V. Di Gregorio

P921 NEGATIVE PROGNOSTIC IMPACT OF HEPATIC ENCEPHALOPATHY IN CIRRHOSIS: IS IT TIME TO IMPLEMENT THE MELD SCORE TO IMPROVE THE TRANSPLANT BENEFIT?

levels 30–60 minutes after ACTH stimulation; delta cortisol (Dc = Pc −Bc]. AI was defined as at least two of the following: Bc < 148nmol/L, Pc < 550nmol/L, Dc < 250nmol/L. All patients had Methylprednisolone intraand post-operatively. Parameters of graft and renal function were recorded 48 hours post-LT. Results: 18 patients (22.5%) had AI. Patients with AI had higher MELD score (19 vs. 15; p = 0.003), higher pre-LT INR, bilirubin and potassium, and lower sodium and haemoglobin levels. 48 hours post-LT patients with AI had higher creatinine (152 vs. 91umol/L; p = 0.038) compared to those with normal adrenal function. There was no difference in mechanical ventilation, vasopressor support, renal replacement therapy, length of ICU and hospital stay between the two groups. Parameters that correlated with 48-hour creatinine were age, Bc, Pc and pre-LT creatinine. In multivariate analysis only Pc and pre-LT creatinine were significant predictors of 48-hour creatinine. Conclusions: Pre-LT AI was associated with immediate post-LT renal dysfunction in our study. The full extent of AI implications may have been masked by the intaand post-operative use of steroids. These results should be confirmed in further studies.

O9 BACTERIAL INFECTIONS INDUCE BOTH OVERT AND MINIMAL HEPATIC ENCEPHALOPATHY: RESULTS OF A PROSPECTIVE STUDY

Background and Aim: Nosocomial infections represent a frequent and severe complication in cirrhotic patients. Predisposing factors for nosocomial infections in this patients have not been clearly identified. The aim of the present study was to assess the risk factors for nosocomial infections in cirrhotic patients. Material and Methods: Consecutive cirrhotic patients admitted at our University Hospital in the last 24 months were enrolled. Diagnosis of infection in the first 48 hours, concomitant HIV infection, immunosuppressive or steroid therapy were considered as exclusion criteria. All possible risk factors for the development of infections (severity of liver disease, variceal bleeding, hyponatremia, presence of TIPS, hospitalization in a room with additional bed, days of hospitalization, invasive procedures) were considered. Results: 238 patients were enrolled (66% males; median age 63 years; median Child score 8, MELD score 14). During the hospitalization, 43 nosocomial infectious episodes were recorded. The main infections were: urinary tract infection (40%), pneumonia (20%), spontaneous bacterial peritonitis (17%). Multidrug resistant bacteria were isolated in 45% of the cases. Patients who developed an infection during the hospitalization were more likely to present a worse liver function (MELD 15±8 vs 12±4; p< 0.01), to bear a TIPS (20% vs 7%; p = 0.05), to be hospitalized in a room with addictive bed (53% vs 19%; p< 0.01) and to undergone a major number of invasive procedures (2.7±2 vs 1.7±1.1; p = 0.01). Moreover, these patients were hospitalized for a longer time (25±17 vs 11±10). At the multivariate analysis, MELD score (p = 0.03; OR 1.1; IC 1.01-1.2), hospitalization in a room with an additional bed (p = 0.004; OR 2.9; IC 1.5-8) and a longer hospital stay (p = 0.001; OR 1.06; IC 1.021.1) were selected as independent factors for the development of nosocomial infections. Conclusions: Severity of liver disease and factors more strictly related to hospitalization, like duration and conditions of hospital stay, are significantly related to the development of nosocomial infections in cirrhotic patients. O9 BACTERIAL INFECTIONS INDUCE BOTH OVERT AND MINIMAL HEPATIC ENCEPHALOPATHY: RESULTS OF A PROSPECTIVE STUDY C. Lucidi, V. Di Gregorio, V. Giannelli, M. Giusto, I. Pentassuglio, C. Pasquale, S. Nardelli, A.F. Attili, O. Riggio, M. Merli. Gastroenterology, Department of Clinical Medicine, “Sapienza” University of Rome, Italy

O3 THE IMPACT OF MALNUTRITION ON THE OUTCOME OF CIRRHOTIC PATIENTS WITH INFECTIONS

Background and Aim: Malnutrition and infections are frequent burdens in patients with end-stage liver disease and both have been demonstrated to impair prognosis. Moreover, a poor nutritional status has been associated with an increased susceptibility to infections in cirrhotic patients. The aim of the present study was to investigate the role of malnutrition on the outcome of cirrhotic patients with infections. Patients and Methods: Cirrhotic patients consecutively admitted at our university hospital in the last 24 months were enrolled. Protein malnutrition was defined as Mid-Arm Muscle Circumference below 5th percentile. Bacterial infections were actively searched. The onset of portal hypertension related complications (hepatic encephalopathy, variceal bleeding, hepato-renal-syndrome and hyponatremia) and the modification in liver function (MELD and CHILD) were analyzed during the infection. In-hospital and short term (6 weeks) follow up was considered. Results: One-hundred-two cirrhotic patients with infection (70% males; median age 64 yrs; median Child score 9 and MELD score 14) were evaluated. Malnutrition was diagnosed in 40% of patients. Malnourished patients were more frequently males (90% vs 56%) with similar age and degree of liver function vs not malnourished patients. Episodes of sepsis (61% vs 57%) and multi-drug-resistant infections (27% vs 43%) were not different between malnourished and not malnourished patients. Moreover, sites and epidemiology (community acquired, nosocomial, healthcare associated) of infections were also similar. The occurrence of portal hypertension related complications and the deterioration of liver function (MELD and CHILD) caused by the infection were similar in malnourished and not malnourished patients. In-hospital and short term (6 weeks) mortality rates were comparable in patients with and without malnutrition [(24% vs 25%, (p = 0.9) and 14% vs 17% (p = 0.5)]. Conclusions: While malnutrition increases the susceptibility for infections, the present data suggest that the impact of malnutrition on the outcomes and short term survival of cirrhotic patients with a concomitant infection is less relevant.