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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.
HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 357A However, associated mortality has decreased and hospital length-of-stay has not changed. Further studies are needed to assess the reasons for decreased mortality, as well as measures to decrease costs associated with hospital stay. Table 1. Incidence, mortality, and costs of patients with hepatorenal syndrome, NIS sample 2005-2011 had the highest bilirubin (27mg/dl) compared to ATN alone (18 mg/dl) p
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1000A AASLD ABSTRACTS HEPATOLOGY, O
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1312A AUTHOR INDEX HEPATOLOGY, Octo
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1366A CATEGORY INDEX HEPATOLOGY, Oc
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