DDW 2007:  Extra Abstracts – HBV

 

Clinical Hepatitis: Advances in the basis for and markers of progressive disease

585. Elevated levels of circulating mesenchymal stem cells in patients with chronic hepatitis B and C

J. A. Abrams; V. Jacob; J. S. Manavalan; T. C. Wang; S. Wang

 

Background:

Adult stem cells play a crucial role in the repair and maintenance of tissues. There are three major populations of adult stem cells: mesenchymal stem cells (MSC), endothelial progenitor cells (EPC), and hematopoietic stem cells (HSC). Mesenchymal stem cells generate fibrous connective tissue, bone, cartilage, and the reticular network that supports blood cell formation. The pathways that lead to hepatic fibrosis in chronic hepatitis are not completely understood, and the recruitment of MSCs and other progenitor cells may be involved in this process. We conducted an exploratory analysis of circulating progenitor cells in patients with chronic viral hepatitis.

 

Methods:

Peripheral blood mononuclear cells (PBMCs) were isolated from 7 patients with chronic hepatitis B or C without cirrhosis and from 7 healthy controls. Data were collected regarding age, gender, and stage of fibrosis on liver biopsy. Quantification of circulating progenitor cells was performed by flow cytometry. PBMCs were labeled with fluorochrome conjugated monoclonal antibodies against CD45, CD34, CD133, VEGFR2, CD117, and CD44, and incubated and washed prior to 6-color analysis using a LSR II flow cytometer. EPCs were defined as CD34+ CD133+ VEGFR2+, HSCs as CD45+ CD34+ CD117+, and MSCs as CD45- CD44+. Counts were expressed as number of progenitor cells per 10,000 mononuclear cells.

 

Results:

Patients with chronic hepatitis B or C had a significantly higher mean number of MSCs per 10,000 mononuclear cells than healthy controls (68.7 vs. 38.9, p=0.04) (Table 1). There was no difference between patients with chronic viral hepatitis and controls with respect to number of circulating EPCs (2.8 vs. 2.9, p=0.91) or HSCs (6.7 vs. 5.5, p=0.50). There was no significant correlation between number of circulating MSCs and age, gender, or stage of fibrosis on liver biopsy.

 

Conclusions:

Mesenchymal stem cells are present in significantly higher levels in serum from patients with chronic hepatitis B and C than from healthy controls. It is possible that recruitment of MSCs plays an important role in the development of hepatic fibrosis. Further studies should be aimed at defining the role of MSCs in hepatic fibrosis and identifying the signaling mechanisms that trigger their recruitment.

 

Table 1. Mean number of circulating progenitor cells per 10,000 mononuclear cells in patients with hepatitis B or C and in healthy controls. Standard deviations in parentheses.

 

 

Hepatitis B or C

Controls

p-value

MSC

68.7 (28.9)

38.9 (18.1)

0.04

EPC

2.8 (1.3)

2.9 (2.4)

0.91

HSC

6.7 (3.5)

5.5 (2.9)

0.50

 


588. Correlation of hepatic fibrosis with serum ALT and viral levels in patient with chronic hepatitis B. 

R. Vachhani; D. Moonka; V. Pampati; H. Vachhani; K. Brown; M. Sherbondy; L. Lamerato; S. Gordon

 

Background:

Current guidelines emphasize the importance of serum ALT and HBV DNA levels when assessing the role of HBV treatment. Because of disease course fluctuation, however, patients with normal ALT or low-level viremia may have significant fibrosis.

 

Objective:

We sought to determine the relationship between hepatic fibrosis and serum ALT values and baseline viral levels in a large cohort of US patients with chronic hepatitis B

 

Methods:

We reviewed the charts of consecutively presenting treatment naďve chronic HBV patients who underwent liver biopsy between 1997-2006. We recorded liver histology and serum ALT/HBV DNA levels done at the time of liver biopsy. We used means for patients with multiple values. We defined normal ALT as ≤40 U/L for men and ≤35 U/L for women. Metavir scores (F0-F4) were used to grade fibrosis. Chi-square table was used for statistical analysis.

