AASLD Abstracts Findings of the univariate logistic regression models of iron panel and liver enzymes on the result HFE testing. Su1491 HEALTH PROMOTION, AS MEASURED BY IMMUNIZATION, IN PATIENTS WITH CHRONIC VIRAL HEPATITIS Gerald Fletcher, Sheldon Ferguson, Eric M. Alatevi, Joan A. Culpepper-Morgan, Alvaro Genao, Olumide Ajayeoba Background: Adherance to health maintenance guidelines promotes well-being in patients with chronic viral hepatitis (CVH). Vaccinations against infectious diseases reduce morbidity and mortality in CVH. While vaccination against HAV and Penumococcus are recommended in patients with chronic liver disease, rates in CVH have been shown to be suboptimal. While several studies have reported aggregate vaccination rates in CVH, none to our knowledge has specifically looked at rates of vaccinations in chronic HBV compared with chronic HCV cohorts. Our objective was to compare two cohorts of patients (chronic HBV vs chronic HCV) in their meeting standard immunization guidelines for HAV and pneumococcus and identify factors that may influence vaccination rates within the cohorts. Methods: Using a retrospective study design, we identified patients with CVH who attended GI Clinic. These were established patients who had been seen at least twice within a six-month period from January 2016 to December 2017. The patients were then classified by the type of viral agent and other demographic variables including age, gender, race, and country of birth were recorded from the electronic medical record. Data on immunity to HAV and vaccination against HAV and Pneumococcus were obtained from lab results and vaccination records. Patients were considered immune against HAV if there was documented vaccination or positive IgG antibody against hepatitis A. Vaccination status against Pneumococcus was confirmed through the vaccination records or documentation by an attending clinician. Results: Out of 377 patients with CVH identified, 33% (126) had chronic HBV, 66% (248) had chronic HCV and 1% (3) were co-infected with HBV and HCV. In the chronic HBV cohort, 80% (103) were non-US born, 20% (26) were US born. In the HCV cohort, 18% (44) were non-US born while 82% (207) were US born. 8% of the HBV cohort identified as Hispanic while 88% (114) were Non-Hispanic Blacks and 4% (5) identified as Others. In the HCV cohort, 17% (42) were Hispanic, 80% (201) were Non-Hispanic Blacks, and 3% (8) identified as Others. HBV patients were more likely to have received HAV vaccination or confirmed immunity than HCV patients with an OR 2.2 CI 95% [1.3,3.9]). Chronic HCV patients were more likely to have received Pneumococcus vaccination compared to HBV (OR 2.0 CI 95% [0.24,0.94]. The odds of having received both HAV vaccination or confirmed immunity to HAV and pneumococcal vaccination were not statistically significant (OR 1.8 CI 95% [0.2,1.4]. Conclusion: Rates of protection against infectious HAV and Pneumococcus differ in chronic HBV and HCV patients. Differences in country of birth, age, and ethnic background were statistically significant between the two groups. These factors may affect the design and implementation of strategies to improve the health maintenance of patients with CVH. Su1492 WHO IS DOING LIVER BIOPSY AND WHY? AN AUDIT OF ONE YEAR'S LIVER BIOPSY WORKLOAD Umair Iqbal, Michael Makar, Taylor Anspach, Harshit S. Khara, Amitpal S. Johal, Bradley Confer, David L. Diehl Introduction: Liver biopsy (LB) is considered the gold standard in the diagnosis and management of intrinsic liver diseases. Percutaneous (PC) approach generally the most widely used biopsy technique. Transjugular (TJ) biopsy is reserved for patients with coagulopathy or if there is a need for portal pressure measurements. Endoscopic ultrasound EUS-guided LB (EUS-LB) is an emerging technique with increasing availability. We did a retrospective study at our hospital on the patients who underwent liver biopsies to evaluate for indications, referral patterns, route of LB, and pathologic diagnosis. Methods: A query of pathology results was done of all LB in patients over 18 years of age in a 1-year period. Patients with biopsy of a focal hepatic mass were excluded. Demographics data was collected, including age, sex, BMI, LB technique, adverse effects of LB, and referring provider specialty. For EUS-LB, any indication for EUS or EGD in addition to LB was noted. Results: 200 consecutive parenchymal liver biopsies were identified (57 patient with biopsy of a focal liver lesion were excluded). Mean age was 52 years, BMI 34.8 kg/m 2, and 95% were Caucasians. Elevated liver enzymes were the most common indication for the LB and non-alcoholic fatty liver (NAFLD) disease was the most frequent pathologic diagnosis (53%). Referrals were from hepatologists (37%), gastroenterologists (23%), internists (4%) and the remainder by other physician specialties. EUS-LB was utilized in 53% of the patients, surgical biopsy in 32% (patients usually were undergoing bariatric surgery), TJ in 10%, and PC in 5%. Adequacy of the samples were similar among all the approaches with 100% adequacy in samples obtain through TJ, US guided and surgical techniques, and 99% of EUS-LB samples were 99%. There was no difference in the adverse events among different biopsy techniques. 