studies

348A AASLD ABSTRACTS HEPATOLOGY, October, 2015
(64.9-83.4), PPV 34.3% (19.1-52.2) and VPN 97.2% (90.2-
99.7). In this study, the prevalence of SIRS was 13.2%. In
5 samples, neutrophil count was above 250/mm 3 (385 to
13020/ mm 3 ) but the strip was considered as negative. When
setting “trace” as the first positive result, Se and NPV were both
of 100% for outpatients. Conclusions: This study shows, for the
first time, in a large sample size of cirrhotic patients that the
Periscreen TM strip is a robust screening tool for the detection of
SBP. More importantly, this new leukocyte esterase strip has
an excellent accuracy to exclude SBP in the outpatient setting.
(1) Nousbaum JB, et al. Hepatology 2007;45:1275-1281. (2)
Mendler MH, J Hepatol 2010;53:477-483.
Disclosures:
Alexandra Heurgué-Berlot - Consulting: Abbvie; Speaking and Teaching: Gilead
Christophe Bureau - Grant/Research Support: Gore; Speaking and Teaching:
Gore
Isabelle Ollivier-Hourmand - Speaking and Teaching: gilead, jansen, bayer
Eric Nguyen-Khac - Speaking and Teaching: Gilead, Abbvie, Janssen, Roche,
MSD, BMS
Si Nafa Si Ahmed - Board Membership: La Roche Hoffmann; Grant/Research
Support: Janssen; Speaking and Teaching: BMS, Gilead, Abbvie
The following authors have nothing to disclose: Thierry Thevenot, Charline Briot,
Vincent Macé, Hortensia Lison, Laure Elkrief, Caroline Jezequel, Ghassan Riachi,
Alexandre Louvet, Hélène Labadie, Nicolas Carbonell, Karim Aziz, Denis Grasset,
Rodolphe Anty, Mehdi Kaasis, Thomas Mouillot, Arnaud Pauwels, Florence
Tanné, Jean Paul Cervoni, Jean françois D. Cadranel, Matthieu Schnee
265
Deleterious effect of beta-blockers in cirrhotic patients
with refractory ascites: potential role of myocardial dysfunction
Valerio Giannelli 1,2 , Olivier Roux 2 , Pierre-Emmanuel Rautou 2 ,
Emmanuel Weiss 2 , Richard Moreau 2 , Didier Lebrec 2 , Francois
Durand 2 , claire francoz 2 ; 1 gastroenterology, university of rome
“sapienza”, Rome, Italy; 2 Service d’Hépatologie, Hôpital Beaujon,
Assistance Publique-Hôpitaux de Paris, Clichy, France; INSERM
U1149,CRI, Paris, France
Introduction: Recent studies have suggested that non selective
beta-blockers (NSBB) could be deleterious in cirrhotic patients
with refractory ascites (RA) by increasing transplant-free mortality.
It has been proposed that NSBB may increase the risk
of paracentesis-induced circulatory dysfunction but the mechanisms
involved are still unclear. The aim of this study was to
explore the impact of NSBB on systemic and splanchnic hemodynamics
in cirrhotic patients with RA evaluated for liver transplantation
(LT). Patients and methods: 583 cirrhotic patients
evaluated for a first LT in a single center between 1997 and
2013 were studied. There were 74% males, mean age was
52 years. The cause of cirrhosis was alcohol in 43%, HCV
in 24% and HBV in 11%. 29% of patients had hepatocellular
carcinoma. 196 patients (34%) had RA, and among them, 51
% received NSBB. Physiological MELD score was comparable
in RA and no—RA groups (17 vs 16, ns) as well as the proportion
of patients receiving NSBB (51 vs 51 %, ns). In addition
to standard preLT workup, all patients had measurement of
both splanchnic and systemic hemodynamics by right heart
catheterization with assessment of cardiac work (Left and Right
Ventricular Stroke Work Index, LVSWI and RVSW). Results:
Waiting list mortality was higher in RA compared to no-RA
group, (62 vs 38 % at 1 year, p=0.001). RA patients had significantly
lower mean arterial pressure (MAP) lower heart rate
(HR) and higher hepatic venous pressure gradient (HVPG) than
no-RA patients. Cardiac index (CI) as well as systemic vascular
resistance (SVRI) were similarcomparable in both groups. By
contrast, Left and Right Ventricular Stroke Work Index (LVSWI
and RVSWI) were significantly lower in RA patients compared
to no-RA. In both RA and no-RA patients, NSBB resulted in a
significant decrease in HR, MAP, and CI. In the no-RA group,
NSBB did not affect LVSWI (57+15 vs 60+21 g.m/m 2 , ns). By
contrast, in the RA group, NSBB were associated with a significant
decrease in LVSWI (48+15 vs 56+15, p