral load received daclatasvir plus sofosbuvir for 12 weeks while 344(32.1%) patients with high viral load received daclatasvir, sofosbuvir and weight based ribavirin for 24 weeks. ETR and SVR24 have been reported of 163(15.2%) patients till now. All these patients achieved ETR however only 161 patients achieved SVR24. One patients had high viral load while other had low. Treatment failure rate is 1.23% till now but exact figure can only be predicted after completion of study as more results are awaited.

CONCLUSION:

Treatment failure rate in treatment naive chronic hepatitis C patients without cirrhosis with daclatasvir plus sofosbuvir with or without ribavirin is low. Similar results have been reported previously. However these preliminary results show that there is need to investigate the factors leading to treatment failures.
964 Patient Flow Across Physician Specialties Over the Course of the Hepatitis C Care Cascade: A Real World Analysis From the United States
Authors: Rege Sanika , Gonzalez Yuri Sanchez , Marx Steven , Reau Nancy
Published: October 2019

INTRODUCTION:

Hepatitis C virus (HCV) infection is a major cause of hepatic and extrahepatic morbidity and mortality. In spite of recommendations for HCV screening, diagnosis, linkage to care and treatment, significant gaps remain in the cascade of care for HCV. As the role of physician specialties for closing these gaps is poorly understood, this study assesses the flow of HCV patients across physician specialties in the US, over the course of the care cascade.

METHODS:

This retrospective real-world study used two large de-identified national laboratory datasets (2013–2016). Screened patients had a HCV antibody (AB) test and/or HCV RNA viral load test. Diagnosed patients had a positive HCV RNA viral load test, and among this group, fibrosis assessment, genotype test and treatment were evaluated. Treatment was inferred with an algorithm based on changes in viral load. The number/proportion of patients at each step in the care cascade was calculated by physician specialty. Patient flow by physician specialty over the course of care cascade was assessed using Sankey Diagrams.

RESULTS:

Approximately 17 million patients received HCV screening, and 913,529 were diagnosed. Over the course of the care cascade, there was an increase in the proportion of patients switching to HCV specialists (gastroenterologist, hepatologist, and infectious disease specialist). Generalists (primary care, family practice, internal medicine) ordered 37% of the AB tests, and 15% initiated treatment. HCV specialists ordered 3% of screening tests and 37% initiated treatment. Most of the fibrosis assessment (30%) and genotype tests (29%) were ordered by HCV specialists. Obstetricians/gynecologists ordered 11% of screening tests but only 0.3% initiated treatment. Among 974,277 patients who received a positive AB test, 46% did not receive a confirmatory RNA test. Among diagnosed patients, 57% did not receive fibrosis assessment, 47% did not receive genotype test and 90% did not receive treatment.

CONCLUSION:

Generalists account for more than one third of all HCV screening tests, however, HCV specialists play a more prominent role in patient assessment (fibrosis status, genotype testing) and treatment. Significant gaps remain in all stages of the cascade of care for HCV, and improved efforts are needed for every physician specialty to address them. Timely screening, monitoring and linkage to care by generalists coupled with early treatment by specialists could effectively reduce the hepatic and extrahepatic burden of HCV.
966 Minimal Hepatic Encephalopathy and Driving
Authors: Dwivedi Sankalp , Balagoni Harika , Putrus Alan , Tapper Elliot , Piper Marc
Published: October 2019

INTRODUCTION:

Minimal hepatic encephalopathy (MHE) is a well-known complication of cirrhosis that is difficult to detect. Patients with MHE have deficits in multiple domains that may lead to motor vehicle accidents (MVAs). Clinicians have little guidance on how to manage driving recommendations in this setting. We conducted a systematic review to find studies that indicated the prevalence of MVAs in patients with MHE, testing available to identify such patients, and interventions that may improve the surrogate measures of driving in patients with MHE.

METHODS:

A systematic review of full-text studies reporting the prevalence of MVAs in patients with MHE, along with testing and treatment options in this setting. Two librarians searched PubMed from inception to January 2018 using the keywords liver cirrhosis, hepatic encephalopathy (HE), automobile driving and accidents along with related synonyms. Studies were excluded if the patients had overt HE, non-liver related HE, and non-automobile accidents. Three reviewers independently extracted data from each study including study design, year of data collection, location, exclusion criteria, prevalence, diagnosis and treatment options.

