Sara Bertilsson

Bacterial infections in alcoholic and nonalcoholic liver cirrhosis

Objectives Longitudinal, population-based data on the occurrence, localization, and severity of bacterial infections over time in patients with alcoholic compared with nonalcoholic cirrhosis are limited. Materials and methods All patients with incident cirrhosis diagnosed in 2001–2010 (area of 600 000 inhabitants) were retrospectively identified. All bacterial infections resulting in or occurring during an inpatient hospital episode during this period were registered. The etiology of cirrhosis (alcoholic vs. nonalcoholic), infection localization, and outcome as well as bacterial resistance patterns were analyzed. Patients were followed until death, transplant, or the end of 2011. Results In all, 633 cirrhotics (363 alcoholic, 270 nonalcoholic) experienced a total of 398 infections (2276 patient-years). Among patients diagnosed with cirrhosis each year from 2001 to 2010, increasing trends were noted in the occurrence of infection (from 13 to 27%, P<0.001) and infection-related in-hospital mortality (from 2 to 7%, P=0.05), the latter mainly in the alcoholic group. Although alcoholic etiology was related to the occurrence of more frequent infection (Kaplan–Meier, P<0.001), this relationship was not significant after adjustment for confounders in Cox regression analysis (P=0.056). Resistance to piperacilin-tazobactam and carbapenems was more common in infections occurring in alcoholic versus nonalcoholic cirrhosis (13 vs. 5%, P=0.057 and 12 vs. 2%, P=0.009). Alcoholic etiology predicted pneumonia and infections caused by Gram-positive bacteria in multivariate analysis (P<0.05 for both). Conclusion In a population-based cirrhotic cohort, bacterial infections increased over time, which, in the case of alcoholic cirrhosis, was associated with pneumonia and bacterial resistance to antibiotics. However, alcoholic etiology was not related indepedently to the occurrence of bacterial infections.

Acute Pancreatitis and Use of Pancreatitis-Associated Drugs: A 10-Year Population-Based Cohort Study.

Objectives To assess the use of acute pancreatitis (AP)–associated drugs in patients with AP, the relation between sales of these drugs and the incidence of AP, and the potential impact on AP severity and recurrence. Methods All patients with incident AP between 2003 and 2012, in a well-defined area, were retrospectively identified. Data regarding AP etiology, severity, and recurrence and use of AP-associated drugs were extracted from medical records. Drugs were classified according to an evidence-based classification system. Annual drug sales data were obtained from the Swedish drug administration service. Results Overall, 1457 cases of incident AP were identified. Acute pancreatitis–associated drug users increased from 32% in 2003 to 51% in 2012, reflecting increasing user rates in the general population. The incidence of AP increased during the study period but was not related to AP-associated drug user rates (P > 0.05). Recurrent AP occurred in 23% but was unrelated to AP-associated drug use (P > 0.05). In logistic regression analysis, after adjustment for comorbidity, AP-associated drug use was not related to AP severity (P > 0.05). Conclusions Use of AP-associated drugs is increasingly frequent in patients with AP. However, it does not have any major impact on the observed epidemiological changes in occurrence, severity, or recurrence of AP.

