ABSTRACTS 23rd Annual Conference of APASL March 12–15, 2014, Brisbane, Australia Ó Asian Pacific Association for the Study of the Liver 2014 Topic: 1 Acute Liver Failure Absno: 22 Acute liver failure in Sapporo, Japan: clinical features according to the aetiologies Jong-Hon Kang, Takeshi Matsui, Hajime Yamazaki, Kazumasa Nagai, Kunihiko Tsuji, Yoshihisa Kodama, Yasuo Sakurai, Hiroyuki Maguchi Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan Background/aims: As for acute liver failure (ALF), not all patients need liver transplantation (LT), because clinical outcome is different by every etiology. Artificial liver support (ALS) including hemodia- filtration has started to treat ALF with encephalopathy in 2000. Our study was aimed to clarify the clinical impact of etiology for ALF. Methods: A total of 102 ALF patients (52 females, median age 48 years) referred from all Hokkaido areas in Japan during 1997 through June 2013 were enrolled, and etiological assessment underwent. ALF was defined to be 1.5 or more in INR. When hepatic coma was diagnosed, intensive care including ALS started using antivirals and/ or corticosteroid, if necessary. LT underwent for the patients showed refractory. Results: The distribution of etiologies for ALF was viral infection 48, circulatory disturbance 12, autoimmune hepatitis 9, drug-induced liver injury 7, metabolic diseases 4, infiltration of liver by malignant cells 2 and miscellaneous 20. Among 48 cases of viral infection, hepatitis B virus (HBV), HEV, HAV or others was causative in 26, 15, 5, and 2, respectively. Out of 53 patients presented hepatic encephalopathy, 25 (47.2 %) had viral infection, 6 (11.3 %) AIH 5 (9.4 %) drug-induced, 6 (11.3 %) others, and 11 (20.7 %) miscella- neous. Non-comatose 46 and comatose 29 including 8 undergone LT survived. 37 of 48 patients with viral infection were saved by antiv- irals and/or ALS, and 11 of 12 caused by circulatory disturbance survived after the treatment for underlying disorders, whereas all 4 with HBV reactivation and 2 caused by malignancy were died, despite of intensive therapy. Conclusions: In Japan, infections of hepatotropic viruses have sig- nificant impact for the etiologies of ALF. According to the different etiologies, the optimal treatments should be prepared, and ALS is one of useful arms against hepatic encephalopathy in Japan where chronic donor shortage for LT has persisted. Keywords: Acute liver failure, Etiology, Clinical feature Topic: 1 Acute Liver Failure Absno: 35 Adherence to surveillance poor in chronic liver disease presenting as acute on chronic liver failure: single centre experience Rajneesh Kumar, Thinesh Lee Krishnamurthy, Hiang Keat Tan, Hock Foong Lui, Wan Cheng Chow Department of Gastroenterology, Singapore General Hospital, Singapore Introduction: Acute on chronic liver failure is increasingly being recognised as a condition which results in acute deterioration of patients leading to liver transplant or mortality. The causes for this deterioration have been variable and in spite of varied etiology. Early recognition of this condition has resulted in early intervention and GSF has been shown to improve survival in acute on chronic liver failure (ACLF). Prevalence and demographics for such group of patients is not known in Singapore. Aim: This retrospective study in prospective was done to assess the disease burden, know the demographics and the triggering event for ACLF. Method: 1835 discharge summaries of liver related condition was scrutinised to assess of the patients fulfilled the APASL diagnostic criteria for ACLF i.e. Observation: 55 patients were identified who fulfilled the above criteria. Records of 53 patients was available at the time of reporting Mean age of presentation was 55.89 ± 1.46 years with 73.5 % being male 74.5 % were Chinese, 20 % Indians and 1.8 % others. The common cause of underlying chronic liver disease was Hepatitis B in 63.6 % of patients and 23.6 % had alcoholic liver disease. The most common cause of Acute deterioration was spontaneous hepatitis B flare seen in 24.5 % of patients, while Alcoholic hepatitis was seen on 18.9 %. Cirrhosis was seen in 66 % of patients with ACLF. Non adherence to regular follow-up was seen in 69.8 % of patients. All the 123 Hepatol Int (2014) 8:S1–S405 DOI 10.1007/s12072-014-9519-7