 

Results:

We identified 105 HBV carriers (67% men), including 38% Asian, 25% African American, and 30% Caucasian. The median age was 43, median ALT was 55 and median HBV DNA was 214,000 copies/ml, including 13 patients with no detectable viremia (≤300 copies/ml or 0.02 pg/ml). ALT values were not available for five patients. Fifty-four percent were HBeAg negative. Serum ALT values strongly correlated with degree of fibrosis (p < 0.001) but 19% of those with normal ALT had significant fibrosis (F2 or F3). Increasing HBV DNA levels trended toward more advanced fibrosis (p=0.063). HBV DNA levels >105 copies/ml correlated with more advanced fibrosis (p=0.007) although 34% (16/47) with viral loads ≤105 copies/ml were ≥F2. Age was not significantly correlated with degree of fibrosis. The sensitivity, specificity, PPV and NPV of abnormal ALT and viral load >105 copies/ml to detect fibrosis ≥F2 were 87,46,58,81 and 69,57,60,66 respectively.

 

Conclusion:

Although higher ALT and higher HBV DNA levels were associated with more advanced fibrosis, 34% of patients with viral levels ≤105 copies/ml at presentation and 19% with normal ALT values had fibrosis grades of ≥F2. These findings validate the role of liver biopsy to assess HBV disease severity, especially among those patients with a low suspicion of significant fibrosis.

 

ALT

N

Fibrosis (2-4)

P value

< 1 x ULN

31

19%

<0.001

1 – 2 x ULN

37

43%

> 2 x ULN

32

75%

HBV DNA (copies/ml)  

< 104

25

36%

0.063

104-105

22

32%

105-106

13

62%

> 106

45

60%

 


Clinical Portal Hypertension Poster Session

T1039. Impact of prophylactic antibiotics in cirrhotic patients presenting with sepsis. 

L. Lim; S. Lim; D. Sutedja; Y. Dan; Y. Lee; C. Wai

 

Aim:

Cirrhotic patients are prone to infection. Prophylactic antibiotics after an episode of spontaneous bacterial peritonitis (SBP) could potentially select out resistant organisms, such as extended spectrum beta-lactamase (ESBL)-producing organisms. We aimed to investigate the characteristics and outcomes of patients with cirrhosis who were admitted for sepsis of any source in our institution, which is a tertiary university liver transplant center.

 

Methods:

All patients with liver cirrhosis admitted to our institution from March 2004 to August 2006 for sepsis, who had documented organisms in any body fluid cultures, including blood, urine, ascites, sputum or pleural fluid, were retrospectively studied.

 

Results:

47 patients with a total of 63 admissions (16 for SBP, 15 for urinary tract infection) were studied: 26 (55%) were male, aged 65.3±1.6 years, whose major etiology of cirrhosis were cryptogenic cirrhosis (32%), chronic hepatitis B (26%), and alcoholic liver disease (26%). 13 (28%) had hepatocellular carcinoma. Of the 63 admissions, fever and abdominal pain was the presenting complaint in 36 (57%) and 26 (41%) respectively, with mean white cell count at 9.1±0.9 x10(9)/L, and mean C-reactive protein at 6.8±0.7mg/dL. Organisms isolated in cultures were, in decreasing order of frequency: Escherichia coli (22%), Klebseilla pneumoniae (18%), ESBL-producing Escherichia coli (13%), ESBL-producing Klebseilla pneumoniae (8%). Patients on prophylactic ciprofloxacin for prior SBP were more likely to harbor ciprofloxacin-resistant organisms (90% vs. 43%, p=0.007), and ESBL-producing organisms (50% vs. 15%, p=0.012) than those without. 5 of 6 (83%) episodes due to pneumonia compared with 12 of 57 (21%) episodes with infection other than pneumonia resulted in death (p=0.001). 16 of 37 (43%) septic episodes involving Child’s C patients resulted in death, compared with 1 of 26 (4%) involving Child’s A or B patients (p=0.001). The mean Child’s score (12.9±0.4 vs 9.4±0.4, p= 0.000) and MELD score (24.4±1.9 vs 17.3±0.9, p=0.000) were higher in those who died than those who survived. Using multivariate analysis, high Child-Pugh score (OR=0.579, p=0.021) and pneumonia (OR=12.6, p=0.043) had significant correlations with mortality.

 

Conclusions:

Sepsis, in particular pneumonia, was an important cause of mortality in cirrhotics, especially in those with high Child-Pugh score. Cirrhotics who were on antibiotic prophylaxis were more likely to be infected with ESBL-producing organisms, and should be started empirically on second line antibiotics such as carbapenems upon diagnosis.


