studies

352A AASLD ABSTRACTS HEPATOLOGY, October, 2015
273
Use of non-selective beta blockers in cirrhotic patients
with ascites is associated with increased risk of acute
kidney injury at hospital admission
Juliana R. de Carvalho, Rodrigo Luz, Henrique Sergio M. Coelho,
Cristiane Villela-Nogueira, Renata M. Perez; Hepatology Service,
Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Introduction Use of non-selective beta blockers (NSBB) in
patients with advanced cirrhosis has recently become an issue
of debate, with concerns about their safety and possible association
with complications such as acute kidney injury (AKI).
Objective The aim of this study was to evaluate the association
between use of NSBB and the presence of AKI in the first 48
hours of hospital admission in cirrhotic patients with ascites.
Methods Hospitalizations of cirrhotic patients with ascites in
an university hospital were retrospectively reviewed. AKI at
hospital admission was defined as a difference of at least 0.3
mg/dL in two serum creatinine values obtained in the first 48
hours of admission. Association between use of NSBB and AKI
was evaluated by logistic regression analysis. Results This study
included 328 hospitalizations of cirrhotic patients with ascites,
with a mean age of 59 (SD: ±12.7) years. Men represented
59% of cases. At admission, 133 patients (41%) were classified
as Child B and 195 (59%) as Child C. History of previous
gastrointestinal bleeding episode was present in 144 patients
(44%) and 200 (61%) were on NSBB. AKI at hospital admission
occurred in 196 patients (60%), being present in 66% of
patients on use of NSBB and 50% of those not on use of the
drug (p=0.004). In Child B patients, AKI occurred in 61% of
those on NSBB and 51% of those without the drug (p=0.24).
In Child C patients, a significant association between NSBB
use and AKI was observed (69% vs 49%; p = 0.006). The
variables age, gender, previous episode of gastrointestinal
bleeding, previous episode of spontaneous bacterial peritonitis,
history of diabetes mellitus, history of arterial hypertension,
use of diuretics, use of NSBB, Child-Pugh score at admission
and serum sodium at admission were included in a logistic
regression model. In the final model, variables independently
associated to AKI in the first 48 hours of admission were: age
(OR: 1.03; 95% CI: 1.00 – 1.05; p=0.004), serum sodium at
admission (OR: 0.95; 95% CI: 0.92 – 0.99; p=0.014) and
use of NSBB (OR: 1.91; 95% CI: 1.20 – 3.06; p=0.007). Conclusion
In Chid C cirrhotic patients with ascites, use of NSBB
is associated with increased risk of AKI at hospital admission.
Use of these drugs in this population should be reassessed.
Disclosures:
The following authors have nothing to disclose: Juliana R. de Carvalho, Rodrigo
Luz, Henrique Sergio M. Coelho, Cristiane Villela-Nogueira, Renata M. Perez
274
Slow, continuous low-dose albumin and furosemide
infusion (SCLAFI) mobilizes large ascites safely in
decompensated liver cirrhosis
Gaurav Pande; gastroenterology, Sanjay gandhi post graduate
institute of medical sciences, Lucknow, India
Background: Graded increase of oral diuretics has been the
standard therapy for mobilizing large ascites in decompensated
liver cirrhosis. Large volume paracentesis (LVP) with or without
albumin infusions has been the commonest rescue therapy.
Both are sought with complications. Aim: To study the efficacy
and safety of low-dose, continuous, infusionof furosemide with
albumin, administered according to a response-guided protocol
in patients with cirrhosis and large ascites. Methods: All cirrhotic
patients with large ascites on maximally tolerated dirutics
and creatinine