M1773

Clinical and Histologic Features Associated with Steatosis in a Cohort ofPatients with Chronic Hepatitis CRahul Nayak, Eric R. Kallwitz, Jennifer Layden, Manish K. Dhamija, Grace Guzman, ScottJ. Cotler, Thomas J. Layden

Steatosis occurs in some patients with chronic hepatitis C and has been associated withfibrosis. Steatosis may result from viral mediated factors such as genotype 3 or coexistantmetabolic syndrome. The aim of this study was to evaluate the association of demographicand clinical factors with the presence of steatosis and to evaluate the association betweensteatosis and histologic features on biopsy and disease progression. Methods: 598 patientsunderwent biopsy for HCV staging over a 10 year period and were well characterizedclinically and histologically. Demographic and clinical data were collected retrospectively.Liver biopsies were read by two clinicians masked to clinical data. Biopsies were systematicallyevaluated by histology activity index (HAI) [Knodell 1981] and steatosis was graded 0-3.Disease progression was characterized by the fibrosis index (fibrosis stage 0-4/years sincefirst risk factor). Results: The mean age was 49 ± 9 years and the mean BMI was 30 ± 7kg/m2. The mean duration of infection was 26 ± 9 years. The population was 61% maleand was 41% African American, 39% Non-Hispanic White and 20% Hispanic. Diabetesmellitus (DM) was present in 22%, hypertension in 36%, hyperlipidemia in 10% and pastalcohol use in 26%. Steatosis (fat >5%) was present in 48% of patients. Those with steatosishad higher mean ALT level (91 ± 81 vs 70 ± 57, p<0.001) and higher mean BMI (30.9 ±6.9 vs 28.7 ± 6.8, p=0.001). Patients with genotype 3 infection were more likely to havesteatosis compared to other genotypes (72% vs 47%, p=0.009). Sixty five percent of Hispanicshad steatosis compared to 44% of Non-Hispanic Whites and 43% of African Americans(p<0.001). Steatosis was more common in patients with DM (64% vs 43%, p<0.001).There was no association between steatosis and AST level, duration of infection, gender,hypertension, hyperlipidemia or past alcohol abuse. In multivariate analysis, Hispanic race,BMI and DM remained associated with steatosis. Patients with steatosis on liver biopsy hadhigher mean levels of portal inflammation (2.3 ± 0.9 vs 2.0 ± 0.8, p<0.001), interfacehepatitis (2.9 ± 1.9 vs 2.2 ± 1.8, p<0.001), lobular inflammation (1.3 ± 0.7 vs 0.9 ± 0.9,p<0.001), fibrosis (2.7 ± 1.1 vs 2.4 ± 1.2, p=0.002) and total HAI (9.1 ± 3.8 vs 7.5 ± 3.9,p<0.001). Fibrosis index was higher in those with steatosis (0.12 ± 0.07 vs 0.10 ± 0.07,p=0.021). Conclusion: The presence of steatosis on biopsywas associatedwithmore histologicactivity and faster rates of disease progression by fibrosis index. BMI, DM and Hispanic racecan help clinicians identify patients at risk for steatosis.

M1774

Evaluation of Liver Fibrosis in Diffuse Liver Disease Using Real-Time TissueElastographyKenji Fujimoto, Chie Tatsumi, Kazuomi Ueshima, Tsuyoshi Shiina, Akiko Tonomura,Tsuyoshi Mitake, Keiji Yamamoto, Masatoshi Kudo, Michio Kato

