P68 Low-density lipoprotein can predict hospital readmissions and outcomes following acute decompensation of cirrhosis

<h3>Background and Aims</h3> In liver cirrhosis, serum lipid and lipoprotein levels are altered due to pathological changes in synthesis, secretion and catabolism. Whilst most research has focussed on the role of high-density lipoprotein (HDL), relatively little attention has been given to the predictive capacity of low-density lipoprotein (LDL). We aim to explore the role of serial LDL measurements in predicting liver-related events following acute decompensation (AD). <h3>Method</h3> 232 patients from the PREDICT cohort were included in this study. This was a European, multicentre, prospective, observational study recruiting patients admitted non-electively with an episode of AD cirrhosis. Blood tests including lipids were performed at baseline and day 7. Patients were followed up for 3 months to obtain clinical outcome data. <h3>Results</h3> There was no difference in baseline LDL and HDL levels when comparing patients treated with statins versus those who were not, although only 17 (7%) of patients were prescribed statins. During the 3-month follow-up period, 32 (14%) patients developed acute-on-chronic liver failure (ACLF), 62 patients (27%) had re-admissions and 13 patients (6%) died. HDL measurements and LDL/HDL ratios were not associated with outcomes. In contrast, when comparing patients who were subsequently re-admitted versus those who were not, day 7 LDL results were significantly lower (55.0 vs 78.6 mg/dL, p=0.003). Indeed, day 7 LDL remained an independent predictor of subsequent readmissions in both univariable and multivariable analyses (OR 0.984 [95% CI 0.972–0.995], p=0.01). With regards to ACLF development, a marked difference was noted in the delta change between baseline and day 7 LDL in those who developed ACLF versus those who did not (-7.7 vs 3.8 mg/dL, p=0.05). Finally, with respect to 90-day transplant-free mortality, when comparing those who died versus those who survived, there was a trend towards lower day 7 LDL levels (42.5 vs 75.8 mg/dL, p=0.06) as well as decreased LDL between baseline and day 7 (-12.3 vs 3.9mg/dL, p=0.08). <h3>Conclusion</h3> This study demonstrates novel findings that decreased LDL independent of statin treatment can predict readmissions and provide a potential signal for other liver-related events, including mortality, though this needs further validation. Given its biological relevance, ease of measurement, and low cost, LDL may be an ideal biomarker for predicting outcomes in patients with decompensated cirrhosis.