Western countries but no real-world data on the burden of NAFLD on health-care resources are available from European countries. The proportion of patients with NAFLD seen in outpatient visits and the utilization of medical resources for the management of these patients are unknown. This study aimed to assess the prevalence of NAFLD among outpatients in a specialized liver clinic at a tertiary care center. Method: All outpatient visits at the liver clinic of the University Medical Center Mainz over a total of 20 weeks in 2 independent intervals in 2016 and 2017 were included. Data of patients with suspected NAFLD from the 2016 cohort was available fora 6 month follow-up study and the utilized resources, final diagnosis and disease severity was analyzed in this group. The cohort is part of the pan-European EPoS CONSTANS study. Results: A total of 1973 patients (mean age 51.9 ± 15.3 y, 51% females) were seen in the outpatient clinic. Among the 2016 cohort 15.6% were newly addressed for suspected NAFLD, 40.5% for chronic viral hepatitis, 8.7% for alcoholic liver disease, 2.2% for suspected gastrointestinal cancer, and 28.7% for miscellaneous reasons. In the work-up of these patients, a follow-up visit was scheduled in 78%, 89% of patients underwent additional blood tests, 72% imaging by ultrasound and 20% Fibroscan. A liver biopsy was ordered in 7% and 2.4% of patients were hospitalized. Patients with suspected NAFLD presented with steatosis on imaging studies (2.3%), altered liver function tests (5.9%), known NAFLD (7.8%), increased ferritin level (0.1%) or cirrhosis of unknown origin (3.9%). In the 6 months following the initial 2016 consultation, NAFLD was confirmed in 50% of cases. In this group 23% were diagnosed with NASH on liver biopsy, 10% NAFL on liver biopsy and 9% had NAFLD cirrhosis. 14% of patients did not undergo biopsy but remained with suspected NAFLD. In 24% of patients a final diagnosis was not established in the 6 month follow-up period. The resources utilized to reach these diagnosis was ultrasound in 86%, 31% Fibroscan, 5% MRI, 8% CT, and 37% liver biopsy. In the group of patients that underwent liver biopsy during follow-up, NASH was found in 37% and advanced fibrosis/ cirrhosis in 41%. Cost analyses for medical resource utilization will be presented. Conclusion: In this prospective study, based on real-world data, 15.6% of patients at a Hepatology outpatient clinic were referred with a presumptive diagnosis of NAFLD, which was the second most common cause of consultation. Of these, half had confirmed NAFLD including 46% (3.1% of the entire cohort in 2016) with advanced fibrosis/cirrhosis. Both the prevalence of this condition and medical resource utilization and related costs are indicative of the substantial burden of disease NAFLD places on hepatological practice. SAT-504 Analyze of ballooning biomarker in patients with non-alcoholic steatohepatitis: A multicenter study Y. Honda 1 , T. Kessoku 1 , W. Tomeno 1 , K. Imajo 1 , M. Yoneda 1 , S. Saito 1 , T. Nakahara 2 , S. Ooeda 3 , H. Takahashi 3 , H. Hyogo 4 , Y. Eguchi 5 , A. Nakajima 1 . 1 Yokohama City University School of Medicine; 2 Hiroshima University; 3 Saga Medical School; 4 JA Hiroshima General Hospital; 5 Saga Medical School Email: rainbowman0803@gmail.com Background and Aims: The progression of non-alcoholic fatty liver disease (NAFLD) has been considered to be complex involving multiple genetic factors interacting with the environment and lifestyle, however, the fundamental pathophysiology of NASH is still unknown. Recently, paired liver biopsy studies revealed that the annual fibrosis progression rate was found to be 0.07 stages for nonalcoholic fatty liver (NAFL) and 0.14 stages for patients with NASH. This means that it is important to noninvasively diagnose the presence or absence of ballooning, which is characteristic patho- logical findings diagnosis for NAFL or NASH. This study aimed to understand