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Legend: CI=interval of confidence; PPV=positive predictive value; NPV=negative predictivevalue; PLR=positive likelihood ratio; NLR=negative likelihood ratio.

Sa1027

Plasma Cysteine Levels and Muscle Cramps in Patients With CirrhosisIrakli Kaloiani, Alisha C. DeCook, Janice L. Petz, Patrick S. Kamath, E. Rolland Dickson,W. Ray Kim

Background/Aims: Muscle cramps are common in patients with cirrhosis, particularly whendiuretics are used for ascites. Its pathophysiologic mechanism remains uncertain. In thiswork, we conducted field testing of a questionnaire to measure the extent and severity ofmuscle cramps in patients with cirrhosis and explored plasma metabolomic biomarkers formuscle cramps. Methods: Patients with an established diagnosis of cirrhosis were prospect-ively contacted prior to their follow-up appointment in our liver clinic. Patients were askedto fill out a muscle cramps questionnaire (mMCQ) which asks about occurrence, frequency,location and impact (sleep and daily living) of muscle cramps. Blood samples were drawnafter a minimum of 12 hours of fasting, which were promptly cold-centrifuged and plasmawas separated for metabolomics assays. Results: In this on-going study, 109 patients havebeen contacted to date, of whom 46 patients have responded to the questionnaire (responserate=42% to date). The respondents were 57.8 ± 11.1 years of age and 59% were men. Themean MELD score was 12.8 ± 5.5. Approximately half (46%) reported history of hepaticencephalopathy and 6.5% refractory ascites requiring therapeutic paracentesis. In this patientcohort, the prevalence of muscle cramps was 76%. Of those who reported muscle cramps,50% had moderate to severe symptoms (occuring at least daily or causing at least moderatedisturbance of activities of daily living). To date, we have assayed 25 amino acid in theplasma samples (n=43), including taurine, threonine, serine, asparagine, glutamic acid,argininosuccinic acid, glutamine, proline, glycine, alanine, citruline, α-amino-N-butyricacid, valine, cysteine, methionine, isoleucine, leucine, tyrosine, phenyl alanine, β-alanine,ornithine, lysine, histidine, arginine, and allo-isoleucine. Of these, plasma cysteine levelswere significantly different according to the severity of muscle cramps. In patients withoutmuscle cramps the median plasma level was 59 nmol/mL with an interquartile range (IQR)of 52-75 nmol/mL, compared to those with cramps (median=82 nmol/mL, IQR=61-94). Inthe figure, patients with severe cramps had the highest cysteine levels (median 90 nmol/mL, IQR=78-106) compared to those with mild cramps (median:73 nmol/mL, IQR=51-86).Conclusion: Muscle cramps are extremely common in patients with cirrhosis receiving on-going care at a liver clinic. Plasma cysteine levels may be a potential biomarker for musclecramps, as they correlate with their occurrence and severity.

Sa1028

Iatrogenic Infections in Hospitalized Cirrhotics Predict MortalityMuhammad Ali, Shahryar Ahmad, Nilay Kumar, Gagan Kumar, Kia Saeian

Background: Iatrogenic infections are a burden on healthcare and are associated with worseoutcomes. We wanted to determine impact of iatrogenic infections on hospitalized patientswith cirrhosis. Methods: A retrospective case control design was utilized using the NationwideInpatient Sample (NIS) from year 2000-2008. The NIS is the largest all payor dischargedatabase in the US. Appropriate International Classification of Diseases(ICD-9CM)codeswere used to identify patients with any discharge diagnosis of iatrogenic infection and anydischarge diagnosis of cirrhosis. Data was analyzed using STATA 10. Chi square test andlogistic regression were used for analysis. Results: There were 73,394 admissions withiatrogenic infection among admitted cirrhotics from years 2000-2008. This comprised 1.26%of all admissions among patients with cirrhosis. On logistic regression, iatrogenic infectionswere independently associated with mortality in cirrhotics (OR 1.79, 95% CI 1.71-1.88).Female sex was associated with a lower mortality in cirrhotics with iatrogenic infectionswhereas teaching status of a hospital was associated with a higher mortality (OR 1.12, 95%CI 1.10-1.13). Cirrhotic patients with iatrogenic infections were more likely to be dischargedto a facility as compared to cirrhotic patients without iatrogenic infections (31.50% vs.15.65%). Patients with iatrogenic infections were also more likely to receive home care(23.26% vs. 11.71%). Conclusions: Iatrogenic infections are associated with higher odds ofmortality in hospitalized patients with cirrhosis. Iatrogenic infections lead to higher utilizationresources (home care and facility discharge).

