J. van Vlymen

A method of identifying and correcting miscoding, misclassification and misdiagnosis in diabetes: a pilot and validation study of routinely collected data

Diabet. Med. 27, 203–209 (2010)

Trends and transient change in end-digit preference in blood pressure recording: studies of sequential and longitudinal collected primary care data.

Background:  End‐digit preference (EDP) is a known cause of inaccurate BP recording. Distortion has been reported around pay‐for‐performance (P4P) indicators.

Automated identification of miscoded and misclassified cases of diabetes from computer records.

Diabet. Med. 29, 410–414 (2012)

[OP.1A.04] PLASMA SODIUM CONCENTRATION AND THE RISK OF CARDIOVASCULAR DISEASE: A LARGE COMMUNITY-BASED COHORT STUDY

Objective: Reducing dietary salt lowers both blood pressure and cardiovascular risk. The mechanisms underlying the adverse effects of high salt intake are incompletely understood, but parallel increases in plasma sodium (PNa) may be of importance: observational and experimental studies have identified that small increases in PNa are associated with increased blood pressure and changes to endothelial function, independent of changes in plasma volume. However, very few studies have investigated whether there is an association between PNa and cardiovascular disease (CVD). Design and method: This was a retrospective cohort study using the Royal College of General Practitioners Research and Surveillance Centre database. Data collected between April 2005 –March 2015 was extracted, and the baseline period was defined as before April 2010. The primary outcome was incident CVD (myocardial infarction, acute coronary syndrome, coronary revascularisation, stroke or heart failure diagnosis) during the 5-year follow-up period. Exclusion criteria were: age less than 40, diabetes mellitus, prior CVD event, end-stage renal disease and liver cirrhosis. Baseline PNa was determined using the most recent laboratory result, and a mean was calculated if a second result was available at least 3 months apart. Results: 234,764 individuals were included in the study. A PNa of 137 mmol/L or less at baseline was associated with increasing age, female gender, hypertension, and prescription of cardiovascular medications including diuretics. After multivariate adjustment for confounding factors, there was a significant ’J-shaped’ relationship between PNa and CVD (Figure 1). No linear association between increased PNa and blood pressure was demonstrated. Figure. No caption available. Conclusions: To our knowledge, this is the largest study to investigate the relationship between PNa and CVD. The association was greatest with lower PNa, and was such that the risk increased at concentrations well within the normal physiological range (140 mmol/L or less). One hypothesis is that lower PNa is an indicator of neurohormonal activation prior to the development of overt CVD. A lower PNa may be a useful indicator for the future development of CVD but obscure the potential importance of high PNa over longer periods of time.

PTU-087 Developing Models of Engagement in a New Migrant Population: Results from a Large Scale Hepatitis B & C Testing Study in the UK Nepali Community

Introduction The UK Nepali community has grown by over 900% since 2004, when settlement rights were introduced for ex-Gurkha servicemen and their dependants. Nepal sits between India and China; two countries with higher rates of hepatitis B & C, but rates in the UK Nepali population is unknown Methods The Nepali community has multiple castes and religious beliefs. Little is known about disease and healthcare perception, and focus group sessions were held before testing. National ethics approval was obtained, and testing sessions were held in community venues centrally located to known population clusters in Surrey, UK. Study advertising was limited to existing Nepali language media and word of mouth, following concerns raised by the activity of far right groups. Fingerprick testing was used, with community leaders helping to facilitate testing. Questionnaires were used for possible risk associations including: blood transfusions, surgery, and place of origin. Results 1005 Nepali individuals (age > 18 yrs, Male = 45%) were tested over 17 sessions from Mar 2013 - Jan 2015. A total of 973 individuals were included in final analysis (mean age 63 yrs, range 19–86). Median length of stay in the UK was 36 months, with 18 individuals (1.8%) present in the UK for more than 10 years HBsAg was detected in 3 (0.31%) and HCVAb in 4 (0.41%) separate individuals; showing low rates of infection. HBsAg patients had absent or low level HBV DNA (<300iu/ml), and all HCV patients were RNA negative, with no evidence of cirrhosis in attending patients on follow-up (5/7). Hepatitis B core Ab (HBcAb) was detected in 93 individuals (9.6%), mean age 67 yrs (22–84 yrs) Regression analysis showed no statistical associations with HBsAg / HCVAb presence; but HBcAb was significantly associated with male gender and fewer years spent at school (p = 0.002 and p = 0.02 respectively) Conclusion Rates of active CVH were very low in the Nepali community, but with higher rates of previous HBV exposure, which may have implications for ongoing testing programmes. Given the absence of a common religious or cultural forum to target this new community, we used detailed focus group sessions and developed strong community links to produce a successful community-based approach to engagement, which we hope will act as a model of testing in other communities. Disclosure of Interest None Declared

PWE-116 Gp210 and/or sp100 antibodies in primary biliary cirrhosis: predictors of cirrhosis/autoimmune (aih) overlap syndromes?

Introduction Primary Biliary Cirrhosis (PBC) is a progressive cholestatic liver disease, with Anti-mitochondrial antibodies (AMA) found in ∼ 95% of patients. Anti-GP210 and SP100 are suggested as additional markers in AASLD guidance, and may help in predicting disease prognosis. However, the role and benefit of anti-GP210 and SP100 testing in routine clinical practice is unclear. Method We conducted a retrospective study of all PBC patients (diagnosed according to AASLD criteria), across 3 hospitals in Surrey, England; serving a population 1.1million. Prospective ELISA testing for GP210 and SP100 antibodies were undertaken on all active PBC-patients in follow-up. Baseline characteristics (laboratory/clinical) and progression during follow-up were analysed and compared between both groups. Results 51 PBC patients were identified, with anti-GP210/SP100 demonstrated in 14 patients (27%); 9 with anti-SP100, 5 with anti-GP210. Demographic characteristics were similar between both groups: age 64 vs. 61 years, Females 80% vs. 70% in the PBC and GP210/SP100 groups. Consistent with the high sensitivity of AMA in PBC, only 1 (1/51) patient was AMA negative, and also negative for M2, GP210 and SP100. Baseline cirrhosis (imaging/biopsy) was present in 3/27 patients (11%) in the PBC group vs. 3/12 (25%) in the GP210/SP100 group. Quantitative mean M2 values were similar (100 vs. 96), as were baseline mean laboratory values (Bilirubin, ALT, ALP, GGT and IgM). Cirrhosis was present at follow-up (range 0.5–10 years) in 5/37 patients (13.5%) vs. 4/13 (31%) in the GP210/SP100 group. Treatment response to UDCA at one year (Barcelona criteria) was similar: 10/24 (42%) vs. 5/13 (38%) in the GP210/SP100 group. Post-treatment mean alkaline phosphatase levels were higher in the GP210/SP100 group 231 vs. 174 (p = 0.84). 8/51 PBC patients (16%) had diagnosed Autoimmune hepatitis (AIH)/PBC Overlap Syndrome (OS) (based on histological/serological features). OS cases were seen in 2/37 (5%) in the non-ANA group vs. 6/14 (43%) of those in the GP210/SP100 group, reaching statistical significance (p = 0.05); with no significant difference in ALT levels between the OS/non-OS groups. Conclusion Although a small sample, our findings support the role of anti-GP210/SP100 as possible markers of disease severity (cirrhosis), and suggest a role for these auto-antibodies in identifying patients with PBC/AIH overlap syndromes; even in the absence of a significant transaminitis. Disclosure of interest None Declared.