Abstracts S343
Conclusion: In a large single ICU experience, IH was identified in 1.4% using AST/ALT >800 U.L. Over- fatty liver disease (NAFLD) is well established. However, as HCC is heterogeneous regarding etiology
all mortality was 44%, driven in large part by sepsis leading to multiorgan failure, and accounting for
higher TB levels compared to those without sepsis. Higher TB and LDH levels were among the factors
independently associated with increased mortality, often reflecting sepsis.
762
Screening for Hepatitis C Infection in the Outpatient Colonoscopy Setting
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Esther Kim, DO, Jeffrey Fiorenza, MD, Stephen Fabry, MD. Lahey Hospital and Medical Center,
Burlington, MA.
Introduction: The purpose of the project was to examine the efficacy of using outpatient colonoscopy
to improve screening for Hepatitis C Virus (HCV) infection among patients born between 1945 and
1965. HCV can cause long-term inflammation of the liver, which can lead to cirrhosis and hepatocel-
lular cancer. Approximately 3.2 million people in the U.S. have HCV, and most of these individuals are
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asymptomatic and unaware of infection. In 2013 the U.S. Preventive Services Task Force updated its
recommendation for HCV screening to include all persons born between 1945 and 1965, regardless of
risk factors. Unfortunately, screening rates by healthcare providers have remained low.
Methods: A total of 357 subjects born between 1945 and 1965 scheduled for an outpatient colonoscopy on
18 separate days between February 2015 and May 2016 were analyzed. Review of the Electronic Medical
Record (EMR) system revealed that 69 subjects (19% of the total) had been tested for the HCV antibody. A
total of 67 patients were consented to have their blood drawn for HCV antibody testing. Forty-six patients
were asked to proceed to the phlebotomy lab after colonoscopy (Group 1), and 21 patients were planned
to have the blood test collected prior to colonoscopy at the time of peripheral IV insertion (Group 2).
Results: Of the 46 consented patients in Group 1, 33 patients (71.7%) underwent HCV antibody testing
during the study period. Mean number of days to testing was 100; only 8 (24%) underwent phlebotomy
directly after colonoscopy. Of the 21 patients consented in Group 2, 18 patients (85.7%) underwent HCV
antibody testing prior to colonoscopy (1 had unsuccessful phlebotomy and 2 were deferred to later testing).
Of the 51 total tested, no positive antibody results were found.
Conclusion: The outpatient screening colonoscopy setting is an effective way of capturing the segment
of population (patients born between 1945 and 1965) recommended to undergo HCV antibody test-
ing. Unfortunately, most patients did not proceed to phlebotomy directly after colonoscopy, and testing
before the procedure proved to be labor-intensive and time-consuming. However, through the use of
saved orders in the EMR system, allowing patients to undergo HCV antibody testing at a later time, com-
pliance rates significantly improved overall in Group 1. Recruiting patients in the outpatient colonoscopy
setting for deferred HCV testing through the EMR system may be a convenient and effective way of
improving screening rates for HCV.
763
Lipid Profiles After Therapy with Direct-Acting Antivirals in HCV Mono-infected and HCV/HIV
Co-infected Patients
Okeefe L. Simmons, MD1, Henning Drechsler, MD2, Marcus Kouma, PharmD2, Geri Brown, MD2, Roger
Bedimo, MD, MS2. 1. University of Texas Southwestern Medical Center, Dallas, TX; 2. VA North Texas
Health Care System, Dallas, TX.
Introduction: Chronic hepatitis C (HCV) infection is associated with significant decreases in low-den-
sity cholesterol (LDL-c) and triglycerides (TG). Potential mechanisms include interactions between lipid
metabolism and HCV life-cycle, HCV-associated inflammation, or hepatic fibrosis. Limited data suggest
that interferon-based HCV therapy results in increased lipid levels. It is unclear if HCV therapy with
direct-acting antivirals (DAA Rx) alters lipid profiles, and, if so, whether these changes differ among
HCV mono-infected (HCV) and HCV/HIV co-infected (HCV/HIV) patients and whether they correlate
with hepatic fibrosis scores (FIB-4).
Methods: We compared LDL-c, TG, and FIB-4 scores at baseline (BL) until 1-year after end of DAA Rx in
HCV and HCV/HIV patients with sustained virologic response after DAA Rx at a Veterans Affairs Medi-
cal Center from 01/2014 until 10/2015. We analyzed changes and correlations using Wilcoxon signed
rank test and Spearman’s rho, respectively.
