savings of wall suction over the traditional glass vacuum bottle method for ascites drainage.The secondary objective was to compare the safety profile of LVP using these two techniques.Methods: We conducted a prospective randomized case-control pilot study of 34 hospitalizedadults who underwent LVP from August 2010-June 2012. We excluded patients who wereunable to consent, were in the intensive care unit, had loculated ascites or peritonealthickening, were on hemodialysis or had a creatinine ≥3mg/dl, or were previously enrolledin the study. All LVPs were performed under ultrasound guidance by a single hospitalproceduralist. Patients who had ≥4 liters removed received 25% intravenous albumin,8 gm/L of fluid removed in accordance with guidelines. Demographic, baseline clinicalcharacteristics, and procedure details were recorded. Laboratory and hemodynamic datawere recorded for 24hr prior to and 24-48hr post LVP. An electronic chart review wasconducted to evaluate for procedure-related complications. Data were compared using Fish-er's exact test, t-test, or Mann-Whitney U test as deemed appropriate. Results: Thirty-fourpatients were randomized to either wall suction at 200 mmHg (N=17) or glass vacuumbottle drainage (N=17). There were no differences in baseline characteristics between thegroups. Wall suction was significantly faster than glass vacuum bottle drainage (7 vs. 15minutes, P= 0.0024). The mean supply cost was less for wall suction compared to glassvacuum bottle drainage ($4.59 vs. $12.73, P,0.0001). There were no procedure-relatedcomplications in either group, and both time to repeat LVP and 60 day mortality weresimilar. There were no differences in changes in mean heart rate, blood pressure, hemoglobin,creatinine or sodium at 24 and 48 hr post LVP between the groups. Patient satisfaction wassimilar between the two groups. (Table) Conclusions: In this randomized controlled pilotstudy, performing LVP using wall suction resulted in significantly shorter procedure timeand supply cost savings. There were no procedure-related complications in either group,suggesting equivalent safety profiles for each method, though larger studies powered todetect small differences are needed. Given its efficiency, convenience, and cost effectiveness,wall suction may be a superior method of ascites drainage for LVP.Table 1. Comparison of glass vacuum bottles vs. wall suction for LVP ascites drainage

a Includes Hepatocelluar carcinoma as well as other metastatic cancers b Includes hemochro-matosis, HBV, primary biliary cirrhosis c rated on scale 1-10, with 10 being very satisfiedand 1 being very unsatisfied IQR, interquartile range;SD, standard deviation.

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Large Spleen Volume At Baseline Predicts Hepatic Function Deterioration toClinical OutcomesJohn C. Hoefs, Saif Al Yaseen

Ishak fibrosis stage (2010;Hepat;51:585) and rate of fibrosis score progression (2011Gastro141:900) were strong predictors of clinical outcomes in patient with HCV. However, predic-tion of clinical outcomes was even better with the perfused hepatic mass (PHM) by QLSS(2012;Hepat;55:1019) with 48 % of patients with PHM , 94 had clinical outcomes within7 years (compared to 5 % in the rest) and spleen volume per IBW (SV/IBW) .2.5 cc/lbwas almost as good (46% vs 8%). Deterioration in PHM in serial studies at UCI predictedclinical outcomes in a prior report (AASLD 2012). This study evaluates serial changes inhepatic and splenic sizes in these patients. Methods: A database over 20 years of quantitativeliver spleen scans (QLSS) after Tc99 sulfur colloid injection (more than 6000 scans) wassearched for patients with 3 or more scans with first to last scan . 4 years apart in theabsence of death or LT, first scan prior to 1999 and had at least 1 PHM value , 94. Laband clinical data at the time of each scan was completed retrospectively. Spleen length (SL)in cm on posterior view and liver size (LS) (right lobe plus ½ left lobe length) on the anteriorview. Splenic and hepatic volumes were corrected for IBW (SV/IBW, LV/IBW). We recordedthe outcomes in 59 patients meeting our criteria: liver transplant (LT), MELD .14 (referral

S-1003 AASLD Abstracts

for LT) and death due to liver disease (D). The mean of the linear regression slope of PHMvs time for each patient was - .004+/-.016 and patients were divided into 3 groups basedon the slope: 18 patients having ..001 (I-improving)(.009+/-.020), 10 between -0.001 -.001 (MC-minimal change)(.0002+/-.0004) and 31 , -0.001 (W-worsening)(-.01226+/-.0107). Adequate treatment (ATx) was defined as abstinence in alcoholic hepatitis (AH)patients, autoimmune CAH (ACAH) that normalized tests on prednisone, hepatitis C withan SVR, and HBV with DNA suppression to , 1000 IU/ml. Length measurements wereobtained from all scans, but volumes only after 1994. Statistical: Length and volume changeswere measured as the linear regression slope of serial measurements per year. Students ttest or paired t test for differences between groups and linear regression between two variableswith p, .05 as significant.Results: 59 patients were identified with 6+/-3 scans per person(range: 3-15) with 9+/-5 years between first and last scan. Cause of liver disease was HCV28, HBV 14, AH 6, and other (11). See table below for summary. Liver size change did notcorrelate with outcomes or progression. Conclusion: 1. Baseline splenomegaly correlateswith lack of ATx and progression to death or transplant, 2. Increasing spleen size correlateswith a good baseline PHM, poor response to treatment, progression to MELD .14 anddeath or transplant.3. Serial QLSS is useful in following patients with CLD.Spleen size changes over time

