parameters found significant on univariate analysis to assess their independent association with mortality for either group with ACLF. Results: In the 76 (34.5%) and 78 (35.5%) patients with ACLF as per the two definitions recruited from 220 patients with CLD, the 28-day mortality was 51.3% and 53.8% respectively. On multivariate ana- lyses, none of the parameters of renal dysfunction in patients with ACLF defined by the APASL criteria and only serum creatinine and the new ICA definition both as applied 48 h after admission were signifi- cantly associated with mortality. Conclusion: AKI as per the ICA definition applied at admission is not significantly associated with mor- tality in patients with ACLF diagnosed as per APASL and EASL–CLIF criteria. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Harneet Singh. E-mail: harneet_156@hotmail.com http://dx.doi.org/10.1016/j.jceh.2016.06.011 10 ASSESS 28-DAY SURVIVAL OF TOP DOWN APPROACH OF SLOW LOW-DOSE CONTINUOUS ALBUMIN + FUROSEMIDE  TERLIPRESSIN (SAFI  T) AND N- ACETYCYSTINE INFUSION AND PROBIOTICS IN ACLF PATIENTS WITH MELD  35, ASCITES AND HIGH CVP (CENTRAL VENOUS PRESSURE)  ORGAN FAILURE Gaurav Pande, Kamlesh Kumar, Prabhat Sharma, V.P. Krishna, Amit Goel, Abhai Verma, Samir Mohindra, Praveer Rai, Uday C. Ghoshal, Rakseh Aggrawal, Vivek A. Saraswat Sanjay Gandhi Institute of Medical Sciences, Lucknow, India Background and Aim: Pathophysiology of ACLF involves dysbalanced systemic inflammation and worsened hyperdynamic circulation and altered gut permeability leading to multi organ dysfunction. A combination cocktail incorporating patho-physiolo- gical changes may impact survival. The aim is to study in ACLF patients the efficacy and safety of top-down therapy administered according to a response-guided protocol to achieve complete (clinically dry) ascites mobilization and UNa > 80 mmol/L. Methods: It was a retrospective analysis of prospec- tive accumulated data. Forty-one patients (20 study group (13:7; M:F)—Arm 1, 21 (15:6; M:F) standard medical treatment (SMT)—Arm 2) fulfilling APASL criteria for ACLF with ascites and high CVP (>10 cm H 2 O) were included. All baseline lab tests (blood, urine, ascetic fluid) and timed 24-h urine collection for urinary sodium (UNa), potassium (UK), creati- nine, albumin were done within initial 24 h. CVP was placed. Study arm group was initiated on furosemide infusion at 2 mg/h and albumin 2 g/h (20–40 g/d) and N-acetylcystine infusion (as per dose of parace- tamol poisoning). Oral probiotic VSL #3 was added. Blood and urine (electrolytes) samples were collected 12 hourly for UNa, UK and graded increase of fur- osemide was done by 1 mg/12 h if UNa < 80 meq/d with aggressive potassium supplementation wherever required. At 48 h if UNa < 80 meq/d terlipressin infu- sion @4 mg/24 h was started after correcting anaemia (8 g/dl) and baseline ECG (repeated 12th hourly) and response guided increase (1 mg/12th hourly) was done (maximum 8 mg/24 h) till ascites mobilization. Second group received SMT (albumin and all therapy as per guidelines). Both groups received aetiology specific treatment as per guidelines. Results: Aetiology for cirrhosis in Arm I and II (alco- hol (OH)—46% vs 46.2%, HCV—9.2% vs 5.5%, HBV— 16.1% vs 20.9%, cryptogenic 27.6% vs 25.3%, autoim- mune (AIH)—1.1% vs 2.2%) and acute insult (mainly sepsis 46% vs 42.9%, OH 27.6% vs 25.3%; HBV reacti- vation—6.9 vs 14.3%; unknown 13.7 vs 9.9%; malena 5.7% vs 7.7%) were not significant. All baseline para- meters were not significantly different including in ARM I and II (creatinine—2.3  1.67 vs 2.4  1.68; CTP—12.8  0.8 vs 12.7  1.38; median MELD—39.5 (36.2–40) vs 37 (35.5–39.5) (P = 0.03); number of organ failure—2.9  1.4 vs 3.1  1.5; CLIF-SOFA— 12.3  1.9 vs 12.2  2.3; urine output (UO)—523  78 vs 525  85 ml/day. Post-therapy in Arm I sig- nificant difference from baseline was seen in urine sodium 27.6  21 to 202  106 mmol/24 h, UO to 2152  815 ml/24 h (ARM II—810  150 ml/24 h), serum creatinine 1.63  0.9; (ArmII—creatinine 1.99  1.7). Twenty-eight day survival in ARM I vs II was 65% (13/20) vs 47% (10/21) (P < 0.05). Hemo- dynamic assessment: baseline renal (RRI) and hepa- tic artery resistive index (HRI) was done in 10 patients only in Arm I pre- and post-therapy. Pre- therapy the mean RRI was 0–806  0.078 and post- therapy changed to 0.67 + 0.04 (P = 0.001). For hepa- tic artery also the median differences were statisti- cally significant. Side effect profiles were not significantly different. ACUTE LIVER FAILURE AND ACUTE ON CHRONIC LIVER FAILURE S6 © 2016, INASL ALF and ACLF