Use Of Lactulose Research Articles

Obtainment, quantification and use of lactulose as a functional food – a review

Abstract Whey (milk serum) is produced by the dairy industry during the manufacture of cheese. In addition to being a valuable source of functional and nutritional proteins, whey also presents almost all the lactose from the original whole milk. However, many industries still consider the whey as an effluent, which can cause serious environmental problems when not properly treated. Therefore, it is important to develop alternatives for the adequate use of whey. The lactose obtained from whey permeate can be converted into lactulose, a prebiotic which may be metabolized in the intestine by probiotic bacteria, such as Lactobacillus sp. and Bifidobacterium sp., through enzymatic isomerization or by using alkaline catalysts, with minimal secondary reactions and high yield. This manuscript provides information about various techniques used to produce lactulose, its purification and analysis, as well as its mechanisms of action and alternative applications in food products and medicines.

Predictive Models of Mortality and Readmission of Patients With Decompensated Liver Cirrhosis

Introduction: Chronic liver disease is one of the major causes of admission and is associated with high morbidity and mortality rates as well as with social and economic charges. The aim of this study was to evaluate the causes for admission, readmission rates, survival and predictive factors of early hospital readmission and mortality. Methods: A retrospective study of patients admitted to our institution between 2008 and 2014 with decompensated chronic liver disease. Results: We enrolled 427 admissions from 176 patients with chronic liver disease, 138 male (78,4%), with mean age of 59 ±12,3 years. According to the Child Turcotte Pugh classification, 8% patients were classified as Child A, 40% as Child B and 52% Child C. The major etiologies of chronic liver disease were alcohol (77,3%) and virus (23,3%). The median days of admission was 9,0 [6,0-14,0] and the main causes of admission were hepatic encephalopathy (33,5%) and variceal bleeding (26,5%). One hundred and twenty-two patients had an infectious complication, being spontaneous bacterial peritonitis the most common one (39%). During the follow-up period, there were 215 readmissions, with a median time of 58 [26,75-133,75] days for readmission, and 31,2% occurring within the 30 days after discharge. In the multivariate analysis, leukocyte count, INR, total bilirubin, CLIF-AD score and portal thrombosis were independently associated and with statistical significance with 30-day survival. Creatinine, albumin, variceal bleeding, use of lactulose, use of rifaximin, variceal banding and use of proton pump inhibitors were independently associated with the need of readmission. Based on regression analysis, two models were calculated to predict 30-day survival, with AUROC 0.862 (0.785-0.938), p. Conclusion: The readmission rate of patients with chronic liver disease is very high. Two models were created to predict 30-day survival (AUROC 0.862) and need of readmission (AUROC 0.821) that could guide the management of the patients at the time of admission.

Hyperglycemia in critical patients: Determinants of insulin dose choice.

To identify factors that can determine the choice of intermittent subcutaneous regular insulin dose in critically ill patients with hyperglycemia. Cross-sectional study in a general adult ICU with 26 beds, data collected between September and October 2014. The variables analyzed were: sex, age, previous diagnosis of diabetes mellitus, use of corticosteroids, use of lactulose, sepsis, fasting, enteral nutrition, use of dextrose 5% in water, NPH insulin prescription and blood glucose level. Patients with one or more episodes of hyperglycemia (blood glucose greater than 180 mg/dL) were included as a convenience sample, not consecutively. Those with continuous insulin prescription were excluded from analysis. We included 64 records of hyperglycemia observed in 22 patients who had at least one episode of hyperglycemia. The median administered subcutaneous regular human insulin was 6 IU and among the factors evaluated only blood glucose levels were associated with the choice of insulin dose administered. Clinical characteristics such as diet, medications and diagnosis of diabetes mellitus are clearly ignored in the decision-making regarding insulin dose to be administered for glucose control in critically ill patients with hyperglycemia.

Which treatment is best for hepatic encephalopathy due to end-stage liver disease?

EVIDENCE-BASED ANSWER Rifaximin is as effective as other antibiotics or oral disaccharides for improving hepatic encephalopathy with a better safety profile (SOR: A, meta-analysis of RCTs). Combination therapy of rifaximin and lactulose is more effective for reversal of hepatic encephalopathy with less mortality than lactulose alone (SOR: B, RCT). Prophylactic use of rifaximin plus lactulose reduces hospitalizations for hepatic encephalopathy more than lactulose alone (SOR: B, RCT).

Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts

To compare age-related morbidity and mortality after transjugular intrahepatic portosystemic shunts (TIPS). We performed a retrospective chart review of patients who underwent TIPS at the University of California Los Angeles Medical Center between 2008 to 2014. Elderly patients (65 y and older) were matched with nonelderly patients (controls, below 65 y) by model for end-stage liver disease (MELD) score (±3), indication for TIPS (refractory ascites vs. variceal bleeding), serum sodium level (±5), in a ratio of 1:1. Endpoints measures were hospital stay post-TIPS, rifaximin, or lactulose use, TIPS failure at 30 days, readmission at 90 days, MELD at 90 days, and mortality at 90 days. A total of 30 patient matches were included in this study: 30 control and 30 elderly patients. The median [interquartile (IQR)] MELD scores for controls and elderly were 11 (9, 13.8) for the controls and 11.5 (9, 14.8) for elderly patients (P=0.139). There were no significant differences in serum sodium and indication for TIPS. Thirty and 90-day follow-up laboratory test results were also similar between elderly and control patients. Event-free survival at 90 days was similar between controls and elderly patients [odds ratio (OR), 0.86; 95% confidence interval (CI), 0.3-2.5; P>0.05]. There was a trend toward greater hospitalization (OR, 1.76; 95% CI, 0.52-5.95; P=0.546) and mortality (OR, 3.3; 95% CI, 0.3-14.01; P=0.182). The results of this study suggest event-free survival is similar between nonelderly and elderly patients. Although statistically significant, there is a tendency toward greater mortality and hospitalization in the elderly.

Poor reproducibility of breath hydrogen testing: Implications for its application in functional bowel disorders.

Limited data are available regarding the reproducibility of lactulose and fructose breath testing for clinical application in functional bowel disorders. The purpose of this study was to investigate the reproducibility of lactulose and fructose breath hydrogen testing and assess symptom response to fructose testing. Results were analysed from 21 patients with functional bowel disorder with lactulose breath tests and 30 with fructose breath tests who completed another test >2 weeks later. Oro-caecal transit time, hydrogen responses, both qualitatively (positive/negative) and quantitatively (area under the curve (AUC) for hydrogen), were compared between tests. In another 36 patients, data scores for overall abdominal symptoms, abdominal pain, bloating, wind, nausea and fatigue were collected during the fructose test and compared to hydrogen responses. No correlations were found for lactulose AUC (linear regression, p = 0.58) or transit time (Spearman's p = 0.54) between tests. A significant proportion (30%) lost the presence of fructose malabsorption (p < 0.01). Hydrogen AUC for fructose did not correlate between tests, (r = 0.28, p = 0.17) independent of time between testing (p = 0.82). Whilst patients with fructose malabsorption were more likely to report symptoms than those without (56% vs 17%; p = 0.04), changes in symptom severity were not different (p > 0.05). Routine use of lactulose and fructose breath tests in functional bowel disorder patients is not supported due to its poor reproducibility and low predictive value for symptom responses.

Lactulose: a prebiotic, laxative and detoxifying agent

Lactulose (a non-digestible disaccharide) has been in medical use for >50 years and is commonly used in the treatment of constipation and hepatic encephalopathy. Depending on the dosage, oral lactulose is effective as a prebiotic, an osmotic laxative or a detoxifying agent. Lactulose also decreases levels of various deleterious elements, especially nitrogen products in patients with chronic kidney disease. According to recent studies, lactulose is also effective in treating post-partum constipation and is safe to use during pregnancy. Because of its various benefits in multiple disorders, the use of lactulose is not limited to only constipation and hepatic encephalopathy.

Gastrointestinal Motility Disorders and Their Clinical Implications in Cirrhosis.

Gastrointestinal motility is impaired in a substantial proportion of patients with cirrhosis. Cirrhosis-related autonomic neuropathy, increased nitric oxide production, and gut hormonal changes have been implicated. Oesophageal dysmotility has been associated with increased frequency of abnormal gastro-oesophageal reflux. Impaired gastric emptying and accommodation may result in early satiety and may have an impact on the nutritional status of these patients. Small intestinal dysmotility might be implicated in small intestinal bacterial overgrowth and increased bacterial translocation. The latter has been implicated in the pathophysiology of hepatic encephalopathy and spontaneous bacterial peritonitis. Enhanced colonic motility is usually associated with the use of lactulose. Pharmacological interventions aiming to alter gastrointestinal motility in cirrhosis could potentially have a beneficial effect reducing the risk of hepatic decompensation and improving prognosis.