45% of the patients who underwent EUS-LB has an EGD or EUS indication in addition to the LB; the most frequent indication for EUS was dilated common bile duct/rule out choledocholi- thiasis and for EGD was screening for gastroesophageal varices. Conclusions: Performance of LB by general gastroenterologists and hepatologists is decreasing, and these procedures are typically referred to interventional radiology. With the support of an active EUS service and a strong referral pipeline, there can be increased use of EUS-LB. Limiting EUS-LB only to patients who require concomitant EGD or EUS in addition to LB can still account for approximately 25% of all LB done at a medical center. Less than 10% of liver biopsies will need to be done by transjugular route due to coagulopathy or need for portal pressure measurements. There are no differences in specimen adequacy or adverse effects between the different approaches. S-1282 AASLD Abstracts Su1493 UNDERUTILIZATION OF ROUTINE VACCINATIONS IN MINORITY PATIENTS WITH CHRONIC VIRAL HEPATITIS IN A COMMUNITY TEACHING HOSPITAL. Gerald Fletcher, Alvaro Genao, Eric M. Alatevi, Joan A. Culpepper-Morgan, Sheldon Ferguson, Olumide Ajayeoba Background: The AASLD, CDC and Advisory Committee on Immunization Practices (ACI- P)recommend vaccinating against Hepatitis A Virus (HAV), Hepatitis B Virus (HBV), and Pneumococcus in all eligible patients with chronic liver disease (CLD) including patients with chronic viral hepatitis. Vaccination against HAV, HBV and Pneumococcal infections in CLD can reduce intrinsic disease progression as well as overall morbidity and mortality. We describe the vaccination and immunity status of patients attending a Gastro-Intestinal (GI) Clinic of an academic hospital which cares for minority populations in New York City. Methods: Using a retrospective study design, we identified patients with chronic viral hepatitis who attended the GI Clinic. These were established patients seen at least twice within a six-month period from January 2016 to December 2017. These patients were classified based on the type of viral agent. From laboratory results and vaccination records, patients’ immunity status against viral hepatitis and vaccinations received were determined. Patients were considered immune against hepatitis A or B if there was documented vaccination or positive IgG antibody against hepatitis A virus or HBcAb/HBsAb respectively. Vaccination against Pneumococcal infections was confirmed as per the vaccination records or documenta- tion by an attending clinician. Results: Out of 377 patients with chronic viral hepatitis identified, 14%(51) were Hispanics, 83%(313) Non-Hispanic Blacks, and 3%(13) Others (which included Non-Hispanic Whites and other multiracial groups). Of these, 61% (231) were US born while 39%(146) were non-US born. Patients with chronic HBV formed 33% (126) of the study, 66% (248) were with chronic HCV and 1% (3) were co-infected with HBV and HCV. Of patients with chronic HBV, 53% (69) had immunity against HAV and 29% (38) had received vaccination against Pneumococcus. Only 16% (21) had received both vaccinations while 30% (39) had a negative HAV antibody test and had not received any vaccination. Of patients with chronic HCV, 38% (94) of eligible patients had received vaccination for HAV or had immunity, 39% (96) had HBV vaccination or had immunity, 53% (131) had received pneumococcal vaccines and only 12% (30) had received all three vaccines or were immune. Seventeen percent (41) of HCV patients had negative antibody tests to HAV and HBV and had not received any of the recommended vaccines. Conclusion: This population of minority patients with chronic viral hepatitis is under-immunized. Further studies are needed to explore barriers to immunization and develop successful strategies to optimize the immunization status of this susceptible population. Su1494 SCREENING FOR NAFLD AT A SUBURBAN PRIMARY CARE PRACTICE: IS IT WORTH SCREENING AND WHICH NON-INVASIVE TOOL SHOULD BE USED? Tarek I. Hassanein, Noha Abdelgelil, Fatma Barakat, Cristobal Soto, Anna Marie Hefner Obesity and NAFLD/NASH are a growing epidemic posing a great health risk and economic burden. Individuals with obesity and metabolic syndrome are at higher risk for NAFLD/ NASH. Hence, early identification of patients at risk for NAFLD/NASH is critical for early intervention and in reducing future burden. Liver injury tests and ultrasound are the most commonly used modalities in primary care to identify patients with chronic liver disease. In March 2017 we initiated a screening program at a large suburban Primary Care Practice (PCP) in Southern California with the aims of 1) estimating the prevalence of fatty liver and fibrosis in a primary care community setting, 2) evaluating the value and ease of four non- invasive fibrosis and fat measures as screening tools and 3) develop criteria and a stratification algorithm to guide PCPs in their management and referral of patients to the respective specialists. We report on our findings thus far. Methods: 958 patients with no-known history of liver disease participated in the screening program between March and June 2017. The screening program consisted of getting a FibroScan® and laboratory tests. Pertinent information was also collected. Patients with a significant CAP score (≥ 290) were further evaluated using ShearWave Elastography (SWE), Fib-4 and NAFLD Fibrosis scores (NFS). Results: 64.1% of patients were female. Mean age was 45.5 ± 15.6 years. 84.7% Hispanic. 24.2% had hypertension, 15.6% hyperlipidemia, 13% Diabetes Mellitus Type 2. 36.2% were overweight by BMI and 43.1% obese or morbidly obese. Over 93% had normal liver injury tests and>98% had normal platelets count. 18% had liver stiffness of ≥ 7 kPa on FibroScan® and 36% had a CAP ≥ 290. Of the 345 patients with a CAP ≥ 290, 108 had other non- invasive fibrosis markers done (see table for results). Summary: In a single suburban Primary Care Practice seeing patients with no-known liver disease and normal liver injury tests, 1) obesity, fatty liver and fibrosis were more prevalent than expected, 2) FibroScan® CAP is useful in identifying patients with significant steatosis, however, the liver stiffness measure