studies

356A AASLD ABSTRACTS HEPATOLOGY, October, 2015
greater than 10, 20 and 30, OR for development of SBP was
4.62 (2.86-7.82), 7.9 (5.18-12.27) and 11.03 (4.92-28.1)
respectively. MELD score cut-off level ≥ 17 had an area under
the receiver operating characteristic curves (AUROC) 0.76 with
sensitivity 63% and specificity 79%. PPI use was independently
associated with development of SBP (OR 2.87, CI 1.78-4.69).
There was an interaction between MELD score and PPI use, but
MELD score was a stronger risk. Conclusion: MELD score and
PPI therapy are associated with development of the first episode
of SBP. Prospective studies are needed to validate these
data and to determine the optimal MELD score above which
patients would benefit from primary prophylaxis of SBP.
18 and 24 months. Overall the included studies had a low risk
of bias, except for two observational studies in which the risk
was judged as moderate. Conclusions: Based on moderate
quality evidence, the use of NSBBs was not associated with a
significant increase in the risk of all-cause mortality in cirrhotic
patients with ascites, including refractory ascites.
Subgroup analyses of 12 studies included in meta-analysis
Multivariate Logistic regression analyses of predictors the first
episode of SBP
Disclosures:
Patrick S. Kamath - Advisory Committees or Review Panels: Sequana Medical
The following authors have nothing to disclose: Sakkarin Chirapongsathorn,
Rashid Khan, Ashwani K. Singal
282
Effect of Beta-Blockers on Survival in Patients with Cirrhosis
and Ascites: A Systematic Review and Meta-analysis
Sakkarin Chirapongsathorn 1,2 , Nelson Valentin 1 , Fares Alahdab
3,4 , Chayakrit Krittanawong 5 , Patricia J. Erwin 6 , Mohammad
H. Murad 3,7 , 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 Robert D and Patricia E Kern Center
for the Science of Health Care Delivery, Mayo Clinic, Rochester,
Rochester, MN; 4 Knowledge and Evaluation Research Unit, Mayo
Clinic, Rochester, Rochester, MN; 5 Cardiovascular Disease, Mayo
Clinic, Rochester, Rochester, MN; 6 Mayo Clinic Libraries, Mayo
Clinic, Rochester, Rochester, MN; 7 Preventive, Occupational and
Aerospace Medicine, Mayo Clinic, Rochester, Rochester, MN
Backgrounds: Recent studies have suggested that non-selective
beta-blockers (NSBBs) are associated with negative impact
on survival in patients with cirrhosis and refractory ascites.
However, other studies showed contradictory findings and suggested
that NSBBs are beneficial in these patients. We performed
a systematic review and meta-analysis to evaluate the
effect of NSBBs on all-cause mortality. Methods: We conducted
a comprehensive search of MEDLINE, Embase, Web of Science
and Scopus databases through January 2015 and manually
reviewed the literature. Attempts were made to contact
the corresponding authors of the relevant studies for additional
information when needed. Trial-specific risk ratios (RRs) were
calculated and pooled using random-effect model meta-analysis.
Between-study heterogeneity was assessed using the I 2
statistic. The quality assessment of included studies and publication
bias were assessed. Result: We included 4 randomized
control trials and 8 observational studies in which 1,206 deaths
were reported in 2,486 patients with ascites. NSBBs users did
not have an increase in all-cause mortality compared to NSBBs
nonusers with overall ascites (RR, 0.94; 95% CI, 0.6-1.46; P
= 0.77); non-refractory ascites (RR, 0.97; 95% CI, 0.45-2.09)
or refractory ascites (RR, 0.86; 95% CI: 0.47-1.57; P = 0.63).
Results were similar in RCTs and observational studies. Use of
NSBBs was not associated with increased mortality at 6, 12,
Disclosures:
Patrick S. Kamath - Advisory Committees or Review Panels: Sequana Medical
The following authors have nothing to disclose: Sakkarin Chirapongsathorn,
Nelson Valentin, Fares Alahdab, Chayakrit Krittanawong, Patricia J. Erwin,
Mohammad H. Murad
283
Increasing incidence and cost, but decreasing mortality
in patients with hepatorenal syndrome: a study of the
National Inpatient Sample 2005-2011
Albert Do 1 , Ghideon Ezaz 2 ; 1 Internal Medicine, Yale-New Haven
Hospital, New Haven, CT; 2 Internal Medicine, Beth Israel Deaconess
Medical Center, Boston, MA
Background: Hepatorenal syndrome (HRS) is significant in
patients with cirrhosis, carrying a high morbidity and mortality
risk. However, its burden on inpatient hospital care presently
is unclear. We report the incidence, costs, and mortality
trends of HRS in the American medical inpatient setting. Materials
and Methods: The Nationwide Inpatient Sample contains
discharge-level inpatient hospitalizations comprising 20% of
non-government hospitals in the United States. We determined
incidence rates, mortality rates, hospital length of stay, and
hospital costs (adjusted to 2011 dollar terms to adjust for inflation)
from 2005 to 2011 for patients with HRS (ICD-9 code
572.4). Results: 153,057 cases of HRS were identified during
2005-2011, comprising a cohort with mean age 57.6 years,
primarily males (64.1%) of white race (55.9%), with public
insurance payers (58.1%), and hospitalized at a teaching hospital
(54.9%). Table 1 summarizes HRS-associated trends in
incidence, mortality and cost, showing increased disease incidence.
Overall hospital mortality was 34.4%, with decreasing
mortality (43.8% in 2005 to 31.2% in 2011). $16.3 billion
was spent in this time, with an annual expenditure increase
from $1.4 billion to $3.5 billion. However, hospital length
of stay did not change during this time period (range 10.1 to
11.9 days). 5,268 patients (3.4% of all patients) received a
liver transplant during their hospital stay. Conclusions: From
2005 to 2011, the incidence and costs of HRS have increased.