Quality of Life as an Integrative Indicator of Health Status in Patients with Chronic Hepatitis C and Concomitant Diabetes Mellitus Type II

The main indicators of quality of life in patients with chronic hepatitis C with concomitant diabetes mellitus type II were studied on the basis of SF-36. A sharp decrease in physical and mental health was observed in patients with combined comorbidity in comparison with the group of patients without concomitant diabetes mellitus type II. Improvement of the patients’ quality of life by all parameters was detected under the influence of alpha-lipoic acid and lactulose use in addition to antiviral therapy.

Impact of a Multi-Disciplinary Approach in Disease Management of Hepatic Encephalopathy in Patients with Decompensated Cirrhosis

Introduction: Hepatic encephalopathy is a life threatening and costly complication of liver cirrhosis that can result in recurrent hospitalizations. The combined use of lactulose and rifaximin for acute hepatic encephalopathy has been shown to be more efficacious in inducing remission, preventing breakthrough episodes of encephalopathy and reducing readmission rates than use of lactulose alone. Our aim was to measure our 30-day readmissions in patients treated for hepatic encephalopathy and to measure the rate of linkage to liver clinic and to determine appropriate medications on discharge. Methods: We conducted a retrospective chart review from 2 large medical centers from 2012-2014. The primary outcome measure was 30-day readmission rates (admission for decompensated cirrhosis within 30 days of discharge). Secondary outcomes included length of stay, linkage to liver clinic, and appropriate medications on discharge. Results: Our study included 243 subjects (115 at BGMC and 128 at ECMC), predominantly Caucasian males with cirrhosis. The majority (74.2%) did not have co-morbid conditions of CHF or COPD. The mean MELD score was 20.2 ± 7.9. The overall 30-day readmission rate was 16% (n = 39; 10 from BGMC and 29 from ECMC). The overall mean length of stay was 13.4 ± 22.3 days. Overall linkage to liver clinic was 10.2% (n = 25) with no significant difference between site. Upon discharge, 26.2% (n = 64) of patients were prescribed lactulose + rifaximin. Conclusion: Our observed 30-day readmission rate was lower than previous estimates of 30 - 40% and this could be related to several hospital systems within the community and the inability to capture admissions at other sites. Our findings demonstrate low rates of linkage to care and of optimal medical management of patients with hepatic encephalopathy upon discharge. Further efforts such as developing a standardized EMR order set are underway.Table 1: Outcome Measures

Ensifer alkalisoli sp. nov. isolated from root nodules of Sesbania cannabina grown in saline–alkaline soils

A group of Sesbania cannabina rhizobia belonging to four recA genotypes of a novel group was further characterized in comparison with the related Ensifer species. They showed 98.2 to 99.9 % similarities among themselves and 92.9 to 93.3 % similarities with the most related strain Ensifer sojae CCBAU 05684T in multilocus sequence analysis of recA, atpD and glnII. The genome average nucleotide identity values between representative strain YIC4027T and the type strains of its closely related species were 81.6 to 88.9 %. Identical symbiotic gene (nodA, nodC and nifH) sequences highly similar with those in other Sesbania-nodulating strains (Rhizobium sp. SIN-1, Neorhizobium huautlense S02T, Ensifer saheli ORS609T and Rhizobium sp. IRBG74) were detected. The representative strain YIC4027T could form effective nodules on its original host Sesbaniacannabina, but not on Sophora flavescens, Trifolium repens, Glycine max, Glycyrrhiza uralensis, Phaseolus vulgaris or Medicago sativa. The use of lactulose as sole carbon source, possession of C13 : 0 2-OH, C13 : 1 at 12-13, C15 : 1 iso ω9c, C17 : 0 anteiso and C18 : 0 iso and absence of C14 : 0 anteiso, C15 : 0 anteiso and C18 : 0 3-OH in fatty acids distinguished the strain YIC4027T from the type strains of its closely related species. Based on all the analyses mentioned above, we propose a novel species Ensifer alkalisoli sp. nov. and designate YIC4027T (=HAMBI 3655T=LMG 29286T) as the type strain. The genome size of YIC4027T is 5.97 Mbp, comprising 5588 predicted genes, and the DNA G+C content is 62.2 mol%.

Lactulose reduces bacterial DNA translocation, which worsens neurocognitive shape in cirrhotic patients with minimal hepatic encephalopathy.