RESULTS:

162 studies were identified, of which 15 met the inclusion criteria, comprising of 1379 patients. Studies were from US(8), Germany(3), Sri Lanka(1), Egypt(1), Japan(1) and Spain(1). Seven articles discussed how often patients with MHE had MVAs, which were conducted as either prospective(5) or survey studies(2) that relied on self-reported and transportation data. These studies suggest that 13–50% of patients with MHE had MVAs. Regarding testing, 10 studies discussed the diagnostic modalities available, including driving simulators(3), inhibitory control tests (ICT)(2), driving instructor(2), smartphone app(1) and Psychometric HE Reliability Score(1). Of these, ICT test was the most predictive. Two studies discussed the treatment modalities. Rifaximin showed improvement in avoiding total driving errors (76%vs31%; P = .01) and branched chain amino acid (BCAAs) significantly improved driving capacity vs placebo (median score of 2 vs 4, P < 0.01) with lower scores indicating the fitness to drive.

CONCLUSION:

Patients with MHE are at significant risk for MVAs. There are several testing modalities to assess driving fitness in patients with MHE. Rifaximin and BCAAs improved fitness to drive in MHE patients. Future studies are needed to help guide clinicians on how to best provide driving recommendations in patients with MHE.
967 Sex Differences in the Utilization of Bariatric Operation for NAFLD
Authors: Gupta Kamesh , Khan Ahmad , Goyal Hemant
Published: October 2019

INTRODUCTION:

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in the developed world. Bariatric surgery is the most validated method for achieving significant, sustained weight loss and has shown to decrease the grade of steatosis.

METHODS:

We utilized the Nationwide Inpatient Sample database from 2004 to 2014 to identify all hospitalized adult patients with a history of NAFLD and patients who underwent bariatric surgery. We excluded NAFLD patients who had a diagnosis code for cirrhosis, alcoholism, viral hepatitis, or metabolic liver disorders. Age, race, insurance, and hospital characters were computed on the basis of sex.

RESULTS:

Our study included 92,293 NAFLD‐related hospitalizations, of which 36787 patients (39.8%) were female. A total of 710 bariatric surgeries were performed from 2004–2014 on patients with NAFLD. Of these, 590 (83.1%) were women. In the general population without NAFLD too, the procedure was more common in females (76.09%, n = 956,186) than males (23.91%, n = 300,500). In the patient population of NAFLD patients undergoing the surgery, females were less likely to have coexisting weight-related illnesses such as hyperlipidemia (46.5% vs 49.0%, P = 0.02), hypertension (49.2% vs 63.7%, P = 0.00), sleep apnea (46.1% vs 53.0%, P = 0.00), hypertension (51.7% vs 44.6%, P = 0.486). Demographic data showed that the female subgroup was significantly younger (43.0 vs 49.7 years, P = 0.01), and more commonly admitted in Midwest (21.5% vs 16.8%) and Western states (29.3% vs 15.2%). No significant differences were noted in the race, income quartile or insurance of the patients. The odds ratio for being a female NAFLD patient versus a male undergoing the procedure was +5.84 (P = 0.00). In the whole study period, only 5 patients died during the hospitalization for bariatric surgery.

CONCLUSION:

Results from our study show that bariatric surgery is more popular amongst females with NAFLD versus males with NAFLD when adjusted for other factors. This discrepancy is even starker than the general bariatric population without NAFLD, where females are more prevalent too. Female patients with NAFLD were more likely to be younger and having lesser weight-related comorbidities than males at the time of the surgery. The increased utilization of bariatric surgery in the female NAFLD population could be driven by cultural factors and self-consciousness. Bariatric surgery has low mortality in NAFLD patients.
970 Thrombolytic Therapy for Acute Non-Malignant Portal Vein Thrombosis: A Systematic Review and Meta-Analysis
Authors: Doherty Bryan , Palmer William , Zhang Allison , Briggs William M. , Marks Lisa A. , Mohanty Smruti R.
Published: October 2019