*one non-liver death in each group **p ,.05paired t test B vs L + P,.05 W vs I,MC

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Outcome of Cirrhotic Patients Admitted to Intensive Care Units At HospitalsWithout Specialist Liver ServicesGeeta Beejooa, Rebecca Oates, Larry E. Loo, Nabil M. Mirza, Sita Shah, Neeraj Prasad,Charles Grimley, Narendra Kochar, Ahmad Al Rifai

Introduction Patients with liver cirrhosis admitted to an ICU are believed to have a poorprognosis with high mortality despite significant use of resources. Most of the literature todate on this topic has been collected at hospitals with Specialist Liver Units and these resultsmay not be representative of the outcome at general ICUs. A recent prospective study ofcirrhotic patients admitted to a tertiary Liver ICU in the UK demonstrated an overall hospitalmortality of 59%. Objective and Aims The aim of this study was to determine the outcome ofcirrhotic patients admitted to non-specialist ICUs in the UK.Methods Data was retrospectivelycollected from three hospitals in the NW region of the UK without specialist liver ICUs.Patients were identified using the Intensive Care National Audit and Research Unit (ICNARC)database. 51 patients with liver cirrhosis admitted to a general ICU between January 2010and January 2012 were included in this study. Results: Age range was 30 to 73 years (average51 years). 78% of patients were male and alcohol was the commonest aetiology for livercirrhosis (90%). The main reason for admission to ICU was for gastrointestinal bleeding(35%). 47% of patients had a Child Pugh score of C on admission to ICU. 51% of patientshad a MELD score between 10 and 19 and 24% had a score between 20 and 29. 86% ofpatients required invasive ventilatory support, 53% required vasopressors and 25% neededrenal replacement therapy. 54% developed further decompensation of their liver diseaseduring their ICU stay. These included GI bleeding (25%), hepatic encephalopathy (12%),HRS (14%) and SBP (4%). 66% of patients had an ICU stay of ,5 days. A 51% inpatientmortality rate was observed in our study with sepsis and multi-organ failure being the mostcommon causes of death. Conclusions Patients with liver cirrhosis admitted to general ICUshave similar rates of mortality compared to those in tertiary liver ICUs. Therefore, admissionto such units should not be deemed futile in cirrhotic patients and earlier admission mayimprove outcome.

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Do Patients With Liver Cirrhosis Have Small Intestinal Bacterial Overgrowth?Investigation With Duodenal Aspirate/Culture and Glucose Breath TestManjushree Gautam, Jessica Valestin, Michael D. Voigt, Satish S. Rao

Small intestinal bacterial overgrowth (SIBO) may occur in patients with liver cirrhosis andhas been implicated in the pathogenesis of spontaneous bacterial peritonitis, but its prevalencehas been poorly defined. A lack of gold standard for the diagnosis of SIBO has furtherhampered its detection. We examined the prevalence of SIBO in patients with liver cirrhosisby performing duodenal aspirate and culture and glucose breath test (GBT). METHODS: 9patients with Childs A or B cirrhosis underwent duodenal aspiration and culture for aerobic,anaerobic and fungal organisms, using a 3mm liguory catheter passed through an upperendoscope using aseptic precautions. These subjects ingested 75gms glucose dissolved in250 ml water and breath samples were collected at baseline and every 15 minutes for 2hours. Breath hydrogen and methane values were measured using gas chromatography(Quintron). Diagnostic yield of each test was examined and compared. RESULTS: 6 menand 3 women (mean age = 56 yr)were enrolled. Median MELD and CTP score were 13 and8 respectively. 5 patients were on antibiotics that were discontinued 1 week before study.6/9 (67 %) patients had a positive culture .105 cfu/ml; aerobic =50% (α hemolytic strepto-cocci, non-hemolytic streptococci, Klebsiella peunominae, Neisseria, gram negative diplo-cocci); anaerobic organisms= 50% (anaerobic streptococci, Moraxella species). Additionallysmall intestinal fungal overgrowth was seen in 2/9 (22%) subjects. GBT was positive in 3/9 (33%) subjects and all 3 subjects also had a positive culture. CONCLUSIONS: Patientswith cirrhosis have a high prevalence of SIBO. This was present even in the 50% of patients

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