Results: 118 consecutive patients were included in the analyses, 23 (19%) of whom were HIV/HCV (all
on stable combination antiretroviral therapy with HIV viral loads < 100 copies/mL). Median age was 61
years, inter-quartile range (IQR): 58-65, 95% were male. Median BL HCV viral load (VL) was 6.4 log
copies/mL, (IQR 6.0-6.8), 81% had HCV-genotype 1, 91% received sofosbuvir-based therapy, 86% for 12
weeks, and 31 patients took anti-hyperlipidemic therapy. Median BL FIB-4 score was significantly lower
in HIV/HCV than in HCV: 2.1 (IQR 1.7-3.5) vs. 4.5, (IQR 2.9-6.4), p < 0.001 while the median BL LDL
was not different: 80 mg/dL (IQR 60-107) vs. 66 mg/dL (IQR 54-81), p=0.13. BL LDL-c and BL HCV
VL were inversely correlated in HCV (r=-0.28, p=0.009) but not in HIV/HCV (p=0.45). After DAA Rx,
median FIB-4 scores declined more in HCV: -1.8 (IQR -0.6 to -3.3) than in HIV/HCV: -0.3 (IQR 0 to
-0.6), p=0.01. Median LDL-c increased similarly: +25 mg/dL (IQR 6-36, p < 0.001) in HCV and +25mg/
dL (IQR -5 to +41, p=0.003) in HIV/HCV. LDL-c and FIB-4 changes were inversely correlated (r=-0.35;
p=0.046) in HCV patients only. Overall median TG declined: -20 mg/dL (IQR +10 to -45, p=0.01) with
no differences between groups (p=0.95).
Conclusion: Successful DAA Rx was accompanied by significant LDL-c increases regardless of HIV co-
infection status. In HCV patients – in whom fibrosis scores were much higher at baseline – this was
inversely correlated with FIB-4 improvements.
764
Obesity Is Protective Factor in Hepatocellular Carcinoma
Yuchen Wang, MD., Bashar M. Attar, MD, PhD, FACG, Sara Bedrose, MD., Keiki Hinami, MD.,
Jayasree Krishnan, MD., Carlos Roberto Simons-Linares, MD. Cook County Health and Hospital Systems,
Chicago, IL.
Introduction: The incidence of hepatocellular carcinoma (HCC) has been increasing significantly with
the nationwide epidemic of obesity. The relationship between obesity, metabolic syndrome, nonalcoholic
© 2016 by the American College of Gastroenterology
and severity of concurrent cirrhosis, the overall role of obesity in HCC warrants more investigation. This
study aims to characterize prevalence of obesity in HCC patients, assess association of obesity with tumor
characterstics and prognosis.
Methods: We retrospectively analyzed patients with diagnosis of hepatocellular carcinoma (by ICD-9
code) at a large public hospital during 10 years (05/2006 through 05/2015). HCC was confirmed with
characteristic radiologic features and/or histology from liver biopsy. Patients are categorized according
to body weight index (BMI) at diagnosis of HCC as underweight (2), normal weight (18.5-24.9 kg/m2),
overweight (25-29.9 kg/m2), Class I Obesity (30-34.9 kg/m2), Class II Obesity (35-39.9 kg/m2), Class
III Obesity (≥ 40 kg/m2). HCC is categorized according to etiology into viral, alcoholic, viral-alcoholic,
nonviral-nonalcoholic. We constructed multivariable regression model of mortality with STATA 13.
Results: 270 patients were included of which 13(4.81%) were underweight, 99(36.7%) normal weight,
78(28.9%) overweight, 50 (18.5%) Class I obese, 15(5.6%) Class II obese, 15(5.6%) Class III obese. There
was no difference in mean BMI by severity of cirrhosis. However there was significant difference of mean
BMI by etiology (p < 0.0001): nonviral-nonalcoholic HCC showed significant higher BMI. Higher BMI
is associated with extra-hepatic metastasis (p=0.026), however there’s no difference in tumor number and
size. BMI is independent risk factor for venous thromboembolic event (VTE) (OR 1.15, p=0.020; CI 1.02-
1.29), and independent protective factor for mortality (OR=0.92 p=0.038; CI: 0.84-0.99). After exclu-
sion of patients with prior paracentesis (70/270), protective effect of BMI persists (OR 0.86, p=0.007;
CI 0.77-0.96).
Conclusion: Patients with HCC of different etiologies have significantly different BMI: nonviral-nonal-
coholic-HCC which mostly represent (NAFLD) is associated with higher BMI. Higher BMI is associated
with extra-hepatic metastasis and risk of VTE. BMI is not risk factor for hospice or preclusion from cura-
tive treatment. However interestingly higher BMI showed protective effect against mortality.
