studies

942A AASLD ABSTRACTS HEPATOLOGY, October, 2015
in sickle hepatopathy. Despite diagnostic challenges with HB
in SCD, DB, ALP and PLT appear to be respectively associated
with increasing portal pressures and mortality.
Disclosures:
The following authors have nothing to disclose: David M. Chascsa, Ohad Etzion,
Hawwa Alao, Courtney Fitzhugh, John F. Tisdale, Caterina Minniti, Matthew
Hsieh, David E. Kleiner, Ahmed M. Gharib, Varun K. Takyar, Jason L. Eccleston,
Theo Heller, Christopher Koh
1499
A half of hepatic hydrothorax in cirrhotic patients were
caused by porous diaphragm syndrome due to radiofrequency
ablation for hepatocellular carcinoma
Kenichi Miyoshi, Masahiko Koda, Toshiaki Okamoto, Tomomitsu
Matono, Takaaki Sugihara, Keiko Hosho, Jun-ichi Okano; Tottori
University School of Medicine, Yonago, Japan
Aims Hepatic hydrothorax is defined as a significant pleural
effusion in cirrhotic patients without underlying pulmonary or
cardiac disease. One of causes of refractory hepatic hydrothorax
is porous diaphragm syndrome. However, the frequency
of porous diaphragm syndrome in hepatic hydrothorax and
the cause of porous diaphragm syndrome are unknown. We
aimed to evaluate its frequency, clinical background, and therapeutic
value of them. Methods From August 2005 to April
2015, 124 cirrhotic patients hospitalized due to hepatic
ascites are enrolled. Patient’s data hospitalized several times
during its period were referred to the most serious cases. We
compared clinical background, and therapeutic value between
patients with and without hepatic hydrothorax. Four patients
with the rupture of hepatocellular carcinoma (HCC), 3 hemodialysis
patients, and 4 patients taking warfarin were excluded.
In 17 of 115 patients from September 2007 with hydrothorax,
we examined the presence of diaphragmatic defects with
intraperitoneal injection of perflubutane (approved by the local
ethics committee). We analyzed clinical background between
patients with and without porous diaphragm syndrome. Results
Forty-one patients (34.2%) in 124 cirrhotic patients with ascites
had hepatic hydrothorax. There was no difference between
patients with and without hydrothorax on clinical background
and therapeutic value. Ten (58.8%) of 17 patients with hydrothorax
had porous diaphragm syndrome. Accordingly, 10
(8.7%) of 115 cirrhotic patients with ascites complicated diaphragmatic
defects. Patients with porous diaphragm syndrome
had higher serum albumin levels and fewer hepatic encephalopathy
events, and more past history of radiofrequency ablation
(RFA) for HCC adjacent to diaphragm than those without
porous diaphragm syndrome. Multivariate analysis showed
that only RFA was an independent factor for porous diaphragm
syndrome. Tour of 10 patients with porous diaphragm syndrome
underwent thoracoscopic diaphragm plication. In all
these patients, pleural effusion disappeared or decreased.
Conclusions 58.8% of patients with hepatic hydrothorax were
caused by porous diaphragm syndrome. Porous diaphragm
syndrome was related to RFA for HCC.
Disclosures:
The following authors have nothing to disclose: Kenichi Miyoshi, Masahiko
Koda, Toshiaki Okamoto, Tomomitsu Matono, Takaaki Sugihara, Keiko Hosho,
Jun-ichi Okano
1500
Sarcopenic obesity impairs prognosis of patients with
cirrhosis
Motoh Iwasa, Ryosuke Sugimoto, Yoshinao Kobayashi, Yoshiyuki
Takei; Department of Gastroenterology and Hepatology, Mie University
Graduate School of Medicine, Tsu, Japan
Aims: It has been reported that there is a high incidence of serious
events and poor outcomes when sarcopenia accompanies
cirrhosis. In terms of body fat, it was recently reported that the
prognosis is poor after resection of hepatocellular carcinoma
in cirrhosis patients with decreased visceral fat. In the present
study, skeletal muscle mass and visceral fat mass of patients
with cirrhosis were measured, and the relationships between
these body composition measurements and prognosis were
investigated. Furthermore, time-dependent changes in body
composition measurements were also examined. Methods: A
total of 161 patients with cirrhosis (94 men, 67 women; 67 ±
9 years) who received medical care and nutritional assessment
were investigated. For body composition, in addition to height
and weight, visceral fat area (VFA, cm 2 ) and upper limb skeletal
muscle mass (kg) were measured using a multi-frequency
bioelectrical impedance analysis device. Subsequently, setting
the cut-off value of VFA at 100 cm 2 for visceral obesity and the
cut-off value of sarcopenia at 1.7 kg/m 2 for men and 1.2 kg/
m 2 for women, patients were classified, and their outcomes
were observed. Furthermore, 60 patients with cirrhosis who
underwent multiple body composition measurements during
the observation period were extracted, and their initial and
final measurements were compared. Results: Although there
was a weak positive correlation between VFA and albumin,
significant correlations were not observed between muscle
mass and blood test results. Patients were classified into the
following 4 groups: normal body composition; visceral obesity;
sarcopenia; and sarcopenic obesity. There were 60, 61, 25,
and 15 patients, respectively, in each group. Sarcopenia and
sarcopenic obesity were more common in men, and sarcopenic
obesity was more common in elderly individuals. In the comparison
of 3 groups (visceral obesity, sarcopenia, and sarcopenic
obesity groups), 22 (36%), 12 (48%), and 10 (67%) deaths
were noted, respectively, during a mean observation period
of 1005 days, and the prognosis was significantly worse in
sarcopenic obesity, followed by sarcopenia and visceral obesity,
in that order (P < 0.05). A significant positive correlation
was observed only between percent change in skeletal muscle
mass and percent change in serum albumin. Sarcopenia is a
common feature of advanced cirrhosis, and transitions were
observed from normal body composition to sarcopenia and
from obese to sarcopenic obesity. Conclusions: Body composition
is a prognostic factor for cirrhosis, and a better body
composition may be advantageous for long-term survival in
patients with cirrhosis.
Disclosures:
The following authors have nothing to disclose: Motoh Iwasa, Ryosuke Sugimoto,
Yoshinao Kobayashi, Yoshiyuki Takei