Acute Pancreatitis: Impact of Alcohol Consumption and Seasonal Factors

Aims: We aimed to evaluate the potential relation between the incidence of (alcoholic and non-alcoholic) acute pancreatitis (AP) and alcohol consumption in the general population, and whether the occurrence of AP shows any seasonal variation, particularly in relation to periods with expected increased alcohol consumption.Methods: All patients with first-time AP between 2003 and 2012 in a well-defined area in Sweden were retrospectively identified. Data on AP aetiology (alcoholic and non-alcoholic) and severity were registered. Data on annual alcohol sales as well as on self-reported alcohol consumption were obtained.Results: In total, 1457 AP patients were included (83% non-alcoholic AP, 17% alcoholic AP). The overall AP incidence showed increasing time trends for women and men (P 0.05). Alcohol sales during the study period decreased (P = 0.002), mainly due to decreased sales of spirits (P = 0.001) and beer (P = 0.002), while self-reported alcohol consumption remained stable for women (P > 0.05) and decreased for men (P = 0.022). Neither alcohol sales nor consumption was related to the time trends of AP (P > 0.05 for all). No significant differences were found in the occurrence of AP among different seasons of the year or between holidays associated with higher alcohol consumption compared to periods before and after these holidays (P > 0.05 for all).Conclusions: Changes in alcohol consumption in the general population do not appear to be related to changes in the incidence of AP and there are no significant seasonal differences in the occurrence of AP in Sweden.Short summary: The incidence of acute pancreatitis (AP) is increasing, and alcohol is still recognized as one of the most common causes. In this study, however, we could not ascertain any clear relations between the sales and consumption of alcohol in the general population and the incidence of alcoholic or non-alcoholic AP. (Less)Aims We aimed to evaluate the potential relation between the incidence of (alcoholic and non-alcoholic) acute pancreatitis (AP) and alcohol consumption in the general population, and whether the occurrence of AP shows any seasonal variation, particularly in relation to periods with expected increased alcohol consumption. Methods All patients with first-time AP between 2003 and 2012 in a well-defined area in Sweden were retrospectively identified. Data on AP aetiology (alcoholic and non-alcoholic) and severity were registered. Data on annual alcohol sales as well as on self-reported alcohol consumption were obtained. Results In total, 1457 AP patients were included (83% non-alcoholic AP, 17% alcoholic AP). The overall AP incidence showed increasing time trends for women and men (P < 0.05), but there were no significant changes in the incidence of alcoholic AP, in either sex (P > 0.05). Alcohol sales during the study period decreased (P = 0.002), mainly due to decreased sales of spirits (P = 0.001) and beer (P = 0.002), while self-reported alcohol consumption remained stable for women (P > 0.05) and decreased for men (P = 0.022). Neither alcohol sales nor consumption was related to the time trends of AP (P > 0.05 for all). No significant differences were found in the occurrence of AP among different seasons of the year or between holidays associated with higher alcohol consumption compared to periods before and after these holidays (P > 0.05 for all). Conclusions Changes in alcohol consumption in the general population do not appear to be related to changes in the incidence of AP and there are no significant seasonal differences in the occurrence of AP in Sweden. Short summary The incidence of acute pancreatitis (AP) is increasing, and alcohol is still recognized as one of the most common causes. In this study, however, we could not ascertain any clear relations between the sales and consumption of alcohol in the general population and the incidence of alcoholic or non-alcoholic AP.

Mo1247 Neutrophil and Monocyte Activity in Stable Cirrhosis: Relation With Cirrhosis Etiology and Severity As Well As Cytokine Profile and 25(OH) Vitamin D Levels

Background: Chronic liver disease and cirrhosis are a major cause of morbidity and mortality worldwide. Hospitalizations due to complications of cirrhosis are associated with substantial economic burden. We hypothesized that the hospitalizations related to complications of cirrhosis varies by season based on individuals various indoor/outdoor activities, diet and seasonal infection; and we aim to study seasonal variations in hospitalizations due to complications of cirrhosis in the USA from a large national inpatient database. Methods: The National Inpatient Sample database of year 2011 which was collected as part of Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality were utilized for this study. The NIS is the largest all payer inpatient care database containing around 8 million hospitalizations from around 1000 hospitals in the United States. The hospitalizations related to cirrhosis and its complications including hepatic encephalopathy, esophageal variceal bleeding, and ascites requiring paracentesis were captured using various ICD-9 diagnosis codes. Four seasons were categorized based on the months of hospitalization (spring: March, April, May; summer: June, July, August; fall: September, October, November and winter: December, January, February). Analyses were performed separately different regions of United States. SAS 9.3 was used for analyses. Results: Our study included 36,684 hospitalizations due to complications of cirrhosis which include hepatic encephalopathy, gastrointestinal bleeding, and ascites requiring paracentesis. The hospitalizations related to these complications were comparable across all regions with 24.64% in Spring, 24.70% in Summer, 25.62% in Fall, and 25.00% in Winter. Though wide variation was seen while analyzing data by different regions with highest rate of hospitalizations due to variceal bleeding in the Northeast during spring (34.8%), in the Midwest during fall (31.43%), in the South during winter (27.96%), and in the West highest during summer (27.08%) months. Similarly, hospitalizations due to hepatic encephalopathy in the Northeast were highest in spring (26.22%), in the Midwest during fall (26.25%), in the South during winter (26.13%), and in theWest during summer (25.52%). Hospitalizations due to ascites requiring paracentesis were highest during fall for Northeast (26.98%) and South (27.17%) regions while Midwest and West regions had higher rates during spring (25.60%), and summer (25.87%) respectively.Conclusion: Seasonal variations in hospitalizations due to the complications of cirrhosis are present when hospitalizations due to hepatic encephalopathy, variceal bleeding, and ascites requiring paracentesis are analyzed by various regions. Understanding the factors behind such variations may help guide preventing hospitalizations secondary to these complications.