pathophysiology of NAFLD and to identify novel blood markers sensitive to ballooning. Method: A total of 135 patients with NAFLD (NAFL = 88, NASH = 47) between 2014 and 2016 were enrolled from four Hepatology centers in Japan. NASH was diagnosed by steatosis, lobular inflammation, and hepatocyte ballooning. For the histological feature scoring system, we used the NAFLD activity score. Fibrosis were scored independently using the NASH Clinical Research Network scoring system. RNA-seq data analysis from liver biopsy samples was obtained from Ion Proton system, and pathway enrichment analysis was performed based on the known pathways from Ingenuity Pathways analysis. Metabolomics profiling analysis were carried out in plasma samples. Ethical approval for this study was given by the respective Institutional Review Board and subject written informed consent was obtained for all subjects. Results: Potential pathways highly correlated with fibrosis stage and ballooning score, e.g. Coagulation System and Axonal Guidance Signaling were identified in NGS profiling in the NAFLD-related subjects. Plasma type IV collagen 7S was highly correlated with ballooning score (correlation coefficient = 0.47), and potential secreted collagens may be a diagnostic marker for ballooning. The metabolomics study indicated plasma metabolites including ether- linked lyso-phospholipids were possible biomarkers of NASH and established a new non-invasive score model, which included liso- phosphatidylcholine (LPC) (e-16:0), phosphatidylcholine (PC) (aa- 32:0) and xanthine to estimate ballooning score of NASH. Conclusion: The potential pathways and the potential blood biomarkers need to be evaluated further and may result in target identification in drug discovery and non-invasive diagnosis in NASH. SAT-505 Health-related quality of life correlates with histological severity in non-alcoholic fatty liver disease Y. Huber 1 , C. Labenz 1 , T. Siebler 1 , B. Straub 2 , M.-A. Wörns 1 , P. Galle 1 , K. Hallsworth 3 , M. Boyle 3 , Q. Anstee 3 , J. Schattenberg 1 . 1 I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; 2 University Medical Center of the Johannes Gutenberg University Mainz, Institute of Pathology; 3 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom Email: yvonne.huber@unimedizin-mainz.de Background and Aims: Chronic liver disease potentially exerts a negative effect on a patient’s health-related quality of life (HRQL). Aim of the current study was to explore the impact of disease severity defined by liver histology in patients with non-alcoholic fatty liver disease (NAFLD) on patient reported outcomes (PROs). Method: As part of recruitment into the prospective EPoS NAFLD Registry, the Chronic Liver Disease Questionnaire (CLDQ), a liver disease specific instrument to assess HRQL, was measured in NAFLD patients within 6 months of routine diagnostic liver biopsy at centers in UK (Newcastle) and Germany (Mainz). A low score represents a lower quality of life. Results: A total of 247 patients (54.3% male) were included in this study. The mean age was 52.1 ( ± 12.7) years. Mean CLDQ-overall score was 4.9 (±1.3) and ranged from the lowest 4.2 (category: worry) to highest 5.4 (category: activity). Women exhibited a significantly lower CLDQ overall score than men (mean (SD) 4.6 ( ± 1.3) vs. 5.2 ( ± 1.2), p < 0.01). Reflecting lower HRQL, there was a negative correlation between overall CLDQ score and both BMI and presence of type 2 diabetes mellitus (p < 0.05). Laboratory parameters, especially liver function tests had no influence on HRQL. In contrast, histological features of NAFLD on liver biopsy had a significant impact on HRQL. Patients with a lower Steatosis-Activity-Fibrosis-score (SAF) showed higher HRQL (SAF0 vs. SAF3: 5.2 ( ± 1.5) vs. 4.4 ( ± 1.4), p < 0.05). Advanced fibrosis and cirrhosis (F3/F4) was observed in 103 patients POSTER PRESENTATIONS S831 Journal of Hepatology 2018 vol. 68 | S605–S842