Future work will seek factor(s) in AH serum that impair mOB and examine how NAC restores mOB and reduces susceptibility to infection in vivo. Disclosures: Debbie Shawcross – Advisory Committees or Review Panels: Norgine; Grant/ Research Support: Norgine; Speaking and Teaching: Norgine Mark R. Thursz – Advisory Committees or Review Panels: Gilead, BMS, Abbott Laboratories The following people have nothing to disclose: Nikhil Vergis, Wafa Khamri, Jennifer M. Ryan, Yun Ma, Charalambos G. Antoniades Study purpose. Current guidelines see more consider a liver biopsy optional to diagnose severe alcoholic steatohepatitis

(ASH) and based on clinical criteria (i.e. Maddrey-score / MDF >32) patients are initiated on corticosteroids (CS). However, in patients with acute decompensation of alcoholic cirrhosis, this diagnosis may be challenging since it clinically resembles acute-on-chronic liver failure (ACLF). We recently identified ductular bilirubinostasis (DB), a histological marker of endotoxemia, as an early risk factor for ACLF. Methods. Prospective trial of 114 patients with alcoholic cirrhosis and suspicion of severe ASH (i.e. MDF >32) who underwent a transjugular liver biopsy within 3 days after admission. Literature-reported clinical, biochemical and histological parameters

Sorafenib nmr indicative of severe ASH and/or ACLF were assessed and correlated to the risk of death and the response to CS using logistic regression and survival

analysis. Results. In 76/114 patients (67%) the diagnosis of severe ASH was confirmed: 42/76 (55%) had severe ASH without and 34/76 (45%) with DB. 26/114 (23%) had DB without severe ASH. Clinical characteristics and outcome are given in table 1. DB was predictive for evolution to ACLF (and associated with infection and multi-organ failure). Multivariate analysis revealed DB as the main independent early variable predicting 6-month-mortality (O.R. 13.5; P<0.001). Patients without DB had the highest 6-month survival, irrespective of the presence of severe ASH (67% vs. 24%; P<0.0001). While patients with severe ASH without DB had a good response medchemexpress to CS, survival increased most significantly after CS in the subset of patients displaying both histological features of severe ASH and DB (median survival 81 vs. 38 days vs. untreated counterparts; P<0.05). Conclusions. * One third of patients suspected with severe ASH were misdiagnosed without histology. * DB on early liver biopsy predicts evolution to ACLF and is associated with poor outcome. * Patients with both severe ASH and DB benefited most from CS treatment. EASL-CLIF criteria. Data as mean±SEM. Disclosures: Frederik Nevens – Consulting: CAF, Intercept, Gore, BMS, Abbvie, Novartis, MSD, Eumedica, Janssen; Grant/Research Support: Ipsen, Roche, MSD, Astellas The following people have nothing to disclose: Len D.