INTRODUCTION:

Acute portal vein thrombosis (PVT) is a rare diagnosis frequently associated with cirrhosis. Clinical presentation is typically nonspecific with potentially catastrophic short-term complications including sepsis, bowel infarction, and death. Management strategies differ for acute and chronic PVT. Guidelines for treating acute PVT recommend immediate initiation of systemic anticoagulation. Direct and indirect thrombolytic therapy (mechanical thrombectomy and fibrinolytic therapy) may be used in combination with systemic anticoagulation in the setting of bowel ischemia or as an adjunct in patients with a contraindication to systemic anticoagulation. We aimed to assess the success of thrombolytic therapy for non-malignant acute PVT and to compare the success of direct versus indirect thrombolytic therapy.

METHODS:

This was a systematic review and meta-analysis in which two independent librarians searched the following databases from the date of inception to March 2019: Ovid Medline, Ovid Embase, Scopus and Web of Science. All included studies provided technical and clinical success data, as well as adverse events, and technique(s) used for the intervention of non-malignant acute PVT.

RESULTS:

The two independent database searches yielded 143 citations, of which 79 duplicates were removed leaving a total of 64 references and 11 were included in our analyses. The overall success rate of thrombolytic therapy using the random effects model was 83% (95%CI: 0.67, 0.92; P = <0.01; I 2 = 61%). The overall clinical improvement rate of thrombolytic therapy using the fixed effects model was 95% (95%CI: 0.88, 0.98; P = 0.73; I 2 = 0%). The overall mortality of thrombolytic therapy using the fixed effects model was 5% (95%CI: 0.03, 0.11; P = 0.92; I 2 = 0%). In the direct and indirect thrombolytic groups, the rate of technical success was 84% and 52%, respectively, with an odds ratio of 3.37 (95%CI (0.96, 7.67), P-value = 0.127).

CONCLUSION:

Our analysis demonstrates that thrombolytic therapy successfully eliminates non-malignant acute PVTs with low rates of mortality. Direct thrombolysis may produce increased efficacy compared to indirect thrombolytic therapy. Larger prospective randomized trials comparing these interventions are warranted.
972 Predicting Transplant Free Survival in Patients With Hepatocellular Carcinoma Undergoing Locoregional Therapy
Authors: Thandassery Ragesh , Lavender Charles A. , Rude Katie , Burdine Lyle , Beheshti Michael
Published: October 2019

INTRODUCTION:

Recently a few scoring systems have been proposed to predict survival in patients with hepatocellular carcinoma (HCC) undergoing locoregional therapy (LRT). We aimed to compare the NIACE score (tumor Nodularity, Infiltrative tumor, serum Alpha-fetoprotein level, Child-Pugh stage, ECOG performance status), hepatoma arterial embolization prognostic score (HAP), and ABCR score (alpha-fetoprotein, BCLC, change in Child-Pugh stage and radiological response after LRT) with Barcelona Clinic Liver Cancer (BCLC) staging in predicting transplant free survival (TFS) in patients with HCC undergoing LRT.

METHODS:

In a multi-centric United States veteran cohort, we retrospectively analyzed 207 patients who had undergone LRT between January 2012 and March 2019. Pre LRT NIACE and HAP scores and post LRT ABCR scores were calculated for all subjects. Kaplan Meier plots were created to identify sub groups with different TFS within individual BCLC stages.

RESULTS:

