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Most patients had normal biochemical liver profiles, with
mean values for bilirubin 18.2 ± 10.6umol/L, ALT 26.5 ±
10.6IU/L, albumin 47.5 ± 5.3g/L and platelets 169 ±55 x10
9
,
despite hepatic imaging of parenchymal abnormalities. Two
patients were found to have hepatocellular carcinomas (HCC),
BCLC stage B and C at diagnosis. There was a total of 4
deaths over a median follow-up of 2.8 years, of which 2
deaths were liver-related.
Conclusions Elevated hepatic stiffness and ultrasound appear-
ance in keeping with severe fibrosis are common in adult Fon-
tan patients, despite normal liver enzymes and synthetic
function. FNH is the most common abnormality on imaging
in high risk patients. The incidence of HCC justifies surveil-
lance in this group of patients, however the optimal surveil-
lance protocol remains to be established.
PTU-038 END OF LIFE CARE PLANNING IN PATIENTS WITH END-
STAGE LIVER DISEASE: CLINICAL PRACTICE REMAINS
VARIABLE
1
Dana Walshaw*,
1
Rumneek Hampal,
1
Sreelakshmi Kotha,
2
Maggie Kennedy,
2
Irene Carey,
1
Philip Berry.
1
Department of Gastroenterology, Guy’s and St Thomas’NHS Foundation
Trust, London, UK;
2
Department of Palliative Care, Guy’s and St Thomas’NHS Foundation
Trust, London, UK
10.1136/gutjnl-2019-BSGAbstracts.247
Introduction End-stage liver disease (ESLD) is a terminal diag-
nosis without transplantation, and anticipatory discussions
regarding end of life (EoL) care are appropriate when poor
prognostic factors are present.
Aim To assess the point at which decisions regarding resuscita-
tion and EoL care were made with patients who died of
ESLD and to analyse factors associated with delayed
discussion.
Methods We identified inpatients with proven ESLD under the
care of a hepatology team over a 24 month period (Jan
2017-Dec 2018) who died during or shortly after their last
admission. Data was collected relating to clinical course, prog-
nostic indicators, EoL care planning considerations, dates of
DNACPR decision, palliative care referral and interval to
death.
Results 19 patients were identified (12 male: 7 female); mean
age at death was 61. 11/19 patients had alcoholic liver disease
(ALD), 5 had ALD/Hepatitis C. 12 patients died on the ward,
3 in ICU, 2 at home and 2 at a nursing home. Child-Pugh
Scores (CPS) ranged from B-6 to C-13 and average MELD
score was 23 (range 8–38). None were eligible for transplanta-
tion: 12 due to active alcohol use, 3 due to co-morbidities, 1
malignancy, 2 unknown. Median number of admissions in the
year preceding death was 2 (range 0–5). Predominant symp-
toms prior to death were respiratory distress, confusion and
pain. Average interval between admission and death was 24
days. 13/19 patients were referred for inpatient palliative care
input. Although all patients had a DNACPR notice in place,
the average DNACPR-to-death interval was just 20 days (range
0–139 days). EoL decisions were made ‘early’(DNACPR-to-
death time >21 days) in patients (n=6) who had gradual dis-
ease evolution and/or a long period of contact with the serv-
ice. In those with ‘short’DNACPR-to-death times (n=13), 9
had been hospitalised 2 or more times in the year prior to
death (this being a known marker of poor prognosis), and 2
had been admitted 4 or 5 times. 5/19 patients had a docu-
mented Amber Care Bundle referral (prognostic uncertainty
tool). 14 patients had a documented ceiling of care discussion;
of these 12 were for ward-based care only and 2 were for
Level 3 escalation.
Conclusions Patients with end stage liver disease continue to
be engaged in EoL and treatment escalation discussions rela-
tively late, despite clear indicators of poor prognosis (includ-
ing recurrent admissions and non-transplantable status) within
the previous year. Those well known to specialist teams who
deteriorate gradually have a greater chance of expressing their
preferences. Increased awareness of poor prognostic features is
required in the secondary care setting.
PTU-039 THE COST-EFFECTIVENESS OF HEPATITIS B AND C
TESTING IN EMERGENCY DEPARTMENTS IN THE UK
1,2
Jack Williams,
2,3
Peter Vickerman,
4
Sam Douthwaite,
4
Gaia Nebbia,
5
Laura Hunter,
6
Terry Wong*,
7
Murad Ruf,
1,2
Alec Miners.
1
Department of Health Service Research and
Policy, London School of Hygiene and Tropical Medicine, London, UK;
2
The National
Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne
and Sexually Transmitted Infections, University College London, UK;
3
Population Health
Sciences, Bristol Medical School, University of Bristol, Bristol, UK;
4
Department of Infection,
Guy’s and St Thomas’NHS Trust, London, UK;
5
Emergency Department, Guy’sandSt
Thomas’NHS Trust, London, UK;
6
Department of HIV/GU Medicine, Guy’s and St Thomas’
NHS Trust, London, UK;
7
Gilead Sciences Medical Department, London, UK
10.1136/gutjnl-2019-BSGAbstracts.248
Introduction The prevalence of blood borne viruses is higher
in emergency department (ED) attendees compared to the gen-
eral population, due to higher attendance of marginalised pop-
ulations. Studies have found prevalence up to 2% and 3% for
hepatitis B (HBV) and hepatitis C (HCV) in EDs in England.
HIV testing in EDs in the UK is recommended in high preva-
lence areas (0.2%), but there is no defined threshold for
hepatitis testing.
Methods A Markov model was developed to analyse the
impact of opt-out hepatitis C (HCV) and hepatitis B (HBV)
testing in EDs in the UK. The model used data from studies
of ED testing in the UK to parameterise test costs and inter-
vention effects (contact rates and linkage to care). For HCV
we used an antibody test cost of £3.64 and RNA test cost of
£68.38, and assumed a direct acting antiviral (DAA) treatment
cost of £10,000. For HBV, we used a HBsAg test cost of
£3.51. We considered what prevalence of HCV (RNA-positive)
and HBV (HBsAg) would be required to make ED testing
Abstract PTU-039 Figure 1
Abstracts
GUT 2019;68(Suppl 2):A1–A269 A131