Steatohepatitis: Clinical

 

T1064. Health Utility Assessment Using SF-6D and Health Utility Index (HUI) in Patients with Chronic Viral Hepatitis and Non-alcoholic Fatty Liver Disaese (NAFLD). 

 A. Dan; J. Kallman; R. Srivastava; Z. Younoszai; A. Kim; Z. M. Younossi

 

Introduction:

Assessment of health-related quality of life (HRQL) and health utilities have become important aspects of clinical research. Patient-derived utility-adjustments are frequently used in economic analysis. Although SF-36 is widely used as a generic HRQL instrument for patients with liver disease, extensive data on the health utilities of patients with liver disease are not available. Recently, SF-6D has been developed to obtain utility scores from the SF-36 questionnaire.

 

Aim:

To assess health utilities of patients with chronic liver disease using two utilities assessments (SF-6D and HUI). Methods: Patients with chronic liver disease were identified from our HRQL databases with available clinical data, SF-36, and HUI scores. SF-6D scores were calculated from SF-36.

 

Results:

140 patients were included[(42% female, age 49.4±11.2, 36% Hepatitis B, 29% Hepatitis C, 24% cholestatic liver disease, and 11% NAFLD. Analyses indicate that Hepatitis B patients had the best HRQL as measured by the SF-6D subscales (only mental health scores did not vary by health condition), while patients with Hepatitis C and cholestatic liver disease had similar HRQL, and those with NAFLD/other had the poorest HRQL (Table 1). HUI scores did not differ as much as SF-6D scores, but those scales that varied also indicated that those with other liver diseases had the poorest quality of life. Female patients experienced poorer HRQL as measured by the pain, social functioning and vitality SF-6D subscales and six of the HUI subscales. Older age was also moderately associated with many of the HRQL subscales.

 

Conclusion:

SF-36 with SF-6D scoring provides not only a generic assessment of HRQL but also a utility score that can be used for economic analysis.

 

 

Cholestatic Liver Disease

Hepatitis C

Hepatitis B

NAFLD/Other

Possible Range

SF-6D

 

 

 

 

 

Physical Functioning

4.5 (1.2)

4.4 (1.6)

5.0 (1.2)

3.4 (1.9) **

1-6

Role limitation

1.6 (.5)

1.5 (.5)

1.3 (.4)

1.8 (.4) ***

1-2

Social Functioning

3.8 (1.2)

3.6 (1.3)

4.4 (.9)

3.4 (1.5) **

1-5

Bodily Pain

3.9 (1.3)

3.9 (1.2)

5.0 (1.3)

3.9 (1.2) ***

1-6

Mental Health

4.5 (1.0)

4.3 (1.1)

4.6 (.8)

4.1 (1.1)

1-5

Vitality

3.4 (1.5)

3.3 (1.5)

4.3 (1.0)

3.1 (1.3) ***

1-5

HUI- Mark 2

 

 

 

 

 

Overall

0.8 (.2)

0.7 (.2)

0.9 (.2)

0.7 (.2) **

0-1

Cognition

0.9 (.1)

0.9 (.1)

1.0 (.1)

0.9 (.1)

0-1

Emotion

0.9 (.1)

0.9 (.2)

0.9 (.1)

0.9 (.2)

0-1

Mobility

1.0 (.1)

0.9 (.1)

1.0 (.0)

0.9 (.2) *

0-1

Pain

0.9 (.2)

0.8 (.2)

0.9 (.2)

0.9 (.3)

0-1

Self Care

1.0 (.2)

1.0 (.2)

1.0 (.1)

0.9 (.3)

0-1

Sensation

0.8 (.1)

0.8 (.2)

0.9 (.1)

0.8 (.1)

0-1

 

*p<.05 **p<.01 ***p<.001 Note: Higher values on utility scale scores as presented above reflect higher HRQL.

 


T1084. Elevated Serum Alanine Aminotransferase (ALT) Activity Does Not Increase Cardiovascular Disease (CVD) Mortality in the United States Population. 

C. E. Ruhl; J. E. Everhart

 

Introduction:

A concern exists that nonalcoholic fatty liver disease may increase the risk of CVD independently of metabolic syndrome components. In a prospective, national, population-based sample, we examined whether elevated ALT was associated with increased risk of all-cause and CVD mortality.

