speeding citations & illegal turns. OHE patients were compared to MHE- & MHE+ groups.Results: 38 MHE+, 12 MHE- & 13 OHE patients (Hepatitis C, MHE-:6,OHE:5,MHE+:23,p=0.4) with similar age (MHE-:52±9, OHE:52±4,MHE+:54±7 yrs,p=0.5) and gender (malesMHE-:8,OHE:7,MHE+:21,p=0.8)were included. All OHE patients were adherent on lactulose(mean 3 bms/day) and did not have asterixis on examination. OHE patients exhibitedimpaired psychometric performance compared to the MHE- group on all tests despite beingon treatment (Table). OHE patients also had significantly higher collisions, speed citations& illegal turns compared to the MHE- group. There was no significant difference betweenOHE & MHE+ patients' psychometric or driving performance. Conclusions: OHE patientsexhibit psychometric & driving skill impairment on a simulator similar to MHE+ patientsdespite clinical response to therapy. Endpoints other than disappearance of asterixis, suchas driving performance, may be important additional measures of therapy efficacy in OHE.Driving Simulator Performance

S1964

Patients with Minimal Hepatic Encephalopathy Have Poor Insight Into TheirDriving SkillsJasmohan S. Bajaj, Muhammad Hafeezullah, Raymond G. Hoffmann, Thomas A.Hammeke, Kia Saeian

Minimal hepatic encephalopathy (MHE) is associated with poor quality of life & a higherrisk of traffic accidents. Personal insight into driving skills is important for a patient to seekmedical attention for MHE therapy. The Driving Behavior Survey (DBS) is a 26-part scalevalidated in attention deficit disorder. Each question is rated on a Likert scale of 0-4(max104). A higher score reflects good driving. It inquires about both driving skills focusing onattention, vigilance and safety judgments(10 questions) and driving habits (16 questions).DBS can be self-administered or completed by others familiar with the individual's driving.The aim was to determine personal insight into behaviors that may result in accidents incirrhotics tested for MHE by comparing personal DBS score (both driving habits & skills)to the others' assessment. Methods: 36 non-alcoholic cirrhotics tested for MHE (25 HCV,7 autoimmune & 4 others; age 51±3 yrs, 23M,education 12±3 yrs) & 46 age/education-matched healthy controls (25 M) were given the DBS for self-assessment at the time of MHEtesting (based on psychometric tests). An adult familiar with their driving was contacted inthe subject's absence to complete an independent DBS assessment of the subject's driving.Total DBS score, driving skill & driving habit components were compared between MHE+,MHE- and controls with respect to self and other assessment. Results: 26 patients wereMHE+ &10 were MHE-. 85% of assessors were spouses, rest were friends. Self vs. others:MHE+ patients were rated significantly lower on driving skills by their assessors compared toself-assessment (table). In contrast, self-assessment of driving skills was similar to independentassessment in MHE- patients & controls. Total score & driving habits showed similar, butnot statistically significant differences between self & others. Comparison between groups:Total score was significantly lower in MHE+ group compared to MHE- & controls. Conclu-sions: MHE+ patients were rated significantly lower on driving skills by their independentassessors compared to self-assessment; indicating poor insight into driving skills. An objectivedriving history should be sought in addition to personal driving assessment to get an accuratepicture of driving abilities in MHE.

* Lower (p=0.03) assessment of MHE+ driving skills by others vs. self. # Lower (p=0.01)DBS score in MHE+ compared to remaining groups.

S1965

Small Intestinal Bacterial Overgrowth of Colonic-Type CarbohidratesFermentative Bacteria in Cirrhotic PatientsGiuseppe Merra, Antonio Dal Lago, Emidio Scarpellini, Rosalba Finizio, Michele Santoro,Maria Grazia Spitilli, Ernesto Cristiano Lauritano, Maurizio Gabrielli, Venanzio Valenza,Giovanni Gasbarrini, Giovanni Ghirlanda, Antonio Gasbarrini

Backgrounds and Aim: Small intestinal bacterial overgrowth (SIBO) is a clinical conditioncharacterized by abnormally high colonic-type bacteria in the small intestine, exceeding 106organisms/mL. In non cirrhotic patients, SIBO is associated with the presence of symptomsrelated to malabsorption and gas production (end product of carbohydrates fermentation)..A role of small bowel bacteria has been hypothesized in the pathogenesis of hepatic encephalo-pathy (HE) and spontaneous bacterial peritonitis (SBP) in cirrhotics. This study to assessSIBO prevalence in cirrhotic patients. Methods: thirthy (30) HCV-cirrhotic pts (10 Child

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A; 10 Child B; 10 Child C) were consecutively enrolled and submitted to H2-lactulosebreath test (LBT). 30 non cirrhotics patients were used as controls. SIBO diagnosis wasbased on LBT positivity criteria (two distinct peaks, consisting of two consecutive H2 values>10 p.p.m. above the basal value after 10 g lactulose ingestion). Results: 18 out of 30cirrhotics (60%) had a positive LBT vs 1 out of 30 controls (3.3%); p<0.05 . Amongcirrhotics, a significative difference was observed in the different Child group: 20% in ChildA, 50% in Child B, 80% in Child C. Conclusion: Cirrhotics have a significant prevalenceof SIBO compared to controls. SIBO prevalence was associated to severity of cirrhosis.Lactulose administration could be a good substrate for the growth in the small bowel offermentative colonic-type bacteria. A role of SIBO presence in HE and SBP has to befully evaluated.