The mean age was 65.6 ± 6.3 years (73.4% Caucasians and 26.6% African Americans). Mean MELD-Na score at the time of first LRT was 14.3 ± 7.2. Predominant etiology of liver disease was nonalcoholic fatty liver disease (52.6%) followed by combination of alcohol and hepatitis C virus (18.4%). 65 (31.4%), 42 (20.3%), 84 (40.6%) subjects had BCLC A, B and C disease stages respectively. 146 (70.5%) underwent transarterial chemoembolization (TACE), 12 (5.8%) underwent ablation, and 42 (20.3%) underwent trans arterial radioembolization as first LRT. After a median follow-up of 15.2 months, the overall TFS was 34.6%. BCLC stages A, B and C had 47.5%, 26.3% and 26.2% TFS respectively. In the BCLC B cohort (Figure 1) only NIACE score (at cut off > 1) identified subgroups with significant difference in TFS (52.9% vs. 5.3%, P < 0.001). In BCLC C cohort, HAP score (at cut off > 2; 37.2% vs. 13.9%, P = 0.002) and ABCR score (at cut off > 2, 83.3% vs. 40.5%, P = 0.03) identified subgroups with different TFS. In BCLC A cohort none of these scores identified sub groups with differential TFS. On separate analysis of subjects undergoing TACE, all three scores identified subgroups with differential TFS (Table 2).

CONCLUSION:

In patients with HCC undergoing LRT, the BCLC B and C stages encompass patients with variable TFS. NIACE score for BCLC B, and HAP and ABCR scores for BCLC C refine differential prognosis and identify subgroups with different TFS. These scores should possibly be incorporated into treatment allocation.
978 Prolonged Survival With Radioembolization Using Theraspheres in Unresectable HCC
Authors: Mantry Parvez , Thompson Mallory , Khanna Prachi , Acharya Priyanka , Shahin Islam
Published: October 2019

INTRODUCTION:

Selective Internal Radiation Therapy (SIRT) with Yttrium 90 using glass beads (Theraspheres) is increasingly being used for the treatment of unresectable Hepatocellular carcinoma approved by the FDA as a Humanitarian Device (HUD exemption). We are presenting data on 70 patients at our center (out of 130) that have undergone this procedure successfully and reporting their outcomes/survival/tolerability and factors impacting survival.

METHODS:

We retrospectively analyzed the charts of 70 patients that underwent SIRT with Theraspheres at our institution from jan 1, 2014 to jan 1, 2019.We performed descriptive statistics on these patients using SAS.

RESULTS:

Demographically 46/70 patients were male. 50% were caucasian, 20% African american and 16% Hispanic. The median age was 64.5 years. In our cohort, Alcohol and HCV infection were responsible etiologies in 77% of all the cancers. 17% patients had NASH as the etiology. 43% of patients had a solitary tumor while 30% had 2 tumors and the remaining 3 or more treatable lesions. The median total tumor diameter was 5.2 cm. 37% of the tumors were bilobar. 39% patients had main or branched portal vein thrombosis (PVT). 65% of the patients had Child's Pugh A cirrhosis while 31% were CPB. Median MELD score was 8. BCLC subdivision was as follows - A (31%), B (41%), C 24%) and D(4%). 67% patients underwent single treatment while 28% patients had 2 treatments done.The dose ranged from 10–110 mci with 50 mci being the median dose. In terms of tumor response, 54% patients had complete response (CR) while 20% had partial response (PR) and 16% had progressive disease (PD) per modified RECIST criteria. Adverse events requiring an intervention were seen in 10% patients.Overall survival is shown in graph below. Mean survival was 14.6 months

CONCLUSION:

In our analysis, SIRT with theraspheres is a safe effective modality of treating patients with advanced HCC even in the setting of multifocal disease with 40% patients having portal vein thrombosis. The median survival was over 12 months with CR seen in 57% patients. Further analysis of our complete data will shed more light on these calculations.
979 MicroRNAs and Biomarkers Clinic as Survival Predictor in Hepatocellular Carcinoma
Authors: Ratnasari Neneng , Renovaldi Dede , Ningsih Juwita Raditya , Lestari Puji , Qoriansas Nanda , Heriyanto Didik Setyo , Indrarti Fahmi , Triwikatmani Chatarina , Bayupurnama Putut , Haryana Sofia Mubarika
Published: October 2019

INTRODUCTION:

Clinical biomarkers can predict disease progression and clinical outcomes due to inflammation process. Circulating miRs can predict disease progression, therapeutic response and patient survival. Aims of study: to evaluate 1 year survival rate based on regulation miRs (miR29c, miR21, and miR155) plasma and clinical biomarkers [neutrophil to lymphocyte ratio/NLR, platelet to lymphocyte ratio/PLR, α-fetoprotein/AFP] in Hepatocellular Carcinoma (HCC) patients.

