1
|
Jafree SR, Naveed A, Ahsan H, Burhan SK, Khan MA, Khawar A, Fischer F. Mental health and quality of life in patients with chronic liver disease: a single-center structural equation model. BMC Gastroenterol 2024; 24:193. [PMID: 38840079 PMCID: PMC11155103 DOI: 10.1186/s12876-024-03268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 05/15/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Chronic liver disease (CLD) is one of the leading disease burdens in Pakistan. Until now, there has only been limited focus in the country on providing health services through tertiary services in urban cities, whereas there is almost no research in Pakistan on the mental health and quality of life of CLD patients. This study aimed to understand which predictors influence the mental health and quality of life of CLD patients in order to advise better policy protection. METHODS Data was collected from CLD patients at the Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan. A total of 850 respondents were part of the final sample. The age of respondents ranged from 18 to 79 years and included the following diagnosis: (i) Chronic Viral Hepatitis (n = 271), (ii) Cirrhosis (n = 259), (iii) Hepatocellular Carcinoma (n = 193), and (iv) Non-viral Liver Disease (n = 127). RESULTS Mean results reveal that females as well as illiterate patients need more support for mental health and communication with their physician; whereas men need more support to develop coping strategies. Structural equation modelling results reveal that the severity of symptoms (β = 0.24, p < 0.001), coping strategies (β=-0.51, p < 0.001), and doctor communication (β=-0.35, p < 0.001) predict mental health. Quality of life is associated with the severity of symptoms (β=-0.36, p < 0.001), coping strategies (β = 0.26, p < 0.05), and doctor communication (β = 0.09, p < 0.05). CONCLUSIONS A 'bio-psycho-social-spiritual' model is recommended for Pakistan's CLD patients which includes the integration of social officers to provide support in four key areas to secure mental health and quality of life of patients.
Collapse
Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College University, Lahore, Pakistan
| | - Ammara Naveed
- Pakistan Kidney Liver Institute and Research Centre, Lahore, Pakistan
| | - Humna Ahsan
- Department of Economics, Forman Christian College University, Lahore, Pakistan
| | | | - Masha Asad Khan
- Academic Dean of Humanities and Social Sciences, Kinnaird College for Women, Lahore, Pakistan
| | - Amna Khawar
- Department of Psychology, Lahore College of Women University, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
2
|
Naftaly JP, Feldman ECH, Greenley RN. Perceived Stigma in Patients with Autoimmune Hepatitis. J Clin Psychol Med Settings 2024; 31:455-464. [PMID: 38127091 DOI: 10.1007/s10880-023-09983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Perceived stigma (PS) adversely impacts psychosocial and disease outcomes in patients with chronic liver diseases (CLD), and those with autoimmune hepatitis (AIH) may be at risk for PS given inaccurate assumptions about the origin of their diagnosis. The aims of the current study are to describe the frequency of PS in patients with AIH, compare rates of PS in AIH to rates of PS in primary biliary cholangitis (PBC) and CLD, and examine demographic correlates of PS. 262 adults with AIH (95% female, Mage = 51.53 years) completed online questionnaires on demographics, disease information, and PS. 54-68% reported PS with themes of selective disclosure, non-disclosure, or hiding diagnosis. PS was higher in those with AIH compared to those with PBC, but lower than those with various CLD. Age was inversely related to PS. Given the results, provider screening of PS and integration of clinical health psychologists may be helpful for identifying PS in patients with AIH.
Collapse
Affiliation(s)
- Jessica P Naftaly
- Department of Internal Medicine-Gastroenterology, Michigan Medicine, University of Michigan, 1500 E. Medical Center Drive, Floor 3, Reception D, Ann Arbor, MI, 48109, USA.
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA.
| | - Estée C H Feldman
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Rachel N Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA
| |
Collapse
|
3
|
Shetty A, Saab EG, Choi G. Social Impact of Hepatic Encephalopathy. Clin Liver Dis 2024; 28:273-285. [PMID: 38548439 DOI: 10.1016/j.cld.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Hepatic encephalopathy is a medical condition that stems from liver dysfunction, leading to the accumulation of toxins in the bloodstream. This can result in cognitive impairments, mood changes, and motor dysfunction. Its social impact includes challenges in employment, relationships, and daily functioning for affected individuals. Stigma and misunderstanding around the condition can further exacerbate the difficulties faced by both patients and their caregivers. Efforts to raise awareness, improve medical management, and provide support systems can help mitigate the social impact of hepatic encephalopathy.