Minimal hepatic encephalopathy is associated with poor prognosis and mortality in patients with cirrhosis. We aimed at investigating whether bacterial-DNA translocation affects hyperammonaemia and neurocognitive scores in patients with mHE according to the use of lactulose. Observational study including 72 mHE cirrhotic patients, as defined by a psychometric hepatic encephalopathy score (PHES)<-4 and/or a critical flicker frequency (CFF)<39Hz. Bacterial-DNA, serum ammonia, pro-inflammatory cytokines and nitric oxide levels were evaluated. A second cohort of 40 lactulose-untreated patients were evaluated before and 6-month after lactulose administration (30-60mL/d). In the first cohort, bacterial-DNA rate was significantly higher in patients without lactulose (39% vs 23%, P=.03). Serum ammonia and inflammatory markers were significantly increased in patients with bacterial-DNA, regardless the use of lactulose, and correlated with the amount of amplified bacterial-DNA. Neurocognitive scores were significantly worse in bacterial-DNA positive vs negative patients (PHES -7.6±1.1 vs -5.5±1.0; CFF 32.5±2.6 vs 36.2±2.8, P=.01). Lactulose was associated with improved neurocognitive scores in patients without bacterial-DNA. Serum ammonia levels inversely correlated with neurocognitive scores in patients with bacterial-DNA (PHES r=-.84; CFF r=-.72, P=.001). In the second cohort, lactulose reduced bacterial-DNA translocation (36%-16%, P=.02). Neurocognitive scores were significantly improved in bacterial-DNA positive patients who cleared bacterial-DNA during the period on lactulose. Serum ammonia levels correlated with both neurocognitive scores in patients with bacterial-DNA, either before or after lactulose. Bacterial-DNA translocation worsens neurocognitive scores in mHE patients and it is reduced by lactulose, enhancing the relevance of controlling bacterial antigen translocation in these patients.

Epilepsy as a risk factor for hepatic encephalopathy in patients with cirrhosis: a cohort study.

BackgroundEpilepsy is associated with an increased mortality among cirrhosis patients, but the reasons are unknown. We aimed to determine whether epilepsy is a risk factor for developing hepatic encephalopathy (HE), which is a strong predictor of mortality.MethodsWe used data from three randomized 1-year trials of satavaptan in cirrhosis patients with ascites. With Cox regression, we compared the hazard rates of HE grade 1–4 between those cirrhosis patients who did or did not have epilepsy. We adjusted for confounding by gender, age, cirrhosis etiology, diabetes, history of HE, Model for Endstage Liver Disease (MELD) score, serum sodium, albumin, lactulose use, rifaximin use, and benzodiazepine/barbiturate sedation. In a supplementary analysis we examined the association between epilepsy and the hazard rate of HE grade 2–4.ResultsOf the 1120 cirrhosis patients with ascites, 21 (1.9 %) were diagnosed with epilepsy. These patients had better liver function at inclusion than the patients without epilepsy (median MELD score 7.9 vs. 11.4), and only one died during the trials. Nevertheless, seven patients with epilepsy had an HE episode during the follow-up, and the adjusted hazard ratio of HE grade 1–4 for patients with epilepsy vs. controls was 2.12 (95 % CI 0.99–4.55). The corresponding hazard ratio of HE grade 2–4 was 3.83 (95 % CI 1.65–8.87).ConclusionsOur findings suggest that epilepsy is associated with an increased risk of HE in patients with cirrhosis.

RIFAXAMIN VS LACTULOSE

Objectives: To compare Rifaxamin and Lactulose in improving the gradesof hepatic encephalopathy in patients with decompensated liver disease. Study design:Randomized controlled trial comparing the use of rifaxamin and Lactulose. Place and durationof study: 1st July 2014 to 30th June 2015 in Department of Medicine, Aziz Bhatti ShaheedTeaching Hospital Gujarat. Results: 1st July 2014 to 30th June 2015 in medical departmentof Aziz Bhatti Shaheed Teaching Hospital Gujarat. Results: 400 cases were divided in twoequal groups: Group A took Rifaximin &amp; Group B Lactulose. Improvement in grades of hepaticencephalopathy were calculated on weekly bases. Monitoring was done by checking bloodammonia levels, number connection tests, flapping tremors and mental status. 40 patients(10%) did not stay in ward for one week. In ninety percent etiology of decompensated liverdisease was hepatitis C virus. Improvement was noted in 76.96% (n=137) in Group-A and72.52% (n=132) in Group-B, p value was found insignificant (&gt;0.05). Conclusions: Rifaximinand lactulose had similar efficacy in the treatment of mild to moderate hepatic encephalopathy.