METHODS:

The longitudinal cohort design was conducted in 29 HCC patients. Subjects were recruited from Dr.Sardjito General Hospital, Yogyakarta, Indonesia during the year of 2012 until 2018. Outcome of the study was survival rate after enrolled the study until 12 months observation. All subjects were enrolled using criteria: MSCT 4 phases and histology examination. Exclusion criteria: co-morbidity with other malignancy. Blood sample collection was treated as follows: (1)plasma isolation, RNA isolation, cDNA synthesis, and quantification by qRT-PCR; (2)blood examination to determine NLR, PLR, and AFP. The miR's plasma level was analyzed by BioradCFX Manager96 software to determine Cq, the calculation of expression levels using Livak's methods. Hazard Ratio and Kaplan Meyer curve were analyzed using STATA 11.0.

RESULTS:

Baseline data: median of age 53 year old (min29; max74), 62.07% male, etiology [58.62% HBV, 6.90% HCV] and BCLC criteria [31% B, 59% C, 10% D], and 48% treated by TACE/TAE respectively. miR29c might be act as tumor suppressor, and the opposite, miR21 and miR155 as oncogene. The HRs were calculated using cutoff for each variable (miR regulations, NLR ≥ 4, PLR ≥ 165.83, PLR-tertile ≥ 292.40, and AFP ≥ 200). Down-regulation miR29c was the most dominant predictor for survival rate (HR = 4.88), while up-regulation miR155 was the second predictor (HR = 1.31). Most of clinical biomarkers showed HR < 1. The Kaplan Meier curve can be seen at Figures 1 and 2

CONCLUSION:

Plasma miR was detected easily and stable. miRs regulation were played a role in tumor tissues dysregulation, tumor suppressors, or oncogenes. Thus, miRs can be used as diagnostic, targeting therapy and prognostic markers in HCC patients. Down-regulation miR29c as a tumor suppressor and up-regulation miR155 as an oncogene might be potential variable predictor for survival rate in HCC patient compared with miR21 and clinical biomarkers.
980 Renal Resistive Index at the Level of Renal Arcuate Artery as a Predictor of Natriuresis in Cirrhotic Patients
Authors: Ul Haque Muhammad Manzoor , Mehmood Nasir , Ahsam Salman , Farid Muhammad , Yaseen Raja Taha , Luck Nasir Hassan , Tulsi Rani , Khan Shoaib Ahmed , Majid Zain
Published: October 2019

INTRODUCTION:

It has been postulated that the vasoconstriction at the level of renal arcuate artery plays a key role in the development of Hepatorenal syndrome(HRS). However, the measure of renal resistive index at the level of renal arcuate artery can provide a direct measure of renal hemodynamics among cirrhotics. The aim of this study is to determine the difference in the renal resistive index amongst both compensated as well as decompensated cirrhotics and to evaluate its association with natriuresis.

METHODS:

This prospective study included all consecutive cirrhotic patients visited gastroenterology clinic of our hospital from May 2018 to May 2019. After obtaining informed consent, the demographic parameters were noted along with a detailed drug history (Dose and duration of diuretics and beta blocker). Later on an ultrasound abdomen was also performed for documenting the features of chronic liver disease and the renal resistive index was noted. These patients were then stratified into two groups i.e. compensated cirrhosis and decompensated cirrhosis. Chi square test was applied and P value was calculated.

