Abstracts 21 st Annual Conference of Indian National Association for the Study of Liver (INASL), March 22–24, 2013 Hyderabad International Convention Centre, Hyderabad, India ACUTE ON CHRONIC LIVER FAILURE [ACLF] UTILITY OF LIVER AND SPLEEN STIFFNESS MEASUREMENT USING FIBROSCAN IN DIFFERENTIATING ACUTE SEVERE VIRAL HEPATITIS AND ACUTE ON CHRONIC LIVER FAILURE AT ADMISSION Praveen Sharma, Pankaj Tyagi, Naresh Bansal, Vikas Singla, Ashish Kumar, Rouf Ahmed, Anil Arora Sir Ganga Ram Hospital, New Delhi, India Introduction: Liver stiffness (LS) and spleen stiffness (SS) measurement using FibroScan is accepted as a highly reproducible and accurate technique for assessment of fibrosis. Often it is difficult to differentiate severe AVH from patients with acute on chronic liver failure (ACLF) at admission. We aimed to determine utility of LS and SS measurement in differentiating patients from severe AVH and ACLF at admission. Methods: A total of 57 patients with severe AVH (serum bilirubin>5 and INR>1.5) and ACLF as per APASL guidelines of varying aetiologies were recruited prospec- tively. LS and SS and biochemical tests were performed at diagnosis. Results: The mean age of the patients (48 men and 11 women) was 41.7Æ16.4 years. The aetiology of acute hepa- titis (n=29) included (HAV, n=8, HEV, n=10, drug induced, n= 3, HBV, n= 3 and unknown, n= 5).Similarly etiology of ACLF were HBV with severe reactivation, n=10, alcoholic with alcoholic hepatitis, n=14, acute viral hepatitis on cryp- togenic cirrhosis, n=4. There was no significant difference at baseline between AVH versus ACLF in age (39.0Æ12.5 vs. 41.0Æ14.8 yrs, P =0.7),body mass index (24.2Æ2.6 vs. 26.3Æ5.8 kg/m2, P =0.07) hemoglobulin (13.0Æ1.4 vs 12.0Æ2.2 gm%, P =0.06), platelet count (188Æ72 vs 164Æ76, P =0.22), serum bilirubin(12Æ7.5 vs 16Æ8.7 mg/ dl, P =0.07) and INR (1.8Æ0.4 s 1.0Æ0.5).However there was significant difference in AVH versus ACLF in median AST (226,145-3721 vs 123,63-1132 IU/L, P =0.01) and ALT(447,128-6349 vs 143,44-1133 IU/L, P =0.01). Mean LS (147.4Æ21 vs 14Æ6 kPa, P =0.01) and SS (46Æ18.2 vs 23Æ6.7 kPa, P =0.01) were significant more in ACLF com- pared to AVH. Taking a cutoff for LS as 22.1kPa sensitivity and specificity for diagnosing ACLF was 84% and 92% respectively and for SS cutoff of 28kPa had sensitivity and specificity of 76% and 80% respectively. Conclusion: Baseline liver and spleen stiffness measure- ment by fibroscan can differentiate severe acute viral hepa- titis from acute on chronic liver failure. Corresponding author: Praveen Sharma. E-mail: drpraveen_sharma@yahoo.com ACUTE-ON-CHRONIC LIVER FAILURE–DOES ETIOLOGY REALLY MATTER? Ankur Jindal, Chitranshu Vashishta, Manoj Kumar Sharma, Shiv Kumar Sarin Institute of Liver and Biliary Sciences, New Delhi, India Background and objectives: Viral reactivation, super-in- fection with hepatotropic viruses or superadded alcohol/ drug related liver toxicity may lead to acute hepatic insult in patients with chronic liver disease; described as ‘acute- on-chronic liver failure’ (ACLF) and connotes poor clinical outcome without liver transplantation. Do ACLF patients with varying etiology present differently and whether it influences disease outcome is not known. Methods: Patients with ACLF (APASL criteria) were classi- fied into etiological groups; Group 1 [Alcoholic cirrhosis with alcoholic hepatitis (ALD-AH)], Group 2 [Reactivation of hepatitis B (RHB)] and Group 3 [Super-infections with hepatitis E, A or D (SH)]. Patients with other etiology, hepatocellular carcinoma, portal vein thrombosis or sepsis were excluded. These selected groups were compared in terms of baseline demographic, clinical and laboratory parameters. The difference in one month mortality and se- verity scores was also determined. Results: Of the 251 patients admitted with ACLF, 193 fulfilled the selection criteria [Group 1 (ALD-AH; n=85, 33.8%), Group 2 (RHB; n=57,22.7%), Group 3 (SH; n=51,20.3%)]. Patients with ALD-AH were younger at ad- mission (41.60 Æ 6.76 years; P -0.001) and all were male. Other clinical parameters, Child Pugh (CTP) score and MELD scores were similar. ACLF due to ALD-AH was asso- ciated with lower haemoglobin (9.16 Æ 2.03 g/L; P -0.001), high INR (2.69 Æ 1.82; P-0.006) and high total leucocyte count (17.97 Æ 10.91 per mm3, P -0.001) at admission. © 2013, INASL Journal of Clinical and Experimental Hepatology | March 2013 | Vol. 3 | No. 1S | S18–S20 Acute on Chronic Liver Failure JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY