Donny D. Kakati

Impact of Metabolic Syndrome on the Hospitalization Rate of Crohn's Disease Patients Seen at a Tertiary Care Center: A Retrospective Cohort Study

Background/Aims: Recent studies suggest that markers of mesenteric inflammation, such as increased adipose tissue, may be associated with poor outcomes in Crohns disease (CD). This studys hypothesis is that CD patients with metabolic syndrome (MetS) have more CD-related hospitalizations than CD patients without MetS. Methods: We conducted a retrospective cohort study of CD patients seen from 2000 to 2012 at our tertiary care center. We analyzed crude and age-, sex- and duration of CD-adjusted incidence rate ratio (IRR) of CD-related hospitalization of those with MetS versus those without MetS. We also investigated possible associations between individual component conditions of MetS and rate of CD-related hospitalization. Results: A total of 868 CD patients were included. There were 37 (4%) patients with MetS at initial observation. After multi-variable adjustment, patients with MetS had a CD-related hospitalization rate twice that of those who did not have MetS. High triglycerides (TG), low high density lipoprotein (HDL) cholesterol and diabetes mellitus (DM) were associated with increased risk of CD-related hospitalization. Conclusions: CD patients with MetS have a higher rate of CD-related hospitalization compared to those without MetS. Hypertriglyceridemia, low HDL cholesterol and DM may be good markers of local and systemic inflammation as seen in CD.

Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation.

Background: To define urine or serum biomarkers in predicting renal function recovery after liver transplantation (LT). Methods: Adults listed for LT (February 2011-July 2014) and with modified diet for renal disease-6 (MDRD-6) <60 mL/min provided urine/blood samples at baseline and serially until LT for biomarkers in serum (pg/mL) and urine (pg/mg creatinine). Results: Of 271 LT listed patients (mean age 57 years, 63% males, median listing MELD 17.5), 1 year acute kidney injury (AKI) probability was 49%, with odds of 1.3-, 3.0-, 4.6-, and 8.5-fold times for listing MELD 16-20, 21-25, 26-30, and >30, compared to MELD <16. Thirty-seven people died over 1 year from the time of listing, with twofold increased odds with AKI. Among 67 patients with MDRD <60, only urinary epidermal growth factor was different comparing AKI (increase in serum creatinine ≥0.3 mg/dL from baseline within past 3 months) vs. no AKI (2,254 vs. 4,253, p = 0.003). Differences between acute tubular necrosis (ATN) and hepatorenal syndrome could not be ascertained for a small sample of 3 patients with ATN. Analyzing 15 of 43 receiving LT and MDRD-6 <30 prior to LT, biomarkers were not different comparing 5 patients recovering renal function (MDRD-6 >50 mL/min) at 6 months vs. 10 without recovery. Conclusions: AKI is common among LT listed patients, with a negative impact on transplant-free survival. Serum and urine biomarkers are not associated with the recovery of renal function after LT. Multicenter studies are suggested to (a) develop strategies to reduce the development of AKI and (b) derive novel biomarkers for use in accurately predicting renal recovery after LT.

Mo1978 Cholecystectomy Does Not Worsen Outcomes in Steatohepatitis Related Liver Disease

Background and Aims: To define if there is an imbalance in plasma levels of some proinflammatory, fibrogenic and antifibrogenic cytokines of patients with liver cirrhosis (LC) and impaired glucose tolerance (IGT) or Diabetes Mellitus (DM) . Methods: We studied 54 patients with compensated LC who had normal fasting plasma glucose (FPG) levels. An oral glucose tolerance test (OGTT) was carried out:18 patients were normal, 18 had IGT, and 18 had DM. Plasma levels of the following cytokines were measured: TNF-α, Soluble Tumor Necrosis Factor Receptor 1 (sTNF-R1), Leptin, TGF-β1, and Hepatocyte Growth Factor (HGF). Also, fasting plasma insulin (FPI) levels were measured and HOMA2-IR was calculated. Results were compared with those of a control group of 18 patients without liver disease or DM. Data were expressed as medians and interquartile ranges. Intergroup comparison was performed using non parametric tests. Results:. Patients with IGT and DM had significantly higher sTNF-R1 (p = 0.0043 and 0.0045 respectively) (Figure 1) and significantly lower TGF-β1 (p = 0.001 and 0.001 respectively) (Figure 2) compared to controls. Leptin , HGF, and TNF-α showed no significant differences among cirrhotic patient and controls. Correlations between sTNF-R1 and HOMA2-IR and between leptin and HOMA2-IR were found. Conclusions: IGT and DM were associated to an imbalance of sTNF-R1 and TGFβ1 in cirrhotic patients. At the same time sTNF-R1and leptin correlated with IR. These findings may suggest that sTNF-R1 might be implicated in the development of DM or in the deterioration of liver function in cirrhotic patients with DM.