 

Methods:

Data were analyzed from 14,950 adult participants in the third U.S. National Health and Nutrition Examination Survey, 1988-94, who were negative for markers of viral hepatitis B and C. Abnormal ALT activity was defined as >40 U/L in men or >31 U/L in women. Participants were followed through 2000 for all-cause and CVD mortality as identified by death certificate underlying-cause diagnoses. Hazard rate ratios (HR) for mortality outcomes were calculated using Cox proportional hazards analysis to adjust for CVD risk factors. All analyses incorporated sample weights and the design effects of the survey.

 

Results:

The prevalence of elevated ALT was 5.3%. During the up to 12 years of follow-up, the cumulative mortality was 13.9% (2,189 deaths) from all causes and 4.2% (665 deaths) from CVD. Participants with an elevated ALT had a non-statistically significant 40% higher risk of all-cause mortality both in age-adjusted analysis (HR=1.4, 95% confidence interval (CI)=0.90-2.1) and after adjusting for multiple factors (HR=1.4, 95% CI=0.88-2.3). Interestingly, the risk of CVD mortality was not increased among persons with an elevated ALT in either age-adjusted (HR=1.1, 95% CI=0.44-2.8) or multivariate-adjusted analysis (HR=1.0, 95% CI=0.37-2.9).

 

Conclusion:

In the U.S. population, elevated ALT may be associated with an overall increase in mortality, but does not predict an increased risk of CVD mortality.

 


Epidemiology

W1044. Digestive Diseases in the Native American Population of the U.S. Central Plains: Disparities in Prevalence, Screening, and Treatment. 

B. Kizer; H. Lazarte; G. Haynatzki; R. Patel; A. Dajani; J. O'Brien

 

Background:

Little is known about the prevalence of digestive diseases among the Native American population from the United States central plains. The Fred Leroy Clinic of Omaha, NE, provides free medical care exclusively for over 4,000 Native Americans from 70 tribes throughout the Dakotas, Nebraska, and Kansas.

 

Methods:

A retrospective study of 449 randomly selected Fred Leroy charts. Each patient chart was reviewed for medical and social history, and the documentation of the prevalence, clinical presentation, and treatments of the ten most common digestive diseases in the United States. Data was also collected on health screening for these conditions. The one-sample z-test for proportions was used in all statistical analyses.

 

Results:

449 patient charts were reviewed. 138 patients were male; 311 were female. 330 patients were 19 to 50 years old; 119 patients were aged 50 to 79.

 

The Body Mass Index could be calculated for all but 2 patients. 113 patients were overweight (BMI 25 to < 30), 131 were obese (BMI 30 to < 35), and 137 were morbidly obese (BMI > 35). The prevalence in this study population of overweight / obesity is 85.3 % (p<0.00001, U.S. prevalence of 65%), the prevalence of obesity and morbid obesity is 60.0% (p<0.00001, U.S. prevalence of 30%).

 

No statistical difference existed between the study population and the U.S. population with regards to the prevalence of colorectal cancer (CRC). However, of 123 persons eligible for CRC screening, only 14 (11.4%, p<0.00001) were offered screening - well below the 42.5% of eligible U.S. patients who underwent screening in year 2000.

 

61 patients (13.6%) have a history of cholelithiasis. No statistically significant difference exists between the prevalence of cholelithiasis in this Native American population and the U.S. prevalence of 10-15% (p<0.00001).

 

27 patients (6%, p<0.00001) have a history of Hepatitis C infection (U.S. prevalence 1.7%).

 

Conclusion:

This is the first study looking at the prevalence of digestive diseases in the Native American population of the U.S. central plains. This population has a dramatically higher prevalence of overweight/obesity and hepatitis C compared to the general U.S. population. This population also lacks access to age and family history-appropriate colorectal cancer screening, which is a standard-of-care in the United States. The prevalence of cholelithiasis in this population is less than the rate reported in the Pima Indians, suggesting geographic variability. This indicates that data on prevalence of digestive diseases from Native Americans of the southwest United States cannot be applied to all Native American populations.