RESULTS:

A total of 60 patients were included in the study. The mean age of the patients was 40.3 ± 18.1, and were predominantly males 31(51.7%). Hepatitis C was the most common etiology for liver disease seen in 22 patients (36.7%).The mean CTP score, MELD and MELD sodium score were as follows: 7.9 ± 1.93, 15.2 ± 6.6 and 13.3 ± 4.2 respectively. Compensated liver disease was present in 16(26.7%) patients, while decompensated liver disease was present in 44(73.3%) patients. Mean renal resistive index of patient with compensated cirrhosis was 0.59 ± 0.04, while with decompensated cirrhosis was 0.62 ± 0.04. Patients with a higher RI had poor natriuresis as manifested by low urinary sodium potassium ratio < 1.0 and AROC is 0.775. At the cut off value of RI = 0.615 sensitivity, specificity, positive predictive value and negative predictive value for nartriuresis was 65.0%, 70.0%, 73.3% and 60.1% respectively. Patient with higher RI value were having decompensated cirrhosis (P = 0.06, 0.62 vs 0.59)

CONCLUSION:

The renal resistive index at the level of arcuate artery were found to be higher among patients with decompensated cirrhosis. At a higher RI value ( >0.615) patients had poor natriuresis. Therefore, RI can be used to predictor of natriuresis among cirrhotic patients. Key words:
983 A Three-Decade Analysis of Oral and Oropharyngeal Malignancy Following Liver Transplantation
Authors: Al Nimri Sarah M. , Corral Juan E. , Al Nimri Lana , Wijarnpreecha Karn , Patel Arpan , Mousa Omar Y.
Published: October 2019

INTRODUCTION:

Immunocompromised liver transplant (LT) recipients are at increased risk of de novo malignancy. Data regarding oral and oropharyngeal malignancy following liver transplantation is limited, and recommendations for oral cancer screening are lacking. The impact of these malignancies on patient survival in the United Network for Organ Sharing (UNOS) database has not been assessed. We aim to evaluate the rates of oral and oropharyngeal malignancy among LT recipients in the US and estimate patient survival.

METHODS:

We examined the UNOS database and identified patients with oral and oropharyngeal malignancy who underwent LT between 1988 and 2016. Patients greater than 18 years of age were included. Kaplan-Meier survival analysis and log-rank tests were performed.

RESULTS:

In the UNOS database, survival data regarding 142,488 patients was available and the cause of death was identified in 14,533 LT recipients.83 patients had oral and oropharyngeal malignancy. 23 patients had cancer of the tongue and floor of the mouth. Mean age 55 years (SD ± 8), mean BMI 26 (SD ± 4), males were 74%, white 83%. 49 patients had tonsillar and oropharyngeal cancer. Mean age 54 years (SD ± 7), mean BMI 25 (SD ± 4), males were 86%, white 80%. 11 patients had oral and palate cancer. Mean age 56 years (SD ± 6), mean BMI 26 (SD ± 5), males were 55%, white 100%. Compared to all LT indications, those who developed oral and oropharyngeal malignancy were more likely to have alcoholic liver disease (P < 0.001). The mean patient survival time in the study population ranged between 5 and 7.5 years. However, patient survival was significantly lower among patients who developed oral and oropharyngeal malignancy compared to other LT recipients (Log-rank test, P < 0.001) (Figure 1).

CONCLUSION:

Analysis of the UNOS database showed that oral and oropharyngeal malignancy is more common among male recipients with a history of alcoholic liver disease. Better outcomes should be expected if such patients were diagnosed earlier, prolonging their life expectancy. Having a history of heavy alcohol use should raise awareness among dentists, gastroenterologists and transplant physicians regarding the increased risk of oral cancers after LT.
985 Racial Difference in the Clinical Features of Non-Alcoholic Fatty Liver Disease
Authors: Qiu He , Shi Michelle , Kyaw May , Sultan Gwyneth , Lee Tai-Ping
Published: October 2019

INTRODUCTION:

Nonalcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis in the absence of significant alcohol consumption. It is the most common liver disease in Western industrialized countries, characterized by excessive accumulation of triglycerides in hepatocytes. The spectrum of conditions ranges from benign hepatic steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and increased risk of hepatocellular carcinoma (HCC). There has been limited study of Asian Americans with NAFLD comparing to the other races. Our study aims to assess the racial difference in clinical features of NAFLD patients.

METHODS:

We conducted a retrospective chart review of patients age ≥ 18 years and < 90 years with NAFLD followed at Sandra Atlas Bass Center for Liver Disease from 2013 to 2018. Patients with co-existing chronic liver disease or significant alcohol consumption (men > 21 drinks/week, women > 14 drinks/week) were excluded. Clinical data including demographics, anthropometrics, comorbidities, laboratory results, Fibrosis-4 (FIB-4) index, and FibroScan were collected and analyzed. Analysis of variance and Pearson’s chi-squared test were used to analyze continuous variables and categorical variables, respectively.