765
Does Venous Thromboembolic Events Increase Morbidity and Mortality in Hepatocellular Carci-
noma Patients
Yuchen Wang, MD., Bashar M. Attar, MD, PhD, FACG, Sara Bedrose, MD., Keiki Hinami, MD., Jayasree
Krishnan, MD., Carlos Roberto Simons-Linares, MD. Cook County Health and Hospital Systems, Chicago,
IL.
Introduction: Venous thromboembolic event (VTE) are frequently associated with malignancy and
leads to increased mortality. Hepatocellular carcinoma (HCC) is often associated with concurrent cir-
rhosis which derange coagulation-anticoagulation balance, leads to higher risk of VTE. This study aim
to characterize VTE in HCC, identify independent risk factors and assess effects of VTE on overall prog-
nosis in HCC.
Methods: We retrospectively analyzed patients with diagnosis of hepatocellular carcinoma (by ICD-9
code) at a large public hospital during 10 years (05/2006 through 05/2015). HCC was confirmed by
characteristic radiologic features and/or histology from liver biopsy. VTE was further categorized into
pulmonary embolism, peripheral deep vein thrombosis, and intra-abdominal thrombosis. We exclude
portal vein thrombosis as tumor thrombus from direct invasion could be confounded with bland throm-
bus. We collected data of patient-related risk factors, tumor characters, laboratory at diagnosis, treat-
ment-related risk factors. We constructed multivariable logistic regression model through STATA V.13.
Results: 270 patients with complete dataset were included. Thromboembolism events were identified in
16(5.9%) patients at an average of 6.2 months since diagnosis of HCC: 7(43.8%) pulmonary embolism,
4(25%) peripheral deep vein thrombosis, 6(37.5%) intra-abdominal thrombosis. VTE frequency by etiol-
ogy of HCC: viral-HCC 2.60% (2/77), alcoholic-HCC 2.5% (1/40), viral-alcoholic-HCC 9.17% (11/120),
nonviral-nonalcoholic-HCC 6.06% (2/33). VTE frequency by severity of cirrhosis: non-cirrhotic liver
4.88% (2 cases of 41), Child A 1.03% (1 cases of 97), Child B 11.11% (10 cases of 90), Child C 6.8% (3
cases of 44). Multivariable regression showed independent risk factors for VTE in HCC include: viral-
alcoholic-HCC (OR 18.7, p=0.017; CI 1.69-207.3), age (OR 2.86, p=0.017; CI 1.21 -6.78), presence of
extrahepatic metastasis (OR 7.27, p=0.025; CI 1.29-41.1), BMI (OR 1.15, p=0.020; CI 1.02-1.29). VTE is
not an independent risk factor for preclusion from curative treatment, hospice or mortality.
Conclusion: VTE occurs in approximately 5.9% of patients with HCC. Patients with viral-alcoholic
HCC, elderly patients, patients with higher BMI or extrahepatic metastasis are at higher risk of develop-
ing VTE; cirrhosis severity by child score is not independent risk factor. VTE does not affect overall
prognosis after HCC diagnosis.
766
United State Women Receive More Resections and Ablations for Hepatocellular Carcinoma Than
Men
Lindsay Sobotka, DO1, Lanla Conteh, MD, MPH1, Alice Hinton, PhD2. 1. The Ohio State University
Wexner Medical Center, Columbus, OH; 2. The Ohio State University Division of Biostatistics, Columbus,
OH.
Introduction: Previous studies have shown conflicting data regarding gender disparities in the treatment
of hepatocellular carcinoma. Different studies have concluded that men are more likely to receive a liver
transplant and women more likely to undergo hepatic resection. Given the recent attention to reducing
gender disparities in healthcare, it is unclear if these disparities continue to exist.The aim of this study
is to use the Nationwide Inpatient Sample to see if gender disparities in the treatment of hepatocellular
carcinoma are still present.
Methods: A retrospective database analysis on the Nationwide Inpatient Sample (NIS) was performed
from 2010 to 2013. Adults with an age greater than 18 and a primary diagnosis of hepatocellular carci-
noma, represented by an International Classification of Diseases 9th Edition (ICD-9) code were included.
Univariate analysis and multivariate logistic regressions were performed to examine gender disparities in
metastatic disease, decompensated disease, mortality and treatment modalities.
Results: The study includes 62,582 patients from the NIS database. There were significantly more men
in the study with a total of 45,908 included and 16,674 women. The majority of the patients, regardless
of gender, were Caucasian, under the age of 64, and had Medicare as the primary payer for their care.
Further analysis of the patient population showed that women were less likely to present with decompen-
The American Journal of GASTROENTEROLOGY