 


Immune Response

280. The Envelope Protein of the Hepatitis C virus (E2) inhibits IL-2 Secretion from T lymphocytes. 

D. Petrovic; L. Golden-Mason; S. Mitchell; Y. Volkov; C. O'Farrelly; D. Kelleher; A. Long

 

Introduction:

T-cell activation is one of the primary responses of the adaptive immune system to pathogens, such as Hepatitis C virus (HCV). Recognition of antigen, via the T cell receptor, initiates signal transduction and the resultant production of IL-2 is central to this response. We have previously demonstrated that the PKC-B enzyme is critical for the process of IL-2 secretion but not mRNA production (Long; et al). More recently we have shown that the Envelope Protein (E2) of the HCV, through its interaction with CD81, modulates PKC-B activity by stimulating its sequestration in lipid rafts, preventing T cell migration (Volkov; et al).

 

Aim:

The aim of this study was to investigate the effect of HCV E2 on T cell IL-2 production.

 

Results:

Analysis of cytokine levels in extracts of snap-frozen liver biopsies from individuals infected with HCV, measured by ELISA, revealed significantly lower levels of IL-2 in these patients when compared to those with other inflammatory liver diseases, such as ALD and PBC (IL-2 levels in ng/100mg protein: 5 ± 0.93 (HCV) vs 25 ± 2.9 (ALD), p<0.027 vs 20 ± 2 (PBC), p<0.003). In a HuT 78 T cell line model, pretreatment of cells with E2 substantially attenuated PMA stimulated IL-2 production (IL-2 levels in pg/ml: PMA stimulated cells 889.3 ± 19.1 vs E2/PMA stimulation 105.9 ± 0.2, p<0.016, (resting cells 20 ± 0.9)). This was also observed in PBMCs, obtained from healthy donors, stimulated with either PMA/Ionomycin or anti CD3 / anti CD28 antibodies (IL-2 levels in pg/ml: antiCD3/antiCD28 1825 ± 58.3 vs E2/antiCD3/antiCD28 53 ± 1.5, p<0.022, (resting cells 27.4 ± 1.4)). In contrast, cells pretreated with viral core protein C22 and NS3 protein C33 did not affect IL-2 secretion, confirming specificity of E2 in inhibition of IL-2 secretion. Inhibition of IL-2 was at the level of secretion and not transcription, as demonstrated by Real Time PCR (IL-2 mRNA level in PMA stimulated cells increased 2.07 fold over resting cells, p<0.01 while it increased IL-2 mRNA 2.19 fold in the presence of E2, p<0.0005). In addition, intracellular IL-2 was detectable by immunofluorescence in PMA activated cells pretreated with E2. Treatment of the HuT 78 cells with the lipid raft disruptor methyl-β-cyclodextrin (MCD) reversed the ability of E2 to inhibit IL-2 secretion.

 

Introduction:

These data suggest that targeting of PKC-B to the lipid raft microdomains in the T cell membrane, following E2 - CD81 interaction, disrupts the association of PKC-B with the microtubule cytoskeleton, thereby inhibiting export of IL-2. E2-mediated inhibition of IL-2 secretion represents a mechanism whereby HCV can undermine the human immune response to establish persistent infection and chronic disease.


Hepatotoxicity and Steatohepatitis

 

513. Associate Factors Of Nonalcoholic Fatty Liver Disease : Results From A Population-Based Study. 

A. Colecchia; A. Vestito; E. Paltrinieri; M. Bacchi-Reggiani; A. Di Biase; G. Mazzella; M. Montagnani; F. Lodato; A. Morselli-Labate; F. Pasqui; D. Festi

 

Introduction:

Nonalcoholic fatty liver disease (NAFLD) represents one of the most common liver disease; however a few studies assessed its prevalence in general population and its association with abnormal liver enzymes is not still clear.

 

Aim:

To evaluate the prevalence and associated factors of NAFLD in a general population and its relationship with abnormal liver enzymes.

 

Material and Methods:

We carried out a cross sectional study in a general population, aged 18-84 yrs, of a small town; 1534 out of 1646 ( 93%) subjects agreed to participate to the study. All subjects underwent abdominal ultrasound, physical examination, fasting blood specimen collection, seven day dietetic diary.

