studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 869A
careful cut-offs from HC, was lower than in literature, adipopenia
was more pronounced.
Disclosures:
The following authors have nothing to disclose: Onan Perez-Hernandez, Geraldine
del Carmen Quintero-Platt, Carlos Jorge-Ripper, Camino Maria Fernandez-Rodriguez,
Maria Blanca Monereo Muñoz, Maria Jose Sanchez-Perez,
Emilio Gonzalez-Reimers, Ruben Hernandez-Luis
Data expressed as mean± SD/ median (IQR) # (C vs. DC), *(HC
vs.C), $ (HC vs. DC)
Disclosures:
Puneet Puri - Advisory Committees or Review Panels: Health Diagnostic Laboratory
inc
The following authors have nothing to disclose: Varsha Shasthry, Jaya Benjamin,
Chethan Kalal, Lovkesh Anand, Ankit Bhardwaj, Vanshja Pandit, Ankur Arora, S.
Rajesh, Viniyendra Pamecha, Vikas Jain, Guresh Kumar, Y.K Joshi, Shiv K. Sarin
1341
The role of proinflammatory cytokines, adipokines and
lipid peroxidation in short term mortality in patients
with Severe Alcoholic Hepatitis
Onan Perez-Hernandez 1,2 , Geraldine del Carmen Quintero-Platt 1 ,
Carlos Jorge-Ripper 1,2 , Camino Maria Fernandez-Rodriguez 1,2 ,
Maria Blanca Monereo Muñoz 1 , Maria Jose Sanchez-Perez 1 ,
Emilio Gonzalez-Reimers 1,2 , Ruben Hernandez-Luis 1,2 ; 1 Medicina
Interna, Hospital Universitario de Canarias, San Cristóbal de La
Laguna, Spain; 2 Medicina Interna, Universidad de La Laguna, San
Cristobal de La Laguna, Spain
INTRODUCTION Acute alcoholic hepatitis is a serious disease
associated with a high short term mortality ranging from 20 to
50%. The factors involved in mortality in patients with acute
alcoholic hepatitis are still controversial. It is well known that
acute alcoholic hepatitis is a disease in which cytokine activation
and oxidative damage play important roles. The aim of
this study is to prospectively assess the relationship between
cytokines, lipid peroxidation, and adipokines with mortality
of patients with alcoholic hepatitis at 30, 90, and 180 days.
PATIENTS AND METHODS Sixty patients with severe alcoholic
hepatitis (Maddrey index ≥32) were successively included.
Cytokine levels (IL-4, IL-6, IL-8, TNF-α, INF-γ, adiponectin,
resistin, leptin, insulin and MDA) were measured within the first
48 hours after admission and one week later. Patients were followed-up
during 180 days; 12 patients died within the first 30
days, 21 within 90 days, and 23 within 180 days. RESULTS
The mean age was 51.9 years (SD=±10.7). Serum levels at
admission of TNF-α were significantly higher among those
who died at admission (p=0.041). IL-4 were significantly lower
among those who died within 30 days (p=0.048) whereas
levels of IL-8 were associated with an increased mortality at
90 and 180 days (p=0.022 and 0.027, respectively). Serum
MDA levels at admission were significantly associated with
mortality at admission, 30, 90, and 180 days. Serum leptin
levels were also associated with mortality at 180 days and
insulin levels were related to mortality at admission, 30, 90,
and 180 days. CONCLUSION Twenty percent of patients died
within the first 30 days after admission; 35.5% died within 90
days, and 38.7% died within 180 days. Increased proinflammatory
cytokine levels at admission and especially increased
MDA levels are significantly associated with short-term mortality
among alcoholics. Lower IL-4 levels were also associated
with mortality. No relation was observed between mortality
and adiponectin levels but indeed between mortality and leptin
levels. Higher mortality was observed among those with low
insulin levels.
1342
Nosocomial Infection in Severe Alcoholic Hepatitis
Onan Perez-Hernandez 1,2 , Geraldine del Carmen Quintero-Platt 1 ,
Emilio Gonzalez-Reimers 1,2 , Maria Jose Sanchez-Perez 1 , Pedro
Abreu-Gonzalez 3 , Maria Jose de la Vega-Prieto 4 , Carlos Jorge-Ripper
1,2 , Francisco Santolaria-Fernandez 1,2 ; 1 Medicina Interna,
Hospital Universitario de Canarias, San Cristóbal de La Laguna,
Spain; 2 Medicina Interna, Universidad de la Laguna, San Cristobal
de La Laguna, Spain; 3 Fisiologia, Universidad de La Laguna,
San Cristobal de La Laguna, Spain; 4 Laboratorio Central, Hospital
Universitario de Canarias, San Cristobal de La Laguna, Spain
INTRODUCTION Both alcoholism and liver cirrhosis increases
the risk of infection. In acute alcoholic hepatitis, especially
in severe cases (Maddrey ≥32), intestinal permeability is
increased. This fact triggers an greater risk of bacterial translocation
and, on the one hand, more infections and on the other,
increased lipid peroxidation mediated proinflammatory activation.
OBJECTIVE The aim of this study is to prospectively assess
the nosocomial infections in severe acute alcoholic hepatitis
(sAAH) and its prognostic value. Furthermore, we examine
the relationship between inflammatory cytokines, adipokines
and lipid peroxidation with nosocomial infections. MATERIAL
AND METHOD Sixty-two patients with sAAH were successively
included. Nosocomial infections were registered. Cytokine levels
(IL-4, IL-6, IL-8, TNF-α, INF-γ, adiponectin, resistin, leptin,
insulin and MDA) were measured within the first 48 hours
after admission and one week later. Patients were followed-up
during 180 days. RESULTS The mean age was 52.2 years
(±10.7). Maddrey’s index on admission was 55.6 (±19.8).
29.5% of patients had a infection during hospitalization
(66.7% were pneumonia), which caused 42.9% of deaths. A
higher percentage of patients with nosocomial infection died
at 180 days (58.8 vs 28.9%; p = 0.03). Infection appeared
after 22.8 days (±16.7). There was a trend to hyponatremia
at admission was more frequent (68.8 vs 31.3%; p = 0.064).
After the first week, infected patients had a worsening of bilirubin
(76.5 vs 48.8%; p=0.048), ABIC≥8 (73.3 vs 40.5%;
p=0,032), platelets 7.91; p=0.031). CONCLUSION Nosocomial
infections were a common complication in patients admitted for
sAAH and were the main cause of death. Data exist relating of
develop it as unfavorable evolution in the first week, measured
by ABIC index, and worsening of bilirubin levels. Thrombocytopenia
and hypofibrinogenemia also associated with increased
risk. Infected patients had lower adiponectin levels, both at
admission and first week. Finally, we also observed lipid peroxidation
was higher in this group.
Disclosures:
The following authors have nothing to disclose: Onan Perez-Hernandez, Geraldine
del Carmen Quintero-Platt, Emilio Gonzalez-Reimers, Maria Jose Sanchez-Perez,
Pedro Abreu-Gonzalez, Maria Jose de la Vega-Prieto, Carlos
Jorge-Ripper, Francisco Santolaria-Fernandez