studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 351A
271
Chronic Rifaximin Therapy Decreases the Risk and
Severity of Hepatorenal Syndrome in Cirrhosis
Tien S. Dong, Andrew I. Aronsohn, Nancy Reau, K. Gautham
Reddy, Helen S. Te; Medicine, University of Chicago, Chicago, IL
BACKGROUND: The intestinal bacterial flora plays an important
and complex role in patients with cirrhosis. Studies in alcohol-related
cirrhotic patients showed that rifaximin reduced the
frequency of acute kidney injury (AKI) and hepatorenal syndrome
(HRS). AIM: To determine the effect of long-term rifaximin
use on the renal function of cirrhotic patients. METHODS:
A retrospective chart review was performed to identify cirrhotic
patients who had at least two visits in the Liver Clinic from
1/1/11 to 12/31/14. The study group consisted of patients
who were on rifaximin for ≥90 days, who were then matched
by age, gender, and baseline MELD score to a control group.
Patients with a diagnosis of hepatocellular carcinoma and
renal replacement therapy (RRT) at baseline were excluded.
Demographic and laboratory data, concurrent midodrine use,
incidence of AKI, HRS, need for RRT, infections, frequency of
hospitalizations and length of stay (LOS) were collected. AKI
was defined as an increase in serum Cr (SCr) by >0.3 mg/
dl within 48 hours or an increase in SCr >1.5 folds above
baseline (International Society of Nephrology criteria). Data
was censored at the last follow-up, initiation of RRT, death, or
liver transplant, and analyzed using logistic regression, oneway
ANOVA, and Pearson’s chi-squared test with the Stata
software. RESULTS: 88 rifaximin cases were identified and
matched to 88 control cases. Age, gender, race, duration of
follow up, baseline MELD score, SCr, and GFR, and etiology
of cirrhosis were not significantly different between the two
groups. There were more patients on chronic midodrine (>90
days use) in the rifaximin group as compared to control (17 %
vs 4.5%, p= 0.008). There was no significant difference in the
frequency of infections, deaths, liver transplants, hospitalizations
or mean LOS between the two groups. Despite a similar
frequency of AKI between the two groups, there was a trend
towards less likelihood for HRS as a cause for AKI while controlling
for midodrine use (OR 0.272 [0.067-1.086], p=0.06).
In addition, the rifaximin group also had a lower likelihood of
having at least one HRS episode (OR 0.257 [0.0696-0.950],
p=0.04) and lower likelihood of requiring RRT (OR 0.257
[0.067-0.950], p=0.04). The number needed to treat to prevent
one episode of RRT is 10. CONCLUSIONS: Chronic use
of rifaximin is associated with a decreased risk of HRS and a
decrease likelihood of requiring RRT for AKI in a general population
of cirrhotic patients. This finding should be validated in
a prospective study in a larger patient population.
Disclosures:
Nancy Reau - Advisory Committees or Review Panels: Jannsen, Merck, AbbVie,
Intercept, Salix, BMS, Jannsen; Grant/Research Support: Merck, Gilead, BMS,
AbbVie, Jannsen, BI
K. Gautham Reddy - Advisory Committees or Review Panels: AASLD Transplant
Hepatology Pilot Steering Committee, ACG Training Committee, Program Director’s
Caucus Steering Committee, Gilead, Inercept, Bristol-Myers Squibb; Grant/
Research Support: Intercept, Ocera, Merck, Lumena
Helen S. Te - Advisory Committees or Review Panels: BMS; Grant/Research
Support: Abbvie, Conatus, BMS
The following authors have nothing to disclose: Tien S. Dong, Andrew I. Aronsohn
272
Ascites Neutrophil Gelatinase-Associated Lipocalin
(NGAL) Identifies Spontaneous Bacterial Peritonitis and
Predicts Mortality in Hospitalized Patients with Cirrhosis
Elizabeth C. Verna 1 , Giuseppe Cullaro 1 , Grace Kim 1 , Mona Gossmann
1 , Thresiamma Lukose 1 , Connie Kim 2 , Sofia Nigar 3 , Marcus
Pereira 1 , Robert S. Brown 1 ; 1 Columbia University Medical Center,
New York, NY; 2 Stony Brook University School of Medicine, Stony
Brook, NY; 3 The Brooklyn Hospital Center, Brooklyn, NY
Background: Neutrophil gelatinase-associated lipocalin
(NGAL) levels in the urine strongly predict acute kidney injury
(AKI) and mortality in patients with cirrhosis. Ascites NGAL
(aNGAL) levels may identify peritonitis in patients on peritoneal
dialysis but have not been tested in cirrhosis. We hypothesized
that aNGAL level is a marker of spontaneous bacterial
peritonitis (SBP) and mortality risk in hospitalized patients with
cirrhosis. Methods: Hospitalized patients with cirrhosis and
ascites undergoing diagnostic paracentesis were prospectively
enrolled and followed until death or discharge. Exclusion criteria
included secondary peritonitis, history of transplantation
and active colitis. NGAL was measured in the ascites, serum
(sNGAL) and urine (uNGAL) by ELISA (Bioporto, Denmark).
aNGAL level was evaluated as a marker of SBP (defined as
ascites absolute neutrophil count >250) and predictor of inpatient
mortality. Results: 79 patients were enrolled in this ongoing
study. The median age was 58.4, 59% male gender, 53%
non-Hispanic white, 21% Hispanic, and 11% black. 44% had
HCV as their primary liver disease, 35% alcohol and 10%
NAFLD. The median MELD was 20, 26% had AKI, defined as
an increase of 0.3 mg/dL from baseline, and median (range)
follow up was 11 (3-374) days. 16 patients (20%) had SBP.
Baseline characteristics were similar between subjects with and
without SBP. Median (IQR) aNGAL was significantly higher
in patients with SBP compared to those without SBP [297.0
(365.0) v. 155.0 (162.5) ng/mL, p= 0.008]. In ROC analysis,
aNGAL had an AUC of 0.72 (95% CI 0.59-0.86). Median
sNGAL (454.5 v. 409.7 ng/mL, p=0.41) and uNGAL (133.6
v. 99.3 ng/mL, p=0.07) were similar between groups. aNGAL
correlated relatively well with sNGAL (r=0.74) and less so with
uNGAL (r=0.40). 8 (10%) patients died in the hospital. aNGAL
(OR 1.02 per 10 units, p=0.02), MELD (1.13, p=0.02), SBP
(OR 4.91, p=0.04) and bacteremia (OR 6.2, p=0.02) were
predictive of in hospital mortality. In the final multivariable
model, aNGAL (OR 1.03 per 10 units, p=0.01) remained
predictive of in hospital mortality, controlling for SBP (OR 9.05,
p=0.03) and AKI (8.82, p=0.04). Conclusions: aNGAL level
may be a biomarker of peritonitis in hospitalized patients with
ascites, and importantly, a predictor of short term in hospital
mortality even controlling for SBP and AKI. Larger studies are
needed to validate these findings.
Disclosures:
Elizabeth C. Verna - Advisory Committees or Review Panels: Gilead; Grant/
Research Support: Salix, Merck
Robert S. Brown - Consulting: Gilead, Janssen, Abbvie, Merck, BMS
The following authors have nothing to disclose: Giuseppe Cullaro, Grace Kim,
Mona Gossmann, Thresiamma Lukose, Connie Kim, Sofia Nigar, Marcus Pereira