 

Results:

479 out of 1534 ( 31.2%) subjects were excluded (391 alcohol, 20 HBV, 63 HCV and 5 autoimmune); thus analyses were performed on 1055 subjects (68%). 382 out of 1055 subjects ( 36.1%)( males 57.8%, mean age: 52.1 ± 12.7) had NAFLD evaluated by US. 88 out of 1055 subjects ( 8.3%) had abnormal ALT ( 15.7% in NAFLD vs 4.2 % in normal subjects; p< 0.001); prevalence of NAFLD was higher in subjects with abnormal ALT than those with normal ALT [ 60 out of 88 (68.2%) vs 319 out of 967( 33%)( p< 0.001)]. Frequency of NAFLD was related to increased BMI,; however 80 out of 382 ( 20%) subjects had normal BMI. Associated factors were, at univariate analysis, male sex, aging , blood hypertension, diabetes, hypercholesterolemia, low HDL-cholesterol, Tg/Hdl ratio ≥ 3.5, hypertriglyceridemia, BMI, large waist circumference and abnormal ALT, AST and gGT; while, at multivariate analysis, they were sex male (OR:1.89), systolic hypertension (OR:1.9), hyperglicemia (OR:1.9), visceral obesity (OR:4.9), Tg/HDL ratio (OR:2.9), ALT (OR:2,5) and gGT (OR:1.8).

 

Conclusion:

NAFLD is highly prevalent in general population; among the associated factors, obesity and Tg/HDL ratio (marker of insulin resistance) were the strongest ones. Furthermore, abnormal liver enzymes (namely ALT) are significantly associated with NAFLD; however, since they largely underestimate the disease prevalence, they cannot be used as markers of NAFLD.

 


Clinical Epidemiology II

 

M1015. Rates and Predictors of Depression in an Out-patient Hepatology Practice . 

G. S. Sayuk; S. El-Dirani; J. E. Elwing; P. Lustman; M. Lisker-Melman; J. S. Crippin; R. E. Clouse

 

Introduction/Aim:

Depression interferes with all aspects of daily living, adherence to medical recommendations, and treatment outcomes. Depression may be under-recognized in patients with chronic liver disease (CLD) because many of its symptoms overlap with symptoms attributable to liver dysfunction. The rate of depression symptoms across types of CLD is not known.

 

We administered a commonly used depression assessment instrument, the Beck Depression Inventory (BDI), to out-patients attending a university-based practice to determine the rate of current depression symptoms and predictors of elevated scale scores.

 

Methods:

345 pts with CLD [51.1 ±11.9 yr; 193 (55.9%) female; 104 (30.1%) cirrhotic] completed the 21-item BDI during an office visit (max score 63). Etiologies of liver disease were: hepatitis C (HCV) 115 (33.3%), NASH/cryptogenic 78 (22.6%), primary sclerosing cholangitis (PSC) 18 (5.2%), primary biliary cirrhosis (PBC) 13 (3.8%), hepatitis B (HBV) 16 (4.6%), autoimmune hepatitis (AIH) 25 (7.2%), other CLD 52 (15.1%). Prevalence rates of pts having total BDI ≥16, an accepted cut-off for suspecting major depressive disorder, and a score ≥10 on the cognitive symptom scale (cBDI, excludes overlapping somatic symptoms) were determined per CLD group. Predictors of total BDI score were determined from a linear regression model that included demographic (age, sex, BMI), clinical [type 2 diabetes (T2DM), prednisone use, interferon use, IV drug use (IVDU), current alcohol use], and liver disease variables (MELD score, encephalopathy, AST).

 

Results:

BDI scores ≥16 were found in 37.4% of the total subject group, ranging from 25.0 – 42.6 % without significant difference across the represented disorders (HCV 42.6%, NASH 34.6%, PSC 38.9%, PBC 38.5%, HBV 25.0%, AIH 40.0%, other 29.6%; χ2 = 3.96, p=0.78). cBDI scores ≥10 were found in 24.6% of CLD, ranging from 12.5 – 27.8% across disorders (HCV 27.8%, NASH 26.9%, PSC 27.8%, PBC 23.1%, HBV 12.5%, AIH 16.0%, other 24.1%; χ2=3.65, p=0.81). In regression models of all CLD subjects, younger age, female sex, T2DM, and IVDU predicted higher total BDI and higher cBDI scores (p<0.05 for each). Liver disease variables were not independent predictors of BDI scores in either model.

 

Conclusions:

High levels of current depression symptoms are present in a large proportion of out-patients with CLD. This finding is not related solely to CLD symptoms that might mimic depression and is not conspicuously affected by type of CLD. Depression symptoms are best predicted by clinical features associated with depression in non-CLD populations (female sex, T2DM, IVDU) rather than type of liver disease or measures of liver disease severity.

