capacity in ACLF patients (study 1) and we characterized the albumin functionality in ACLF patients at baseline compared to healthy controls (study 2). Method: Study 1 was a phase II, open-label, single arm, pilot clinical trial (EudraCT: 2010-021360-15) in 10 patients with ACLF treated with 6 PE-A 5% sessions of 1.1 plasmavolumes for 11 days. Albumin functional capacity was assessed. Study 2 used plasma samples of ACLF patients at baseline from study 1 and age-matched healthy controls (n = 19). Albumin binding capacityof fattyacid and aminoacid derivatives were measured byElectronic ParamagneticResonance and by specific fluorescence with dansylsarcosine, respectively. The albumin Cys34 thiol antioxidant capacity was analyzed by anionic- exchange chromatography and expressed as total amount of the reduced albumin (HMA). Results are expressed as lsmean ± SEM. Results: Study 1: 10 ACLF patients were enrolled (12 screened): age 55.0 ± 9.3 years old. PE-A 5% increased serum albumin concentration (29.5 ± 1.3 to 32.5 ± 1.3 g/l, p < 0.01), albumin binding capacity to fatty acids (Kd: 8.2 ± 1.4 to 3.1 ± 1.5 μM; p < 0.005) and to dansylsarcosine (15.3 ± 1.6 to 18.9 ± 1.7 vs. normalized ABiC/mL; p < 0.005), and antioxidant capacity (9.5 ± 1.5 vs. 14.6 ± 1.6 HMA mg/dl; p < 0.005). Study 2: The albumin function in ACLF patients was significantly lower than in age-matched controls: fatty acids Kd increased 6.8-fold (p < 0.001), binding to dansylsarcosine was 2.1-fold lower (p < 0.001) and antioxidant capacity decreased 2.5-fold (p < 0.001). Conclusion: Albumin binding capacity to fatty acids and aminoacid derivatives as well as albumin antioxidant capacity are markedly decreased in advanced cirrhosis, which may contribute to the pathogenesis of systemic inflammation and ACLF. PE-A 5% improved non-oncotic albumin functions in ACLF patients. THU-261 Hyperkalemia influences the outcome of patients with cirrhosis with acute decompensation (AD) and acute on chronic liver failure (ACLF) G. Mezzano 1 , A. Cardenas 1,2 , F. Aguilar 3 , M. Pavesi 3 , C. Sole 1 , E. Solà 1 , L. Napoleone 1 , I. Graupera 1 , A. Juanola 1 , M. Carol 1 , G. De Prada 1 , N. Fabrellas 1 , J. Martinez 4 , F. Saliba 5 , T. Welzel 6 , V. Arroyo 3 , P. Ginès 7 . 1 Hospital Clinic, Liver Unit, Barcelona, Spain; 2 Institut d’Investigacions Biomediques August Pi i Sunyer yCentro de Investigaciones en Red Hepaticas y Digestivas (CIBERehd), Barcelona, Spain; 3 EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; 4 Hospital Universitario Ramón y Cajal, Department of Gastroenterology and Hepatology, Spain; 5 Hôpital Paul Brousse, Hepatology, Spain; 6 JW Goethe Universität, Hepatology, Germany; 7 Liver Unit, Barcelona, Spain Email: acardena@clinic.cat Background and Aims: Hyperkalemia is considered a risk factor of mortality in different clinical scenarios such as heart failure, chronic kidney disease and diabetes mellitus. The aim of this study was to investigate whether hyperkalemia is a risk factor for mortality in patients with cirrhosis and acute decompensation (AD) with and without ACLF Method: We performed an analysis of the Chronic Liver Failure Consortium CANONIC database in 1,314 consecutive patients admit- ted to 29 European centers with AD both with and without associated ACLF (294 and 1,020 respectively). Hyperkalemia was defined as serum potassium above 5.0 mEq/L. For the analysis, we considered all patients with presence of at least one valid measure of serum potassium from admission through hospitalization. Results: Of the 1314 patients admitted with AD, 294 presented ACLF at admission. Prevalence of hyperkalemia in the whole cohort was 11.7% with a mean serum potassium of 5.47 mEq/L. The prevalence of hyperkalemia was significantly higher in patients with ACLF versus those with AD (22.4% and 8.6% respectively, p < 0.001). Presence of hyperkalemia was associated with an increased 90,180 and 360-day mortality risk with higher hazard ratio (HR) in ACLF than in acute decompensation (10 vs 2.3 at 90-day p<0.001, 8.9 vs 3.1 at 180-day, p < 0.001 and 5.8 vs 3.8 at 360-day, p < 0.001). In a multivariate analysis development of hyperkalemia during admission was independently associated with 90-day mortality [HR 2.4 (1.7–3.4)]. To assess further the prognostic value in the whole cohort, we compared the ROC curves of the MELD score with and without hyperkalemia during admission; this showed an increase of the AUC for MELD score from 0.74 to 0.76 p < 0.001. This MELD-K model resulted in a higher diagnostic accuracy to predict 90-day mortality on the whole cohort. Conclusion: The presence of hyperkalemia is an independent predictive factorof survival in patients with cirrhosis AD and ACLF. The addition of hyperkalemia to the MELD score improves the diagnostic accuracy to predict 90-day mortality in patients with AD and ACLF. THU-262 Impact of organ failure in patients with acute on chronic liver failure (ACLF) and the newly defined AARC liver failure score in predicting 90 days survival-results from APASAL-ACLF research consortium (AARC) A. Pande 1 , A. Choudhury 1 , M. Kumar 1 , S. Rahman 2 , H. Deverbhavi 3 , Z. Duan 4 , D.J. Kim 5 , C. Eapen 6 , Q. Ning 7 , Y. Chawla 8 , W. Jafri 9 , S.-S. Tan 10 , H.L. Ghazinyan 11 , D. Amarapurkar 12 , S. Treeprasertsuk 13 , G.H. Lee 14 , J.H. Hu 15 , L.A. Lesmana 16 , A. Shukla 17 , S. Shah 18 , C. Kalal 18 , M. Sahoo 19 , Z. Abbas 20 , S. Joyes 21 , F. Karim 22 , G. Lau 23 , N.R. Padaki 24 , D. Payawal 25 , A. Kadir Dokmeci 26 , V. Saraswat 27 , M.-F. Yuen 28 , V. Gm 29 , O. Yokosuka 30 , A. Shrestha 31 , I. Paulson 32 , P. Jain 32 , G. Kumar 32 , S.K. Sarin 1 . 1 Institute of liverand Biliary Sciences, Hepatology, New Delhi, India; 2 Bangabandhu Sheikh Mujib Medical university, Dhaka, Bangladesh, Dhaka; 3 St John Medical College, Bangalore, India; 4 Beijing You’an Hospital/Translational Hepatology Institute Capital Medical University, China; 5 Hallym University College of Medicine, South Korea/ Beijing Friendship Hospital, Capital University, Beijing, China; 6 CMC; 7 Tongji Medical College; 8 PGI; 9 Aga Khan University Hospital; 10 Hospital Selayang, Bata Caves, Selangor; 11 Nork Clinical Hospital of Infectious Disease Armenia; 12 Mumbai; 13 Chulalongkorn University, Bangkok; 14 Yong Loo Lin School of Medicine, National University of Singapore; 15 302 Millitary Hospital Beijing, China; 16 Medistra Hospital, Jakarta, Indonesia; 17 KEM Hospital and Seth GSMC; 18 Global Hospital, Mumbai, India; 19 IMS &SUM hospital, Odisa; 20 Ziauddin University Hospital, Karachi; 21 University of Santo Tomas, Manila, Philippines; 22 Sir Salimullah Medical College, Mitford Hospital Bangladesh; 23 Humanity and Health Medical Group, China; 24 Asian Institute of Gastroenterology Hyderabad, India; 25 Cardinal Santos Medical Center10 Wilson St. Greenhills West San Juan City, Metro Manila; 26 Ankara University School of Medicine; 27 Sanjay Gandhi Postgraduate Institute, Gastroenterology, Lucknow, India; 28 Queen Mary Hospital Hong Kong, China; 29 VGM Hospital; 30 Chiba University Japan; 31 Foundation Nepal Sitapaila Height, Kathmandu; 32 ILBS Email: pandeap@gmail.com POSTER PRESENTATIONS S244 Journal of Hepatology 2018 vol. 68 | S105–S364