Collapse
Affiliation(s)
- Akshay Shetty
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Elena G Saab
- School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Gina Choi
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
4
|
Donlan J, Zeng C, Indriolo T, Li L, Zhu E, Zhou J, Pintro K, Horick N, Edelen M, Chung RT, El-Jawahri A, Ufere NN. The Edmonton Symptom Assessment System is a valid, reliable, and responsive tool to assess symptom burden in decompensated cirrhosis. Hepatol Commun 2024; 8:e0385. [PMID: 38497942 PMCID: PMC10948137 DOI: 10.1097/hc9.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND While there is a growing need for interventions addressing symptom burden in patients with decompensated cirrhosis (DC), the lack of validated symptom assessment tools is a critical barrier. We investigated the psychometric properties of the revised Edmonton Symptom Assessment System (ESAS-r) in a longitudinal cohort of patients with DC. METHODS Adult outpatients with DC were prospectively recruited from a liver transplant center and completed ESAS-r at baseline and week 12. We examined reliability, floor/ceiling effects, structural validity, and known-groups validity. We examined the convergent and predictive validity of ESAS-r with health-related quality of life using the Short Form Liver Disease Quality of Life (SF-LDQOL) and responsiveness to changes in anxiety and depression using the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 from baseline to week 12. RESULTS From August 2018 to September 2022, 218 patients (9% Child-Pugh A, 59% Child-Pugh B, and 32% Child-Pugh C) were prospectively recruited and completed the ESAS-r, SF-LDQOL, Patient Health Questionnaire-9, and Hospital Anxiety and Depression Scale at baseline and week 12 (n = 135). ESAS-r had strong reliability (Cronbach's alpha 0.86), structural validity (comparative fit index 0.95), known-groups validity (Child-Pugh A: 25.1 vs. B: 37.5 vs. C: 41.4, p = 0.006), and convergent validity (r = -0.67 with SF-LDQOL). Floor effects were 9% and ceiling effects were 0.5%. Changes in ESAS-r scores from baseline to week 12 significantly predicted changes in SF-LDQOL (β = -0.36, p < 0.001), accounting for 30% of the variation. ESAS-r was strongly responsive to clinically meaningful changes in SF-LDQOL, Patient Health Questionnaire-9, and Hospital Anxiety and Depression Scale. CONCLUSIONS ESAS-r is a reliable, valid, and responsive tool for assessing symptom burden in patients with DC and can predict changes in health-related quality of life. Future directions include its implementation as a key outcome measure in cirrhosis care and clinical trials.
Collapse
Affiliation(s)
- John Donlan
- Harvard Medical School, Boston, Massachusetts, USA
| | - Chengbo Zeng
- Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Teresa Indriolo
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucinda Li
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Enya Zhu
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joyce Zhou
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kedie Pintro
- MGH Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nora Horick
- MGH Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Edelen
- Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Raymond T. Chung
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nneka N. Ufere
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Park JY, Kim MS, Ryu JM. Predictors of sleep quality components in patients undergoing transarterial chemoembolisation: a cross-sectional study. Support Care Cancer 2024; 32:149. [PMID: 38329591 DOI: 10.1007/s00520-024-08338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Patients undergoing transarterial chemoembolisation experience postembolisation symptoms and interferences affecting sleep quality, which require intervention. The study aimed to identify the predictors of sleep quality components in patients undergoing transarterial chemoembolisation. METHODS This study included two groups of participants: 50 patients undergoing transarterial chemoembolisation and 45 nurses caring for them. Data were collected from September to November 2022 using a structured questionnaire, and analysed using descriptive statistics, the t-test, analysis of variance, Spearman's rank correlation, and multiple regression analysis using the SPSS 27.0 program (IBM Corp., Armonk, NY, USA). RESULTS The mean sleep quality score was 40.28±14.10. Heat sensation (t=-2.08, p=.043) and fatigue (t=-4.47, p<.001) predicted sleep fragmentation in 38.6% of the patients. Abdominal pain (t=-2.54, p=.014), vomiting (t=-2.21, p=.032), and the expected fatigue by the nurses (t=2.68, p=.014) predicted sleep length in 41.7% of patients. Abdominal pain (t=-2.05, p=.046) explained 42.9% of sleep depth. CONCLUSION Based on the predictors of sleep quality components obtained in this study, strategies to improve sleep quality tailored to patients undergoing transarterial chemoembolisation should be developed. This study highlighted the need to bridge the gap between patients' and nurses' expected fatigue and its contribution to sleep fragmentation and sleep length. It also highlighted the importance of noncontact temperature measurement, controlling vomiting, and pain relief for improving sleep length in patients undergoing transarterial chemoembolisation.