RESULTS:

We identified 342 patients with NAFLD. We analyzed 289 patients including 209 Caucasians (72.3%), followed by 38 Hispanics (13.2%), 26 Asian Americans (9%), and 16 African Americans (5.5%). There is no difference in age, gender, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipid profile, blood pressure, steatosis score, FIB-4 index, and fibrosis stage among these four groups. However, Asians are less likely to be obese (26% BMI ≥ 30, vs. 66.5%, 62.5% and 60.5% for Caucasians, Africans, and Hispanics, respectively; P = 0.001); yet, they are more likely to have elevated hemoglobin A1c (HA1c) (100% with HA1c >5.6% vs. 63.3%, 62.5% and 84% for Caucasians, Africans, and Hispanics, respectively; P = 0.0002).

CONCLUSION:

Our study suggests that Asian Americans with the diagnosis of NAFLD are less likely to be obese but are more likely to have elevated hemoglobin A1c compared to the other racial groups. The difference observed in this study raises the possibility that the Asian Americans may be different from that among the other racial/ethnic groups in the pathogenesis of NAFLD. Further research is warranted to assess the detailed relationship and possible mechanisms between HA1c and NAFLD.
988 Severe Thrombocytopenia Predicts Lower Survival Rate and Higher Transplant Rate in Patients With Liver Cirrhosis
Authors: Moore Andrew , Jensen Donald , Reau Nancy , Wu Andy
Published: October 2019

INTRODUCTION:

Thrombocytopenia (TMP) is one of the most common hematologic abnormalities seen in patients with chronic liver disease and cirrhosis. TMP is largely due to two factors: decreased thrombopoietin production and splenic sequestration due to portal hypertension. We hypothesized that the most severe TMP would have a significant impact upon survival. Since the current MELD-Na score does not factor these components, we sought to compare ‘marked’ (25K-50K) and ‘severe’ (<25 K) TMP with MELD-Na score and 90 day survival.

METHODS:

A retrospective study was conducted and identified 131 patients at a tertiary academic institution between 7/12016 and 7/1/2018 who had a diagnosis of cirrhosis (any-cause) and a platelet count < 50 K. Patients were then divided as ‘marked’ TMP or ‘severe’ TMP based on the lowest platelet count. Age, BMI, sodium, creatinine, total bilirubin, INR, hemoglobin, and white blood cell count at the time of the lowest platelet value were also recorded and compared. Mortality between the two groups was compared using Kaplan-Meier curves, and survival models were created using multivariate proportional hazard models with an endpoint of death/transplant at 90 days.

RESULTS:

Of the 131 patients identified with a platelet count of <50 K, 107 were included in the study (24 were excluded; 6 received transplant prior to lowest platelet count and 18 were lost to follow-up at 90 days). 74 were identified as ‘marked’ TMP and 33 were identified as ‘severe’ TMP. In the ‘marked’ TMP group, there were 22 deaths (29.7%) at 90 days, while in the ‘severe’ group there were 23 deaths (69.7%) at 90 days (HR 2.56, 95% CI 1.87-3.24, P = 0.0078). In the <25 K group, 3 patients (9.1%) had a transplant prior to 90 days. In the 25–50 K group, one patient (1.4%) underwent transplant prior to 90 days. The survival rate between the two groups at 90 days was statistically significant (P < 0.0001). MELD-Na score was not significantly different between the two groups (21.84 vs 23.61, P = 0.12).

CONCLUSION:

Despite similar MELD scores, patients with severe TMP had a significantly decreased survival probability and higher rate of transplant at 90 days. Platelet count was a better predictor of mortality than MELD score among this subgroup of patients. Patients with severe thrombocytopenia had a mortality rate more than triple that predicted by MELD-Na score. Confirmation of this important finding in a larger patient population and delineation of the role of TMP in outcomes require additional investigation.