English

Objectives: To compare Rifaxamin and Lactulose in improving the gradesof hepatic encephalopathy in patients with decompensated liver disease. Study design:Randomized controlled trial comparing the use of rifaxamin and Lactulose. Place and durationof study: 1st July 2014 to 30th June 2015 in Department of Medicine, Aziz Bhatti ShaheedTeaching Hospital Gujarat. Results: 1st July 2014 to 30th June 2015 in medical departmentof Aziz Bhatti Shaheed Teaching Hospital Gujarat. Results: 400 cases were divided in twoequal groups: Group A took Rifaximin &amp; Group B Lactulose. Improvement in grades of hepaticencephalopathy were calculated on weekly bases. Monitoring was done by checking bloodammonia levels, number connection tests, flapping tremors and mental status. 40 patients(10%) did not stay in ward for one week. In ninety percent etiology of decompensated liverdisease was hepatitis C virus. Improvement was noted in 76.96% (n=137) in Group-A and72.52% (n=132) in Group-B, p value was found insignificant (&gt;0.05). Conclusions: Rifaximinand lactulose had similar efficacy in the treatment of mild to moderate hepatic encephalopathy.

Implications and benefits of the use of rifaximin for preventing episodes of hepatic encephalopathy

108 British Journal of Healthcare Management 2016 Vol 22 No 3 © 2 01 6 M A H ea lth ca re L td Encephalopathy has a wide manifestation of signs and symptoms, from non-specific personality changes to unresponsiveness and coma. Recurrences are frequent after an overt episode of encephalopathy, with a 40% recurrence rate within 6 months. In the USA, encephalopathy is the main reason for 110,000 hospitalizations annually (Stepanova et al, 2009), while there are no such figures available in the UK. The most widely used treatment for encephalopathy is lactulose, which is a laxative in liquid form. The efficacy of lactulose, however, is not universal, and many patients develop recurrent episodes of encephalopathy requiring hospitalisation on this drug. Moreover, increasing doses to control encephalopathy symptoms are associated with diarrhoea. Therefore, the treatment of patients with recurrent hepatic encephalopathy despite the use of lactulose remains an unmet clinical need. A randomised, double-blind, placebo-controlled trial has shown that rifaximin significantly reduces the episodes of recurrent encephalopathy in adult patients with two or more previous episodes of overt encephalopathy in the last 6 months as compared with placebo (Bass et al, 2010). Rifaximin, although effective, is costly with the estimated cost of a 6-month treatment being £1689.65. Recently, the National Institute for Health and Care Excellence (NICE) (2015) technology appraisal guidance TA337 addressed the use of rifaximin for preventing episodes of overt hepatic encephalopathy in patients with cirrhosis. The guidance followed 4 evidence submissions by the manufacturing company, each of which provided alternative modeling for costEmmanuel A Tsochatzis, Senior Clinical Lecturer and Honorary Consultant, UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, UK Implications and benefits of the use of rifaximin for preventing episodes of hepatic encephalopathy

Treatment of Chronic Functional Constipation during Pregnancy and Lactation

Natural fibres (bulk-forming agents), docusate sodium (stool-softener), mineral oils (lubricant laxatives), macrogol (polyethylene glycol, PEG), sugars and sugar alcohols (osmotic laxatives) and anthraquinones and diphenolic laxatives (stimulant laxatives) seem to be safe medicaments regarding teratogenicity and lactation. The US Food and Drug Administration (FDA) risk categories for these substances taken during pregnancy and lactation are often the result of the lack of studies than of evidence-based information. So risk categories do not help in the decision-making for the right laxative. Alternative solutions such as proposals of the American College of Gastroenterology's Committee on FDA related matters, (ACG-FDA) and the Motherisk Programme try to improve decision-making. For newer compounds such as chloride-channel-activators and procinetics no data regarding safe use in pregnancy and during breast-feeding are available as yet. We suggest the use of macrogol and lactulose as the first-line therapy in treating chronic constipation during pregnancy. Macrogol shows some advantages, such as faster onset of bowel action and fewer flatulences. If this treatment does not work or starts but then stops working, we recommend in the second and third trimenon a second-line treatment with diphenolic laxatives such as bisacodyl and and sodium picosulfate. During pregnancy the decision on the application of these laxatives is largely determined by the side-effects of tenesmus associated with preterm births. During lactation we recommend macrogol (preferable to lactulose due to the lack of data), lactulose, bisacodyl and sodium picosulfate, according to the nature of the conditions.

