studies

350A AASLD ABSTRACTS HEPATOLOGY, October, 2015
269
Hepatiq Measure Of Hepatic Function: Threshold Function
For Ascites And Death In Patients With Chronic Liver
Disease (CLD)
John C. Hoefs 1,2 , Lien Tran 2 , Dipu Ghosh 3 ; 1 Medicine, Univ of
California, Orange, CA; 2 Medicine, Liver Specialtly Center, Irvine,
CA; 3 HEPATIQ_LLC, Irvine, CA
INTRODUCTION:Functional quantitative tests have been
largely ignored in the non-invasive staging of CLD. The perfused
hepatic mass (PHM) is a precise measure of liver function
correlating with the functional hepatic mass (r2 = .905)(AmJ-
Gastro;92:2054) and adverse clinical outcomes (ACO). PHM
= 95 (HALT-C
2012;Hepat;55:1019). HEPATIQ is an automated measure
of PHM to make quantitative image analysis of SPECT images
easier. METHODS: Sequential SPECT scans from 384 patients
were processed by HEPATIQ for PHM to assess the relationship
to ascites and death. There were normals (N) 29 and patients
with CLD: HBV 61, HCV 138, NASH 49, PBC/ACAH/PSC
34, ALD 13, abnormal AST/ALT44, post liver transplant (LT)
6, and miscellaneous 16. Any ascites that required treatment
was recorded. Patients with recovery from prior ACO from
CLD associated with ascites (R-ACO: requiring no treatment >
2 yrs) or before liver transplant (LT) and prior variceal bleeding
without ascites (VB) were included along with treatable ascites
(RxA), Refractory ascites (RfA), and death (D). SCAN: Patients
were fed prior to IV injection of 5-6 mCi 99Tc sulfur colloid with
subsequent SPECT /planar images and processed by HEPA-
TIQ. RESULTS: 306 patients never had ACO, 5 had a variceal
bleed with no ascites (VB) and 28 patients had current ascites:
responsive ascites RxA 10, refractory ascites (RfA) 12, and
death 6. PHM in N was 104.3+/-2.8 and 306 patients never
having ACO 102.3+/-4.6. In 6 LT patients PHM 99.2+/-4.5
and R-ACO 91.9+/-6.4. PHM was 77.7+/-6.9 with RxA; RfA
64.2+/-11.6 and 6 deaths 49.9+/-16.1 (< 60 for 4 liver failure,
2 HCC). For PHM threshold for ACO PHM < 95, RxA 85,
RfA 78, and death < 60 (see figure) CONCLUSIONS: 1. PHM
using HEPATIQ is a precise measure of CLD severity correlating
with clinical outcomes regardless of CLD cause. 2. Hepatic
function by PHM thresholds for RxA, RfA, and death are relatively
precise, 3. PHM with HEPATIQ is a hepatic function test,
valuable for non-invasive staging and monitoring of CLD.
Disclosures:
John C. Hoefs - Management Position: HEPATIQ_LLC; Speaking and Teaching:
Gilead, Jannsen, Abbvie
Dipu Ghosh - Management Position: HEPATIQ LLC
The following authors have nothing to disclose: Lien Tran
270
The Trigger Matters – Outcome of Specifically-Triggered
AKI versus HRS in Patients with Cirrhosis and Ascites
Theresa Bucsics, Philipp Schwabl, Mattias Mandorfer, Simona
Bota, Bernhard Scheiner, Wolfgang Sieghart, Arnulf Ferlitsch,
Michael Trauner, Markus Peck-Radosavljevic, Thomas Reiberger;
Div. of Gastroenterology and Hepatology, Department of Internal
Medicine III, Medical University of Vienna, Vienna, Austria
Background: Hepatorenal syndrome (HRS) is considered a
severe and often lethal type of acute kidney injury (AKI) in
patients with cirrhosis and ascites. Recently, the International
Club of Ascites (ICA) proposed new criteria for HRS, loosening
some of the stricter criteria in order to enhance diagnostic
sensibility. However, HRS diagnosis still requires the exclusion
of certain triggers of AKI to ensure “hepatic” etiology of AKI.
Aims: To assess survival of patients with HRS according to the
new ICA-HRS guidelines as compared with patients with “specifically-triggered”
AKI. Methods: A cohort of 497 consecutive
patients with cirrhosis and ascites was longitudinally screened
for renal dysfunction. AKI and HRS were diagnosed according
to new ICA criteria. Specific triggers for severe (grade 2/3) AKI
episodes that are considered exclusion criteria for HRS were
recorded (sAKI). Transplant-free survival (TFS) of HRS and sAKI
was compared using log-rank test. Results: Among all patients,
64 cases of HRS and 124 cases of sAKI were recorded. No
differences were found regarding patient characteristics or TFS:
Median TFS was 24 days in HRS (IQR 4-405 days) vs. 16 days
(3-217) in sAKI (p=0.364). sAKI with manifest hypovolemia as
trigger was associated with the shortest TFS [n=70; 8 (3-40)
days], followed by preceding surgery or intervention [n=6;
TFS: 32 (3-109) days] and infections as triggers [n=30; TFS:
44 (2-187) days]. Conversely, patients with acute-on-chronic
renal failure [n=7; TFS: 250 (14-end of follow-up) days] and
nephrotoxic trigger [n=11; TFS: 217 (7-387) days] showed a
favorable TFS. Conclusion: Patients with HRS according to the
new ICA guidelines and sAKI showed similar characteristics
and outcomes. However, since the specific cause of sAKI significantly
influences prognosis, identifying the trigger of sAKI
represents an important clinical priority in cirrhotic patients
with ascites.
Disclosures:
Mattias Mandorfer - Consulting: Janssen; Speaking and Teaching: AbbVie, Gilead,
Janssen, Boehringer Ingelheim, Bristol-Myers Squibb, Roche
Simona Bota - Speaking and Teaching: Janssen Pharmaceutica, Bristol-Myers
Squibb
Wolfgang Sieghart - Grant/Research Support: Bayer Schering Pharma, Bayer
Schering Pharma, Bayer Schering Pharma, Bayer Schering Pharma; Speaking
and Teaching: Bayer Schering Pharma, Bayer Schering Pharma, Bayer Schering
Pharma, Bayer Schering Pharma
Michael Trauner - Advisory Committees or Review Panels: MSD, Janssen, Gilead,
Abbvie; Consulting: Phenex; Grant/Research Support: Intercept, Falk Pharma,
Albireo; Patent Held/Filed: Med Uni Graz (norUDCA); Speaking and Teaching:
Falk Foundation, Roche, Gilead
Markus Peck-Radosavljevic - Advisory Committees or Review Panels: Bayer, Gilead,
Janssen, BMS, AbbVie; Consulting: Bayer, Boehringer-Ingelheim, Jennerex,
Eli Lilly, AbbVie; Grant/Research Support: Bayer, Roche, Gilead, MSD, AbbVie;
Speaking and Teaching: Bayer, Roche, Gilead, MSD, Eli Lilly, AbbVie, Bayer
Thomas Reiberger - Consulting: Xtuit; Grant/Research Support: Roche, Gilead,
MSD, Phenex; Speaking and Teaching: Roche, Gilead, MSD
The following authors have nothing to disclose: Theresa Bucsics, Philipp Schwabl,
Bernhard Scheiner, Arnulf Ferlitsch