794b Natural History of Acute Pancreatitis: Results of a Population-Based Cohort Study

use). The proportion of pts requiring narcotics decreased after TPIAT (p<0.001 vs baseline): 77% (22/42) at 1 year and 52% (14/26), 57% (8/14), 30% (4/13), and 33% (2/6) at 2, 3, 4, and 5 years. Average pain (0-10) pre-TPIAT, at 1 and 5-years post-TPIAT were 5.1±0.4, 2.5±0.4, and 2.75±1.2 respectively (p=0.006). 75-95% of pts perceived their pain and general health as improved vs pre-TPIAT at any yearly assessment (up to 5 years). Insulin independence occurred in 46%, 44%, 41%, and 33% at 1, 2, 3, and 4 years; most on insulin used <1 injection/day. Mean HbA1c was 6.2±0.2% at 1 year, 6.1±0.3% at 2 years. There were no differences in pain improvement, pain scores (Fig. 1 and 2), narcotic use, or QOL in those with normal vs abnormal pancreatic histopathology at TPIAT. Conclusions: TPIAT significantly improved QOL, pain and narcotic requirements in patients with disabling refractory iRAP without evident CP. Minimal or no insulin was required in most. Clinical outcomes did not correlate with histopathology.

Su1301 Impact of Infection Type, Acute Kidney Injury, and Systemic Inflammatory Response Syndrome on Survival of Cirrhotic Patients With Bacterial Infections: A Population-Based Cohort Study

G A A b st ra ct s patients has not been examined. The objective of this analysis was to assess the efficacy and tolerability of rifaximin in maintaining remission from HE in cirrhotic patients with HCV. Methods: Breakthrough HE events and tolerability were assessed from a 6-month, randomized, double-blind, placebo-controlled trial of RFX 550 mg BID in cirrhotic patients (n= 299) with a recent history of recurrent HE but in remission at enrollment (Conn Score [CS], 0 or 1). Breakthrough overt HE was defined as an increase in CS to ≥2, or an increase in both CS and asterixis score of 1 grade each for patients entering with a CS of 0. Lactulose was permitted throughout the study. The incidence of adverse events (AEs) was reported. Results: HCV was the etiology of advanced liver disease in 42.8% (128 of 299) of patients. Demographic and baseline characteristics were generally similar between HCV and nonHCV patients. In HCV patients, breakthrough HE events occurred in 26.2% (16 of 61) of RFX patients vs. 47.8% (32 of 67) of PBO patients, corresponding to relative reduction in risk of a breakthrough HE episode of 52.2% (Figure, P=0.014). In cirrhotic patients with other etiologies (eg, alcohol-related, NAFLD/NASH), there were also significant treatmentrelated differences, with 19.0% (15 of 79) of RFX patients experiencing a breakthrough HE event vs. 44.6% (41 of 92) of PBO patients (P,0.001). In HCV patients, the most commonly reported AEs were nausea (RFX:18.0% of patients, PBO:19.4% of patients), fatigue (RFX:14.8%, PBO:13.4%), and peripheral edema (RFX:14.8%, PBO:7.5%). Conclusions: In patients with HCV and recurrent HE, RFX was efficacious and well-tolerated, with a clinical profile similar to that observed for cirrhotic patients with other etiologies of advanced liver disease.