 


HCV:Pathogenesis/Virology/Diagnosis and Natural History

 

 

M1842. Transient elastography in chronic hepatitis B and C predicts severe fibrosis similarly. 

C. Verveer; H. R. van Buuren; P. E. Zondervan; B. E. Hansen; H. Janssen; R. J. de Knegt

 

Background:

Assessment of liver fibrosis is important in chronic liver diseases. In chronic hepatitis B and C it helps to determine prognosis and indication for therapy. Transient elastography is a novel method for measurement of liver fibrosis. In contrast with the liver biopsy it is comfortable and without any risk.

The Fibroscan® has been validated in large cohorts of hepatitis C patients, but its use in hepatitis B patients is still undetermined. We investigated whether reliability of the Fibroscan® in viral hepatitis B and C are comparable.

 

Methods:

All consecutive patients undergoing a liver biopsy had an additional Fibroscan®-measurement. Correlation between liver histology (Metavir) and the outcome of liver elasticity (Fibroscan®, kPa) was determined. In this cohort we studied the outcomes between both groups of elasticity measurements and liver fibrosis stages in order to investigate comparability.

 

Results:

Among 68 hepatitis B patients 7 had Metavir F0, 25 F1, 21 F2, 9 F3 and 6 F4; corresponding elasticity was (mean:) F0 5.36 kPa, F1 7.69 kPa, F2 9.15 kPa, F3 13.41 kPa and F4 17.05 kPa. Among 73 hepatitis C patients 3 had Metavir F0, 31 F1, 23 F2, 13 F3 and 3 F4; corresponding elasticity was (mean): F0 3.40 kPa, F1 6.48 kPa, F2 7.82 kPa, F3 12.86 kPa and F4 13.73 kPa.

 

To determine the predictive value of the elasticity corresponding to severe fibrosis logistic regression was performed. Graphs for HBV and HCV were not significant different indicating comparable elasticity measurements for predicting fibrosis in HBV or HCV.

 

Conclusion:

The Fibroscan® is applicable in both chronic hepatitis B and C with a similar predictive value for liver fibrosis.

 


Clinical Portal Hypertension Poster Session

 

T1043. Endoscopic Band Ligation May Not Be Inferior to Endoscopic Injection Sclerotheraphy in Cardiac Variceal Bleeding, Not Fundal Variceal Bleeding. 

M. Jang; J. Jang; H. Kim; H. Kim; W. Shin; J. Lee; K. Kim; J. Park; J. Lee; H. Kim

 

Background/Objective:

Endoscopic injection sclerotherapy (EIS) with cyanoacrylate has been used in conditions with both cardiac (GOV1) and fundal (GOV2/IGV1) variceal bleeding of gastric varices. However, cardiac varices are very different from fundal varices both hemodynamically and pathophysiologically. Therefore, therapeutic strategies should be individualized. This pilot study was aimed to evaluate the efficacy of endoscopic band ligation (EBL) in active cardiac variceal bleeding, not fundal variceal bleeding.

 

Methods:

We consecutively enrolled a total of 23 patients with liver cirrhosis presenting with active cardiac variceal bleeding. They were treated by EBL (6/19, EBL group) or EIS (13/19, EIS group). Remained 4 patients could not undergo therapeutic procedures because of sudden cardiac collapse by massive bleeding. GOV1 was defined as the varices within 2-5cm of gastroesophageal junction.

 

Results:

Total patients were 95% of male and 52 (36-72) years old in median (range). The causes of liver cirrhosis were alcoholic (62%), HBV-associated (30%), HCV-associated (4%) and cryptogenic (4%), respectively. The patients had experienced early rebleeding (within 48 hours) in 17% (1/6) of the EBL group and 23% (3/13) of the EIS group (P=NS), and late rebleeding(within 6 months) in 17% (1/6) and 46% (6/13) in each group (P=NS). Rebleeding-free survival was not significantly different between EBL group and EIS group (165 days (1-450) vs. 90 days (1-870), P=0.39 on Kaplan-Meier curve). Mortality by cardiac variceal bleeding was not significantly different between 2 groups (17% vs. 8%, P=NS).

 

Conclusions:

EBL may not be inferior to EIS in controlling an active cardiac variceal bleeding in this pilot study. Therefore, it will be warranted to perform the larger-scale study to reevaluate the role of EBL in active cardiac variceal bleeding, not fundal variceal bleeding.