[Objective] Real-time Tissue Elastography (RTE) is developed for visualizing the tissuehardness/softness by using ultrasound. We have been investigating its ability of evaluatingfibrosis in diffuse liver disease. Recently, newly developed low frequency probe (EUP-L52)has been applied to RTE, and a patient who had difficulty of visualizing RTE image for thereason of low penetration such as obesity has been improved. In this study, multiple linearregression analysis was performed using several features of RTE image to estimate the RTEfibrosis value, and compared with the fibrosis stage to evaluate the clinical usefulness ofRTE. [Material and Method] 26 patients with chronic hepatitis C or liver cirrhosis diagnosedby liver biopsy, and 6 healthy volunteers were examined in this study. The indicated stagesof fibrosis wereF0 in 2 patients, F1 in 6 patients, F2 in 8 patients, F3 in 6 patients, andF4 in 4 patients. RTE were performed with HITACHI HI VISION 900 and EUP-L52 linearprobe(3-7MHz). Scan was performed through the right intercostal space to observe rightlobe. Probe was slightly held to detect the strain by heartbeat. All RTE images were transferredto an external PC, and analyzed with prototype image analysis software. Color data insidethe ROI were converted to relative strain value, and features of RTE image such as meanof relative strain value (MEAN), standard deviation of relative strain value (STD), area ofblue region (AREA), and complexity of blue region (COM) were calculated. Then, multipleregression analysis was performed with features of RTE image and fibrosis stage. [Results]Features of RTE image were highly correlated with fibrosis stage. Correlation coefficient ofMEAN, STD, AREA, and COM were r=-0.604, 0.593, 0.592, and 0.578. With these 4parameters, multiple regression analysis was performed and derived the regression equation,which significantly fit with the data. RTE fibrosis value was calculated from this equationand had high correlation with fibrosis stage(r=0.729). [Conclusion] As a result of havinganalyzed RTE quantitatively, the quantity of characteristic reflected staging well. RTE isparticularly useful as the modality that can grasp improvement of the fibrosis by a hepatitisdiagnosis and the treatment non-invasively. “HI VISION” is a registered trademark of HitachiMedical Corporation in U.S.A.

M1775

Metabolic Syndrome and Risk for Progression to Hepatocellular Carcinoma inPatients with Hepatitis C CirrhosisBhavna Malik, Catherine Frenette

Background/Aim: The presence of hepatic steatosis on liver biopsy has been shown to be arisk factor for progression to hepatocellular carcinoma in patients with hepatitis C relatedcirrhosis. It is not known whether clinical indicators for hepatic steatosis also increase therisk for progression to hepatocellular carcinoma. The aim of this study was to determinewhether the presence of clinical risk factors for NAFLD, i.e. the metabolic syndrome(obesity,type 2 diabetes, hypertriglyceridemia , hypertension) in hepatitis C patients increase theirprogression to HCC. Methods: A retrospective chart review was done on 76 patients withhepatitis C who had undergone liver transplant at a single institution between 2000 and2008 and had biopsy confirmed hepatocellular carcinoma (cases). These were matched 1:1on the basis of age and sex with a cohort of patients with hepatitis C without HCC who

A-835 AASLD Abstracts

had been transplanted during the same period (controls). The percentage of patients withBMI> 30, triglyceride level >150, blood glucose level>100 and BP>130/85 were noted incases and compared to controls. Results: 152 patients were reviewed. The mean age was55 years. 81% were male in each group. HCV patients in the hepatitis C group hadhigher MELD scores than HCV/HCC patients (mean MELD 27.40 versus 12.6),lower plateletcounts(mean 71k versus 77k), higher creatinine (1.75 versus 1.025), higher bilirubin (15.4versus 3.12) and higher INR(2.15 versus 1.4) indicating a greater severity of cirrhosis. Therewas no difference in rates of obesity (31.5%) in each group. Fewer patients with HCV/HCChad diabetes compared to HCV alone (22.3% vs. 32.9%). HCV/HCC patients had higherrates of hypertension (22%) compared to controls (13%). HCV/HCC patients had higherrates of hypertriglyceridemia (27.6%) compared to controls (11.8%). The mean triglyceridelevel in HCV/HCC patients was 127.64 (CI 106.43-148.94) compared to 100.11 (CI 86.25-113.37) in patients with HCV alone (p<0.05). Conclusion: In this case control study, patientswith HCV and HCC had higher rates of hypertension and hypertriglyceridemia than patientswith HCV alone. Other factors of the metabolic syndrome were not seen more commonlyin patients with HCC. Further research is needed to determine the impact of hypertensionand hypertriglyceridemia on patients with HCV and their risk of progression to HCC.

M1776

Utility of FibroTest and MRI for Non-Invasive Assessment of Chronic LiverDiseasesFlorin A. Caruntu, Valeriu Gheorghita