Diabetes as a risk factor for hepatic encephalopathy in cirrhosis patients

It remains unclear whether diabetes increases the risk for hepatic encephalopathy (HE) in cirrhotic patients. We examined this question using data from three randomized trials of satavaptan, a vasopressin receptor antagonist that does not affect HE risk, in cirrhotic patients with ascites. The trials included 1198 patients, and we excluded those with HE before or at randomization and followed the remaining patients for the one year duration of the trials. They were examined for HE regularly, and we compared rates of first-time overt HE between diabetics and non-diabetic patients using Cox regression, adjusting for gender, age, ascites severity, cirrhosis etiology, Child-Pugh class, creatinine, bilirubin, INR, sodium, potassium, albumin, platelets, lactulose use, benzodiazepine/barbiturate use, spironolactone dose, furosemide dose, potassium-sparing diuretic dose, and CirCom comorbidity score. We included 862 patients of whom 193 (22%) had diabetes. In total, they experienced 115 first-time episodes of overt HE during the follow-up. Fewer diabetics than non-diabetic patients were in Child-Pugh class C at baseline (13% vs. 23%), yet they had higher cumulative risk of first-time overt HE (26.0% vs. 15.8% after 1 year), and their episodes of first-time overt HE were more likely to progress beyond grade 2 (64% vs. 42% of episodes progressed to grade 3 or 4, p=0.01 for independence between diabetes and highest HE grade). After the confounder adjustment, the hazard ratio of first-time overt HE for diabetics vs. non-diabetic patients was 1.86 (95% CI 1.20-2.87). Diabetes increased the risk of first-time overt HE among cirrhotic patients with ascites.

576 Relationship Between Hospital Facility Characteristics and End-Stage Liver Disease Readmission Rates in California

infection on/during admission while 70% remained infection-free. During index hospitalization,77 died or went to hospice & 20 were transplanted. Therefore, 481 pts (age 56 yrs, 53% men,37% HCV) were available for analysis. Three month outcomes of these 481; 77% were alive without transplant, 11% were transplanted while 12% died. Readmissions: 50% of patients were readmitted at least once within 3 months; 56% had 1 readmission, 28% had 2, and 16% had ≥3 readmissions. Readmission rates were similar between those admitted with/without an infection (51% vs 50%,p=0.8) during the index hospitalization. Most readmissions were infection related (40%) followed by liver-related complications (17% anasarca, 11% GI bleed, 9% TIPS, 7% AKI, 5% HE) & 11% others. Two regression models were created; Model using index hospitalization day of admission values: A high MELD score (OR 1.1, p=0.001), lactulose use (corollary for HE; OR 1.6, p=0.05) & male gender (OR 1.6, p=0.05) predicted readmission while high serum albumin was protective (OR 0.57, p= 0.004). Infection as the reason for index admission, diabetes or admission WBC count did not impact 3-month readmissions. Model using index hospitalization discharge values: The only predictors of 3-month readmissions on discharge were MELD score (OR 1.1, p=0.002) and SBP prophylaxis use (OR 1.95, p=0.05). Nosocomial infections, diabetes, infections on admission and other medications were not significantly predictive. Conclusions: Readmissions occurred in 50% of hospitalized cirrhotics within 3 months of hospital discharge in this prospective multi-center study regardless of infections as their cause for index hospitalization. Without intervention, admitted cirrhotics are likely to require readmission, most commonly for infection related complications. Strategies to prevent hospital readmissions are urgently needed, especially in higher MELD patients with encephalopathy who have lower serum albumin and are on SBP prophylaxis.

P0121 : Angiotensin II inhibition to treat severe liver fibrosis: A double-blind randomized trial (ANRS HC19)

lactulose use (corollary for HE, OR 1.6, p = 0.05) and male gender (OR 1.6, p = 0.05) predicted readmission while high serum albumin was protective (OR 0.57, p = 0.004). Infection as the index admission reason, diabetes or WBC were not predictive. Using index hospitalization discharge values: The only predictors of 3-month readmissions on discharge were MELD (OR 1.1, p = 0.002) and SBP prophylaxis (OR 1.95, p = 0.05). Nosocomial infections, diabetes, infections on admission and other medications were not predictive. Conclusions: Readmissions occurred in 50% of hospitalized cirrhotics within 3 months of discharge, regardless of infections being the reason for the index admission, in this prospective multi-center study. Without intervention, these pateints likely be readmitted, most commonly for infections. Strategies to prevent readmissions are urgently needed, especially in higher MELD patients with HE and lower serum albumin who are on SBP prophylaxis.