Sa1029

Acute Kidney Injury (AKI) Predicts Mortality in Hospitalized Patient WithCirrhosisMuhammad Ali, Shahryar Ahmad, Adil Jadoon, Nilay Kumar, Gagan Kumar, Kia Saeian

Background: Recent studies have indicated a higher incidence of acute kidney injury (AKI)in cirrhotics and its negative impact on mortality. There is lack of nationwide data fromthe US on prevalence of AKI among hospitalized cirrhotics and its impact on morbidity andmortality. Aim: To determine incidence of AKI in hospitalized patients with cirrhosis andstudy the impact of AKI on outcomes among hospitalized cirrhotics. Methods: A retrospectivecase control study design was utilized using the National Inpatient Sample (NIS) from theyear 2008. NIS is the largest inpatient discharge database in the US. Appropriate International

S-950AASLD Abstracts

classification of Dieases(ICD-9 CM)codes were used to categorize patients. Patients with anydischarge diagnosis code of cirrhosis were included in the study. Patient who had a concomit-ant discharge code of AKI were studied. Prevalence, mortality and length of stay werecalculated. Chi square and logistic regression were used for analysis. Results: There were104,539 cirrhotics admitted with AKI in the year 2008. AKI was more prevalent in cirrhoticsas compared to non cirrhotics (14.63% vs. 6.65%, p=<0.001). Cirrhotics with AKI had asignificantly higher inpatient mortality as compared to cirrhotics without AKI (23.56% vs.3.54%, p=<0.001). AKI in cirrhotics lead to a higher mean length of stay (5.46 days vs.10.58days) and higher average cost of hospitalization ($36k vs. $87k). Conclusion: AKI is moreprevalent among hospitalized cirrhotics and leads to higher mortality, length of stay andhospital charges. Further prospective studies are needed to confirm these findings and tolook into the factors causing increased mortality and morbidity.

Sa1030

Overt Hepatic Encephalopathy in Cirrhosis: Influence of Multiple ClinicalPrecipitants Resulting in HospitalizationGanesh Pantham, Nisheet Waghray, Ravi Prakash, Raja Shekhar R. Sappati Biyyani, KevinD. Mullen

Objectives: Overt hepatic encephalopathy (OHE) is a major cause of significant morbidityand mortality in liver cirrhosis. Previous studies looking into multiple factors causing OHEare limited due to small sample size and focused on individual precipitating factors. Weaimed to study the profile of multiple clinical precipitant factors resulting in hospitalizationsfor the OHE. Methods: Electronic medical records of all patients admitted with primarydiagnosis of OHE between 2005 and 2010 were retrospectively reviewed for the etiologyof cirrhosis and precipitants of OHE. The diagnosis of liver cirrhosis was confirmed usinglaboratory and imaging studies. Other causes for altered mental status were excluded withappropriate investigations. OHE was staged using the West Haven criteria. A total of 109patients are included in the study. Results: 109 cirrhotic patients (70 males and 39 femaleswith a mean age of 55 years) had a total of 200 hospital admissions with a primary diagnosisof OHE. 56 patients were of Child-Pugh class B, 51 patients Child-Pugh class C and 2unclassified. Per West Haven criteria, 2 patients had grade I, 90 grade II, 15 grade III and2 in grade IV OHE. Average duration of hospital stay was 4.8 days. Various types of cirrhosisare shown in table 1 and factors identified as precipitants of OHE are shown in the table2. More than one precipitating factor was identified in 114 (57%) admissions followed by84 (42%) admissions with 2 precipitants, 26 (13%) with 3 precipitants and 4 (2%) with fourprecipitants. Conclusions: Lactulose noncompliance is the single most frequent precipitant ofOHE followed by constipation, opioids and benzodiazepines and dehydration. Presence ofmultiple precipitating factors increases the complexity of hospital admissions. Patient andfamily education regarding lactulose dosing, avoiding precipitating drugs and dehydrationwill potentially reduce a number of hospital admissions.table 1

Table 2

Sa1031

Risk Factors for Inpatient Mortality Among Hospitalized HepatorenalSyndrome Patients- a Nationwide Population Based StudySravanthi Parasa, Arun Raghav Mahankali Sridhar, Ryan C. Mascarenhas, Kevin Olden

BACKGROUND AND AIMS: Hepatorenal syndrome (HRS) is a common complication ofadvanced cirrhosis, characterized by renal failure and major disturbances in circulatoryfunction. The prognosis is very poor and this condition is associated with a high mortalityand morbidity. However, there are few population based studies that are done to evaluatethe risk factors for adverse outcomes of HRS. METHODS: We used data from NationwideInpatient Sample for year 2008 to perform a cross sectional study of the patients hospitalizedfor HRS as identified by appropriate International Classification of Diseases, Ninth Revision(ICD9) discharge diagnoses codes. The patients were then categorized into groups - withconcomitant diagnosis of alcoholic cirrhosis (AC) and biliary cirrhosis (BC), and cirrhosisas identified by ICD9 diagnosis codes. The demographic characteristics, clinical characteristicsand the hospital outcomes of the groups were studied. Univariate and Multivariate logisticregression methods using STATA 12.0 survey commands were used to assess the risk factorsfor in hospital death among these groups after adjusting for clinically important covariates.RESULTS: There were a total of 23,764 discharges that were diagnosed with HRS of whicha total of 8853 (36%) patients died in the hospital. 2219 (9.3%) developed ESRD. TheLength Of Stay (LOS) and total hospital charges were significantly higher for patients withan underlying diagnosis of biliary cirrhosis (table1) On multi-variate analysis, among patientswith HRS, TIPS procedure was associated with decreased risk of inhospital death (adjustedodds ratio (aOR) 0.46, 95%Confidence interval (95%CI) (0.24-0.87)), undergoingHemodia-lysis was not associated with any decreased risk of inhospital mortality (aOR , 1.14, 95%CI (0.93-1.4)). Risk factors contributing to increase in risk of death are increasing age,