ABSTRACTS 24th Annual Conference of APASL, March 12–15, 2015, Istanbul, Turkey Ó Asian Pacific Association for the Study of the Liver 2015 Oral Presentations Topic 1: Acute on Chronic Liver Failure No: 2076 AKI persistence at 48 h predicts mortality in patients with acute on chronic liver failure provided the peak creatinine is above 1.14 mg dl Rakhi Maiwall 1 , Guresh Kumar 2 , Ajeet S. Bhadoria 3 , Shiv K. Sarin 1 Ilbs Hepatology New Delhi-India 1 , Ilbs Biostatistics New Delhi-India 2 , Ilbs Epidemiology New Delhi-India 3 Background and aim: Diagnosis and management of renal dys- function in cirrhotics has changed with advent of AKI criteria. We evaluated the impact of AKI persistence at 48 h on in-hospital mor- tality in a cohort of ACLF patients (APASL definition). Methods: Consecutive patients of ACLF (n = 374) were included. Results: AKI at admission was present in 167 (44.8 %) patients. At 48 h, 77.2 % patients had persistent AKI, 22.8 % had transient AKI and 9 % developed new onset AKI. High MELD (p, OR, 95 % CI) (C33) ( \ 0.01, 8.3, 3.5–19.4), SIRS (0.03, 2.65, 1.1–6.3) and age (C42 years) (0.03, 2.4, 1.06–5.69) were significant predictors of AKI persistence. Persistent AKI was associated with higher in-hospital mortality (P = 0.04, HR 1.8, 95 % CI 1.4–2.4) as compared to conventional criteria using cut-off serum creatinine C1.5 mg/dl (0.04, HR 1.3, 95 % CI 1.01–1.8). A lower cut-off for serum creatinine of 1.14 mg/dl at 48 h had a sensitivity of 100 % and specificity of 75.6 % against the con- ventional 1.5 mg/dl cut-off. The new cut-off predicted mortality with higher odds (OR 2.4, 95 % CI 1.3–4.8) as compared to the conventional cutoff (OR 2.1, 95 % CI 1.1–4.1). Further, a smaller fold change of 26 % from baseline at 48 h was associated with increased mortality (P = 0.02, OR 3.3, 95 % CI 1.1–9.7) in these patients. Conclusion: AKI persistence at 48 h predicts mortality better than serum creatinine of 1.5 mg/dl in patients with ACLF. Lower threshold as well as smaller increases in serum creatinine should therefore be considered for risk stratifying patients of ACLF for additional pharmacotherapy. Topic 1: Acute on Chronic Liver Failure No: 1683 Title does the different etiological profiles affect the outcome of acute on chronic liver failure in pediatric population Seema Alam 1 , Bikrant Bihari Lal 1 , Rajeev Khanna 1 , Vikrant Sood 1 , Dinesh Rawat 1 Institute of Liver and Biliary Sciences Pediatric Hepatology New Delhi-India 1 Aim: To compare the prevalence and outcome of acute-on-chronic liver failure (ACLF) in children with chronic liver disease (CLD) due to various etiologies. Methods: All children between the ages of 3 months to 18 years presenting with chronic liver disease from Dec’2010 to Sept’2014 were included. ACLF was defined as per Survival was observed within 12 weeks of development of ACLF. Results: Out of the total 403 cases of childhood CLD, 27 (6.7 %) were diagnosed as ACLF with the median age of 9 years (1.5–17 years). Median bilirubin and INR were 17.5 mg/dl and 3.3 respectively. Commonest underlying etiology of CLD were Wil- son’s disease 14 (52 %), autoimmune hepatitis (AIH) 8 (29.7 %), and cryptogenic 3 (11.1 %). None of the cases with metabolic liver disease (n = 92) or chronic hepatitis B (n = 100) had ACLF. The common acute events were viral insult 6 (22.2 %), drugs 4 (14.8 %). Flare of the underlying condition was seen in 8 Wilson’s disease and 6 AIH patients. Median PELD/MELD, CLIF-SOFA and APACHE-II scores were 27 (12–54), 9 (8–18) and 9 (0–30). of the 27 children, 10 (37 %) expired within 12 weeks and 2 were transplanted. Mortality was 57 % among Wilson’s disease and 12.5 % in AIH (P = NS). Conclusion: ACLF is common in children with Wilson’s disease and AIH and the mortality is higher in those with Wilson’s disease. 123 Hepatol Int (2015) 9 (Suppl 1):S1–S391 DOI 10.1007/s12072-015-9609-1