studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1217A
2069
Impact of genetic variation of the AVP1a receptor on
the presence of circulatory failure in patients with acute
decompensation of liver cirrhosis or acute-on-chronic
liver failure
Annarein J. Kerbert 1 , Jelte Schaapman 1 , Johan van der Reijden 1 ,
Amorós Àlex 2 , Aiden McCormick 3 , Bart van Hoek 1 , Vicente
Arroyo 4 , Pere Gines 4 , Rajiv Jalan 5 , Victor Vargas 6 , Rudolf E.
Stauber 7 , Hein W. Verspaget 1 , Minneke Coenraad 1 ; 1 Gastroenterology-Hepatology,
Leiden University Medical Center, Leiden,
Netherlands; 2 Data Management Center, CLIF consortium, Barcelona,
Spain; 3 Gastroenterology-Hepatology, St Vincent’s University
Hospital, Dublin, Ireland; 4 Liver Unit, Hospital Clinic, University
of Barcelona, Barcelona, Spain; 5 Gastroenterology-Hepatology,
University College London, London, United Kingdom; 6 Liver Unit,
Hospital Vall d’Hebron, CIBERehd, Barcelona, Spain; 7 Internal
Medicine, Medical University of Graz, Graz, Austria
Background & aims: Acute-on-chronic liver failure (ACLF)
is defined as an acute decompensation of former stable
chronic liver disease (AD) accompanied by the presence of
organ failure and a high risk of short-term mortality. Systemic
hemodynamic derangement and activation of endogenous
vasoconstrictor systems are thought to contribute to the pathogenesis.
Arginine vasopressin is a key-regulator in hemodynamic
homeostasis and mediates splanchnic vasoconstriction
through the arginine vasopressin 1a receptor (AVP1aR). Aim
of the present study was to assess whether genetic variation of
AVP1aR is associated with the presence of circulatory failure
in patients with AD or ACLF. Methods: Eight single nucleotide
polymorphisms (SNPs) of AVP1aR with possible clinical relevance
were identified. From 824 cirrhotic patients admitted for
AD, clinical, laboratory and survival data were retrieved from
the CANONIC database. Presence of circulatory failure was
defined as a mean arterial blood pressure (MAP) < 70 mmHg
or the use of vasopressors. ACLF was defined according to
the CLIF Consortium Organ Failure score. All patients were
genotyped for all eight SNPs using polymerase chain reaction
(PCR) followed by restriction fragment length polymorphism
or PCR allele-specific amplification primers. Fisher’s exact test
and linear regression analysis were used to test for association
between allele frequencies and dichotomous and continuous
variables respectively. Results are shown as mean ± SD. P<
0.05 was considered statistically significant. Results: Patients
with ACLF (n=184) had a significantly lower MAP as compared
to patients without ACLF (80 ± 13 vs. 84 ± 12 mmHg,
p< 0.001). The use of vasopressors was also significantly more
frequent in patients with ACLF as compared to those without
ACLF (19.0% vs. 2.9%, p< 0.001). Circulatory failure was
present in 61 out of 824 patients, of whom 44 fulfilled the
criteria of ACLF. A C>T mutation in SNP rs7308855 showed
a significant association with the presence of circulatory failure
in patients with AD (p= 0.025) and a clear trend towards the
presence of circulatory failure in patients with ACLF (p= 0.085).
A trend was also found for a T>A mutation in SNP rs7298346
to be associated with the presence of circulatory failure in
patients with AD (p= 0.062). In addition, this mutation showed
a significant association with the presence of circulatory failure
in the subgroup of patients with ACLF (p= 0.046). Conclusions:
Single nucleotide polymorphisms in the AVP1a receptor are
associated with the presence of circulatory failure in patients
with acute decompensation of liver disease and ACLF.
Disclosures:
Bart van Hoek - Advisory Committees or Review Panels: Janssen-Cilag, Bristol
Meyers Squib, Gilead, Merck, Abbvie
Vicente Arroyo - Speaking and Teaching: GRIFOLS
Pere Gines - Advisory Committees or Review Panels: Ferring, Ikaria; Grant/
Research Support: Sequana Medical, Grifols
Rajiv Jalan - Consulting: Ocera Therapeutics, Conatus; Grant/Research Support:
Grifols, Gambro; Patent Held/Filed: Yaqrit, Cyberliver
Rudolf E. Stauber - Advisory Committees or Review Panels: Gilead, BMS; Grant/
Research Support: Abbvie, MSD; Speaking and Teaching: Merz
The following authors have nothing to disclose: Annarein J. Kerbert, Jelte Schaapman,
Johan van der Reijden, Amorós Àlex, Aiden McCormick, Victor Vargas,
Hein W. Verspaget, Minneke Coenraad
2070
Prevalence, risk factors and outcome of infections by
multidrug resistant bacteria (MDR) in a liver intensive
care unit (ICU): a prospective study
Amrish Sahney 1 , Cyriac A. Philips 1 , Rakhi Maiwall 1 , Ashok
Choudhary 1 , Lalita G. Mitra 2 , Ankur Jindal 1 , Manoj Kumar 1 , Kapil
D. Jamwal 1 , Vikram Bhatia 1 , Vikas Khillan 3 , Shiv K. Sarin 1 ; 1 Hepatology,
ILBS, New Delhi, India; 2 Critical care, ILBS, New Delhi,
India; 3 Microbiology, ILBS, New Delhi, India
Background & Aim:There is limited data on prevalence, predictors
and impact on extra hepatic organ failure and mortality
due to MDR bacterial infections in critically ill cirrhotic
patients. Methodology: We prospectively studied 522 cirrhoticpatients
admittedto dedicated liver ICU during March
to October 2014. Organ failure was defined as: Kidney failure:
SCr ≥2mg% or need for dialysis, cerebral failure: Grade
3 or 4 hepatic encephalopathy, Circulation failure: shock, &
Lung failure: PaO2/FiO2