S1966

Effects of I.V. Albumin Substitution in Patients with Hepatic Cirrhosis andHypoalbuminemia On the Clearance of Cholyl-Lysyl-Fluorescein As a Markerof Hepatic DysfunctionHans-Jurgen Gruss

INTRODUCTION: Cholyl-lysyl-fluorescein (NRL972) is a flurescent-labelled bile salt, whichis taken up and eliminated via the liver in an analogous way to natural bile salts withoutundergoing biotransformations. NRL972 is an investigational marker of hepatic dysfunction.Present clinical study data have so far indicated that NRL972 may allow separating healthysubjects from patients with cirrhosis, but also allow to stage cirrhosis patients AIMS &METHODS: NRL972 clearance is closely linked to the plasma volume and has a high albuminbinding. The objective of the conducted parallel-group study was an evaluation of thepharmacokinetics of NRL972 before, during and after daily i.v. doses of 1g/kg body weight(BW) low-sodium albumin on two consecutive days in patients with hepatic cirrhosis andhypoalbuminemia (n=24) with either no ascites (n=12) or at least moderate ascites (n=12).In addition, the safety and tolerability of repeat i.v. doses of NRL972 was assessed. RESULTS:36 patients were screened for enrolment, of which 24 patients were enrolled. All 24 patientscompleted the study as planned with two days of albumin infusion and three repeat NRL972assessments. Mean age was 56.9±10.9 years (range: 37 - 74). The mean BW was 79.7±15.6kgand a BMI of 27.5±4.2kg/m2. Patients suffered from a number of concomitant diseases. Allcases had alcoholic cirrhosis. In addition, more then half the patient population had also aviral hepatitis history. Most included subjects were in the Child-Pugh stage B (15), whileone case was stage A and 8 cases stage C. Albumin supplementation had a minimal effecton plasma albumin levels (+9.3g/L;95%CI: +6.8 to +11.8g/L), but did not change othercommon disease features. The pharmacokinetic analysis for NRL972 did not show a signific-ant effect of the two-day albumin infusion in comparison to the baseline values. However,a trend towards a slight prolongation in the t1/2 (ratio: 1.22) and reduction in clearance(mean: -7.0ml/min) was observed directly after albumin supplementation. 53 adverse eventswere reported, of which 10 had at least a possible relation to NRL972 dosing and weremainly linked to untoward changes in clinical laboratory tests. No severe or serious adverseevents were reported. CONCLUSION: A low albumin situation, often seen in hepatic cirrhosispatients, is not the predominant cause of the reduced disposition of NRL972 in such patientscompared with normal controls. Instead, albumin substitution and the resulting rise inplasma albumin caused a short lasting further delay in the disposition of NRL972. Therefore,NRL972 may represent a valuable staging parameter for the clinical assessment of cirrhosis.

S1967

Oxidized Albumin Is Associated with Water Retention and Severity of Diseasein Patients with Liver CirrhosisMasahiro Sakata, Takumi Kawaguchi, Eitaro Taniguchi, Minoru Itou, Mitsuhiko Abe,Chikatoshi Yanagimoto, Ichirou Miyajima, Hironori Koga, Masaru Harada, TetsuharuOriishi, Michio Sata

Background and Aims: Albumin is a major antioxidant in plasma. Serum albumin exists inboth oxidized and reduced forms. Oxidized albumin has various modifications at Cys34and is known to correlate with function of albumin In Vitro, however, the significance ofoxidized albumin remains unclear in patients with liver disease. The aims of this study areto investigate the functional and prognostic significance of oxidized albumin in patientswith chronic liver disease. Patients and Methods: We analyzed 40 patients with chronicliver disease (hepatitis C virus; n = 31, hepatitis B virus; n = 3, alcohol; n = 5, non-alcoholicsteatohepatitis; n = 1) and patients with chronic renal failure were excluded in this study.Oxidized albumin was determined by high-performance liquid chromatography. Waterretention was used as a function of albumin. The degree of water retention was evaluated bya direct segmental multifrequency-bioelectrical impedance analyzer (InBody 3.2, BIOSPACE,Tokyo, Japan) and was expressed as extra cellular water/total body water (ECW/TBW). Theseverity of chronic liver disease was assessed by Child-Pugh score or the model for end-stage liver disease (MELD) score. Correlations between oxidized albumin percentage andECW/TBW, Child-Pugh score, or MELD score were examined. Results: In all patients, meanage was 66.8 ± 9.7. Oxidative albumin percentage, ECW/TBW, Child-Pugh score, and MELDscore ranged from 20.7% to 59.3%, from 0.327 to 0.376, from 5 to 11, and from 6 to 66,respectively. There was a significant correlation between oxidized albumin percentage andECW/TBW (σ = 0.68; p < 0.0001), which was more significant than a correlation betweenserum albumin level and ECW/TBW (σ = - 0.49; p = 0.002). Furthermore, oxidized albuminpercentage was also significantly correlated with Child-Pugh score or MELD score (σ = 0.51;p = 0.013, σ = 0.44; p = 0.006, respectively). Conclusion: In conclusion, oxidized albuminpercentage was associated with both degree of water retention and severity of chronic liverdisease. Oxidized albumin may be a useful new marker assessing function of albumin andseverity of disease in patients with chronic liver disease.

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