studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1227A
2089
Adding C-reactive Protein and Procalcitonin to the MELD
Score Improves Mortality Prediction in Patients Admitted
with Complications of Cirrhosis
Sakkarin Chirapongsathorn 1,2 , Worawan Bunraksa 2 , Dollapas
Punpanich 3 , Amnart Chaiprasert 4 , Patrick S. Kamath 1 ; 1 Gastroenterology
and Hepatology, Mayo Clinic, Rochester, Rochester,
MN; 2 Gastroenterology, Phramongkutklao Hospital and College
of Medicine, Royal Thai Army, Bangkok, Thailand; 3 Biomedical
Research and Development Center, Phramongkutklao Hospital and
College of Medicine, Royal Thai Army, Bangkok, Thailand; 4 Nephology,
Phramongkutklao Hospital and College of Medicine, Royal
Thai Army, Bangkok, Thailand
Background: MELD score has been shown to be the best predictor
of mortality prediction in cirrhosis. Serum C-reactive protein
(CRP) and procalcitonin (PCT) predict the risk of death in critical
illness patients and also help to predict short-term mortality
in cirrhosis. A model adding CRP and procalcitonin to the
MELD score may increase accuracy for mortality prediction in
patients admitted with complications of cirrhosis. Methods: A
prospective cohort study was carried out in consecutive cirrhotic
patients admitted with complications of cirrhosis during September
2012 to December 2013 at Phramongkutklao Hospital,
Thailand. All patients had venous CRP, PCT and laboratory
values for MELD score calculation measured within 48 hours
of admission. Cox regression analysis and ROC curve were
used to predict mortality. The MELD-CRP score was externally
validated in 818 eligible patients from Mayo Clinic, Rochester.
Results: A cohort of 223 patients with cirrhosis was admitted
during the study period. Seventy-one patients were eligible for
analysis. MELD score was predictive of 90-day mortality (OR
1.19 (95%CI; 1.09-1.32); AUROC of 0.81). Adding CRP or/
and PCT to the MELD score improved the predictive of 90-day
mortality: MELD-CRP OR 2.71 (95% CI; 1.66-4.99); MELD-PCT
OR 2.72 (95% CI; 1.66-4.99); MELD-CRP-PCT OR 2.71 (95%
CI; 1.67-4.92). AUROC for MELD, MELD-CRP, MELD-PCT, and
MELD-CRP-PCT were 0.81, 0.83, 0.84, and 0.85 respectively.
Adding CRP or/and PCT to the MELD score also improved
30-day mortality prediction. Similar results of MELD-CRP score
were obtained from the Mayo Clinic external validation cohort.
MELD-CRP score improved the predictive of 30-day mortality
(OR 1.49 (95% CI; 1.28-1.73); AUROC 0.71) and 90-day
mortality (OR 1.43 (95% CI; 1.27-1.62); AUROC 0.69) compared
to MELD score. Conclusion: The MELD-CRP, MELD-PCT
and MELD-CRP-PCT scores are superior to the MELD score in
predicting mortality in cirrhotic patients admitted with complications.
The following authors have nothing to disclose: Sakkarin Chirapongsathorn,
Worawan Bunraksa, Dollapas Punpanich, Amnart Chaiprasert
2090
Presepsin as a new biomarker for old expectations in
the diagnosis and prognosis of bacterial infection in
cirrhosis
Maria Papp 1 , Tamas Tornai 1 , David Tornai 2 , Zsuzsanna Vitalis 1 ,
Istvan Tornai 1 , Peter Antal-Szalmas 2 ; 1 Department of Gastroenterology,
University of Debrecen, Faculty of Medicine, Debrecen,
Hungary; 2 Department of Laboratory Medicine, University of
Debrecen, Faculty of Medicine, Debrecen, Hungary
Background&Aims: Bacterial infections are frequent complications
in cirrhosis with significant mortality. Early diagnosis is
essential but still a diagnostic challenge from both the clinical
and the laboratory part. The aim of this study is to evaluate
and compare the diagnostic and prognostic value of presepsin
plasma levels with CRP and PCT in bacterial infections of
patients with cirrhosis. Methods: A total of 216 patients with
cirrhosis (54.4% males, age: 57.6±10.3 years and median
MELD score: 13 [95% CI: 10-17]) were consecutively enrolled.
At admission enrollment presence of bacterial infection were
assessed on the basis of conventional criteria, liver-oriented
scores were calculated and plasma presepsin, CRP and PCT
levels were measured. A short-term follow-up study was conducted
to assess the development of organ system failure(s) and
28-day mortality associated to bacterial infections. Results: Bacterial
infection was found in 75 (34.7%) patients. Plasma presepsin
levels were significantly higher in patients with infection as
compared to those without (1002 pg/mL [575-2149] vs. 477
[332-680] pg/mL, p0.5 pg/ml (OR:
9.10, p=0.006) or CRP >40 mg/l (OR: 4.03, p=0.039) but
not presepsin level were independet risk factor for 28-day mortality.
Conclusions: Presepsin is a valuable new biomarker for
defining severity of infections in cirrhosis proving same efficacy
as PCT. However, for the prediction of short-term mortality,
liver-oriented scores and admission level of conventional APP
proteins, particularly PCT are the appropriate tools.
Disclosures:
Istvan Tornai - Advisory Committees or Review Panels: Roche, AbbVie, BMS,
Janssen-Cilag
The following authors have nothing to disclose: Maria Papp, Tamas Tornai,
David Tornai, Zsuzsanna Vitalis, Peter Antal-Szalmas
Disclosures:
Patrick S. Kamath - Advisory Committees or Review Panels: Sequana Medical