Abstract TP124: Irraflow® Device (ventricular Irrigation And Drainage System) Achieves Optimal Clearance Of Intraventricular Hemorrhage (IVH)

Introduction: IVH clearance of more than 80% with intraventricular fibrinolysis administered via a conventional external ventricular drain (EVD) is associated with improvements in outcomes; however, 80% IVH clearance is difficult to achieve. The IRRAflow® device offers fluid irrigation and drainage in a unique system that is designed to provide efficient drainage and clearance of hemorrhage, which may provide advantages over a conventional EVD. The purpose of this study is to evaluate the radiographic findings and outcomes of patients with IVH associated with intracranial hemorrhage (ICH) or subarachnoid hemorrhage (SAH) who received treatment with the IRRAFlow® device from April 1, 2021, to May 1, 2022.

Methods: This was a single center, retrospective review. The primary outcome was change in IVH volume which assessed by modified Graeb Scale (mGS). All endpoints were analyzed using descriptive statistics.

Results: Twelve patients were identified during the study period. Four patients were not included in the analysis due to withdrawal of care (n=2) or severe stroke causing death before completion of treatment (n=2). Of the eight patients included in the study, two had IVH associated with SAH, and six had IVH associated with ICH. Four patients received intrathecal boluses of alteplase, and three patients also had a traditional EVD placed in additional to the ventricular flow device. Seven patients had a pre-treatment mGS greater than or equal to 5, and two patients had a pre-treatment mGS of 4. The mean (+/- SD) pre-treatment mGS was 14 (+/- 8), and post-treatment mGS was 2 (+/- 3). The mean (+/- SD) volume clearance, which was calculated using the mGS, was 92% (+/- 12%). All patients had a modified Rankin scale (mRS) of 4 prior to treatment. Mean (+/- SD) mRS was 3 (+/- 1) at post-discharge follow up. All patients achieved IVH clearance, with third and fourth ventricle clearance, except for one patient who removed the device prior to completion of therapy. None of the patients required ventriculoperitoneal shunt placement or died. One patient developed ventriculitis as a complication.

Conclusion: In conclusion, the IRRAFlow® device was successful in achieving goal IVH clearance (mGS less than 5) in all patients, which has been associated with improved outcomes.

Hypovitaminosis D is associated with increased whole body fat mass and greater severity of non-alcoholic fatty liver disease

BACKGROUND & AIMS

Hypovitaminosis D is common in obesity and insulin-resistant states. Increased fat mass in patients with non-alcoholic fatty liver disease (NAFLD) may contribute to hypovitaminosis D. To determine the relation among plasma vitamin D concentration, severity of disease and body composition in NAFLD.

METHODS

Plasma vitamin D concentration was quantified in 148 consecutive biopsy-proven patients with NAFLD (non-alcoholic steatohepatitis - NASH: n = 81; and hepatic steatosis: n = 67) and healthy controls (n = 39). NAFLD was scored using the NASH CRN criteria. Body composition was quantified by bioelectrical impedance analysis and abdominal CT image analysis.

RESULTS

Plasma vitamin D concentration was significantly lower in NAFLD (21.2 ± 10.4 ng/ml) compared with healthy controls (35.7 ± 6.0 ng/ml). Higher NAFLD activity scores were associated with lower plasma concentration of vitamin D (r(2)  = 0.29; P < 0.001). Subgroup analysis among patients with NAFLD showed that patients with NASH had significantly lower (P < 0.01) vitamin D levels than those with steatosis alone (18.1 ± 8.4 vs. 25.0 ± 11.3 ng/ml). Low concentrations of vitamin D were associated with greater severity of steatosis, hepatocyte ballooning and fibrosis (P < 0.05).On multivariate regression analysis, only severity of hepatocyte ballooning was independently associated (P = 0.02) with low vitamin D concentrations. Plasma vitamin D (P = 0.004) and insulin concentrations (P = 0.03) were independent predictors of the NAFLD activity score on biopsy. Patients with NAFLD had higher fat mass that correlated with low vitamin D (r(2)  = 0.26; P = 0.008).

CONCLUSIONS

Low plasma vitamin D concentration is an independent predictor of the severity of NAFLD. Further prospective studies demonstrating the impact of vitamin D replacement in NAFLD patients are required.