Background: Liver histology is considered the reference standard in evaluating the necroinfla-matory activity (“grading”) and fibrosis (“staging”), both playing an important role forprognosis assessment and specific treatment initiation. There are two methods to evaluatethe histology: invasive (liver biopsy) and non-invasive (serological and imagistic) procedures.Objective: The main objective is to evaluate the correlation between liver biopsy (LB),serological markers (FibroTest) and MRI in fibrosis grade assessment for patients with viralor non-viral etiology liver disease. Patients and methods: Between June 2006 and December2007, 123 patients with viral or non-viral etiology liver disease were evaluated for inclusionin this study, undergoing LB- staged according to Metavir criteria (n= 100), FibroTest (n=123) and MRI (n=28). “SPSS v16 for Mac OS X” package (ãSPSS Inc. 1989-2008), was usedfor statistical analisys (p < 0,05). Results: The majority of patients were diagnosed withchronic hepatitis (HCV-66%, HBV-18%, HBV+HDV-11%), all others having other etiologies(alcohol consumption, dyslipidemia). By assessing the corelation between LB and Fibrotest(n=100) for various fibrosis stages we noticed a good correlation (p<0,001) for F0 and F4,but also for F2 (significant fibrosis), with an ICC (interclass correlation coefficient) of 0.681for advanced fibrosis (p<0,001). LB and MRI (n=21) correlated well for advanced fibrosis(F4) (p=0,003),with an ICC of 0.593 (p<0,001). The AUROCs for FibroTest predictionpower in identifying patients with significant fibrosis (>F2) and advanced fibrosis (F4) weredetermined. The AUROC for significant fibrosis (>F2) was 0.787 (95% CI 0.692 - 0.881,p <0.001); in this case the optimal FibroTest cut-off limit is 0.465, with maximal sensitivity(72,2%) and specificity (72,2%). The AUROC for F4 patients was 0.895;(95% CI=0.823-0.967, p<0.001); the optimal FibroTest cut-off limit is 0.735, with maximal sensitivity (87%)and specificity (85.7%). Conclusion: Both FibroTest and MRI can identify fibrosis grade,but the accuracy varies depending on disease severity. FibroTest is quite accurate (78%) forsignificant fibrosis (>F2); for advanced fibrosis (F4) FibroTest has a very good accuracy-89%. We can conclude FibroTest is proving a reliable value in identifying patients whoneed specific antiviral treatment for chronic hepatitis (patients with at least significant fibrosis,>F2); this non-invasive method can be also useful for monitoring disease progression.Nevertheless, liver biopsy still plays a fundamental role in liver fibrosis diagnosis, especiallyin patients with not concordant non-invasive tests.

M1777

Poor Adherence to Screening for Hepatocellular Carcinoma (HCC), Especiallyin Patients with Chronic Hepatitis B (CHB) Without Cirrhosis Compared toPatients with Cirrhosis of All EtiologiesCarrie R. Wong, Ruel T. Garcia, Huy N. Trinh, Huy A. Nguyen, Khanh K. Nguyen, BrianS. Levitt, Mindie H. Nguyen

PURPOSE: Optimal screening may improve HCC survival as compared to no or suboptimalscreening. AASLD guidelines recommend HCC screening with liver ultrasound (US) andserum alpha fetoprotein (AFP) every 6 months for high-risk patients. Our goal was to assessHCC screening adherence in such patients. METHODS: We performed a retrospective cohortstudy of 468 consecutive patients who met HCC screening guidelines: CHB patients withoutcirrhosis ≥45 years old and patients with cirrhosis of any age who started to undergo HCCscreening in 1/00-1/05 and were followed for ≥12 months in a US GI clinic. Optimalscreening was defined as serum AFP+liver imaging (US/CT/MRI) every 6 months. Patientswith suboptimal screening had either AFP or liver imaging every 6-12 months. Patients withpoor screening had either AFP or liver imaging less often than every 12 months. RESULTS:Of the 468 patients, 72% were CHB patients without cirrhosis and 28% were with cirrhosisof all etiologies. Cirrhotic patients were older than CHB patients (mean age=59±11 vs. 55±9,p=0.0002). Almost all were Asians (96%) and foreign-born (97%) (mean years in US=14±8).Figure 1 describes the proportion of patients with various levels of HCC screening adherence(in total, and by CHB vs. cirrhosis diagnosis). Overall, 8% had optimal screening and 54%either had poor or no screening. Employment, insurance status, and years in the US werenot significant predictors for optimal screening. On multivariate analysis also inclusive ofage and sex, antiviral therapy (vs. none) and cirrhosis (vs. CHB alone) diagnosis wereindependent predictors of optimal screening outcome (OR=2.1, p=0.035 and 3.0, p=0.004).CONCLUSIONS: Our study shows that <10% of patients who intended to undergo HCCscreening actually received the recommended HCC screening frequency. CHB patients with-out cirrhosis were less likely to receive optimal screening. Additional efforts are needed toimprove HCC screening adherence, especially in CHB patients without known cirrhosis.

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