Collapse
Affiliation(s)
- Ji Young Park
- Gastrointestinal Surgery Ward, Pusan National University Hospital, Busan, South Korea
| | - Myoung Soo Kim
- Department of Nursing, Pukyong National University, 599-1, Daeyeon 3 dong, Namgu, Busan, 48513, South Korea.
| | - Jung Mi Ryu
- Department of Nursing, Busan Institute of Science and Technology, Busan, South Korea
| |
Collapse
|
6
|
Luk JW, Satre DD, Cheung R, Wong RJ, Monto A, Chen JY, Batki SL, Ostacher MJ, Snyder HR, Shui AM, Liao M, Haight CG, Khalili M. Problematic alcohol use and its impact on liver disease quality of life in a multicenter study of patients with cirrhosis. Hepatol Commun 2024; 8:e0379. [PMID: 38315141 PMCID: PMC10843394 DOI: 10.1097/hc9.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Management of cirrhosis is challenging and has been complicated by the COVID-19 pandemic due to decreased access to care, increased psychological distress, and alcohol misuse. Recently, The National Institute on Alcohol Abuse and Alcoholism has broadened the definition of recovery from alcohol use disorder to include quality of life (QoL) as an indicator of recovery. This study examined the associations of alcohol-associated cirrhosis etiology and problematic drinking with liver disease QoL (LDQoL). METHODS Patients with cirrhosis (N=329) were recruited from 3 sites (63% from 2 Veterans Affairs Health Care Systems and 37% from 1 safety net hospital) serving populations that are economically or socially marginalized. Cirrhosis etiology was ascertained by chart review of medical records. Problematic drinking was defined by ≥8 on the Alcohol Use Disorders Identification Test. Multivariable general linear modeling adjusting for age, sex, race/ethnicity, site, pandemic-related stress, and history of anxiety/depressive disorder were conducted. Sensitivity analyses further adjusted for indicators of liver disease severity. RESULTS Participants were on average 64.6 years old, 17% female, 58% non-White, 44% with alcohol-associated cirrhosis, and 17% with problematic drinking. Problematic drinking was significantly associated with worse LDQoL scores in the overall scale and in the memory/concentration and health distress subscales. These associations remained significant after adjusting for indicators of liver disease severity, including Model for End-Stage Liver Disease-Sodium score and decompensated cirrhosis status. CONCLUSIONS Among patients with cirrhosis, problematic drinking was associated with worse LDQoL, especially in the domains of memory/concentration and health distress. Assessment and awareness of cognitive deficits and negative emotionality within the context of cirrhosis and problematic drinking may help clinicians provide better integrated care for this population.
Collapse
Affiliation(s)
- Jeremy W. Luk
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, USA
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA
| | - Ramsey Cheung
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Robert J. Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Alexander Monto
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer Y. Chen
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Liver Center, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, California, USA
| | - Steven L. Batki
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Mental Health Service, Veterans Affairs San Francisco Health Care System, San Francisco, California, USA
| | - Michael J. Ostacher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Department of Psychiatry, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Hannah R. Snyder
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Meimei Liao
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Christina G. Haight
- Division of Gastroenterology and Hepatology, Veterans Affairs San Francisco Health Care System, San Francisco, California, USA
| | - Mandana Khalili
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Liver Center, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Gastroenterology and Hepatology, Zuckerberg San Francisco General, San Francisco, California, USA
| |
Collapse
|
7
|
Mohamed ZU, Varghese CT, Sudhakar A, Kumar L, Gopalakrishnan U, Balakrishnan D, Narayanamenon R, Sudhindran S. Prostaglandins for adult liver transplanted recipients. Cochrane Database Syst Rev 2023; 8:CD006006. [PMID: 37540003 PMCID: PMC10401650 DOI: 10.1002/14651858.cd006006.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Prostaglandins are naturally occurring lipids that are synthesised from arachidonic acid. Multiple studies have evaluated the benefits of prostaglandins in reducing ischaemia reperfusion injury after liver transplantation. New studies have been published since the previous review, and hence it was important to update the evidence for this intervention. OBJECTIVES To evaluate the benefits and harms of prostaglandins in adults undergoing liver transplantation compared with placebo or standard care. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 27 December 2022. SELECTION CRITERIA We included randomised clinical trials evaluating prostaglandins initiated in the perioperative period compared with placebo or standard care for adults undergoing liver transplantation. We included trials irrespective of reported outcomes. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. all-cause mortality, 2. serious adverse events, and 3. health-related quality of life. Our secondary outcomes were 4. liver retransplantation, 5. early allograft dysfunction, 6. primary non-function of the allograft, 7. acute kidney failure, 8. length of hospital stay, and 9. adverse events considered non-serious. We used GRADE to assess certainty of evidence. MAIN RESULTS We included 11 randomised clinical trials with 771 adult liver transplant recipients (mean age 47.31 years, male 61.48%), of whom 378 people were randomised to receive prostaglandins and 393 people were randomised to either placebo (272 participants) or standard care (121 participants). All trials were published between 1993 and 2016. Ten trials were conducted in high- and upper-middle-income countries. Prostaglandins may reduce all-cause mortality up to one month (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.61 to 1.23; risk difference (RD) 21 fewer per 1000, 95% CI 63 fewer to 36 more; 11 trials, 771 participants; low-certainty evidence). Prostaglandins may result in little to no difference in serious adverse events (RR 0.92, 95% CI 0.60 to 1.40; RD 81 fewer per 1000, 95% CI 148 fewer to 18 more; 6 trials, 568 participants; low-certainty evidence). None of the included trials reported health-related quality of life. Prostaglandins may result in little to no difference in liver retransplantation (RR 0.98, 95% CI 0.49 to 1.96; RD 1 fewer per 1000, 95% CI 33 fewer to 62 more; 6 trials, 468 participants; low-certainty evidence); early allograft dysfunction (RR 0.62, 95% CI 0.33 to 1.18; RD 137 fewer per 1000, 95% CI 241 fewer to 47 more; 1 trial, 99 participants; low-certainty evidence); primary non-function of the allograft (RR 0.58, 95% CI 0.26 to 1.32; RD 23 fewer per 1000, 95% CI 40 fewer to 16 more; 7 trials, 624 participants; low-certainty evidence); and length of hospital stay (mean difference (MD) -1.15 days, 95% CI -5.44 to 3.14; 4 trials, 369 participants; low-certainty evidence). Prostaglandins may result in a large reduction in the development of acute kidney failure requiring dialysis (RR 0.42, 95% CI 0.24 to 0.73; RD 100 fewer per 1000, 95% CI 132 fewer to 49 fewer; 5 trials, 477 participants; low-certainty evidence). The evidence is very uncertain about the effect of prostaglandins on adverse events considered non-serious (RR 1.19, 95% CI 0.42 to 3.36; RD 225 fewer per 1000, 95% CI 294 fewer to 65 fewer; 4 trials, 329 participants; very low-certainty evidence). Two trials reported receiving funding; one of these was with vested interests. We found one registered ongoing trial. AUTHORS' CONCLUSIONS Eleven trials evaluated prostaglandins in adult liver transplanted recipients. Based on low-certainty evidence, prostaglandins may reduce all-cause mortality up to one month; may cause little to no difference in serious adverse events, liver retransplantation, early allograft dysfunction, primary non-function of the allograft, and length of hospital stay; and may have a large reduction in the development of acute kidney injury requiring dialysis. We do not know the effect of prostaglandins on adverse events considered non-serious. We lack adequately powered, high-quality trials evaluating the effects of prostaglandins for people undergoing liver transplantation.
Collapse
Affiliation(s)
- Zubair Umer Mohamed
- Department of Anaesthesia and Intensive Care, Amrita Institute of Medical Sciences, Kochi, India
- Department of Critical Care, King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia
| | - Christi Titus Varghese
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi, India
| | - Abish Sudhakar
- Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Lakshmi Kumar
- Department of Anaesthesia and Intensive Care, Amrita Institute of Medical Sciences, Kochi, India
| | - Unnikrishnan Gopalakrishnan
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi, India
| | - Dinesh Balakrishnan
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi, India
| | - Ramachandran Narayanamenon
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi, India
| | - Surendran Sudhindran
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences, Kochi, India
| |
Collapse
|
8
|
van Dijk AM, Bruins Slot AS, Portincasa P, Siegerink SN, Chargi N, Verstraete CJR, de Bruijne J, Vleggaar FP, van Erpecum KJ. Systematic review with meta-analysis: Branched-chain amino acid supplementation in liver disease. Eur J Clin Invest 2023; 53:e13909. [PMID: 36394355 DOI: 10.1111/eci.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dietary supplementation with branched-chain amino acids (BCAA) is often used in cirrhotic patients to improve nutritional status. We wanted to explore the evidence for BCAA supplementation in chronic liver disease. METHODS We searched MEDLINE and EMBASE for studies with BCAA supplementation with the presence of a disease-control group (placebo or no intervention) using search terms 'liver cirrhosis', 'hepatocellular carcinoma', 'branched chain amino acids' and relevant synonyms. Risk of bias was assessed using ROBINS-I and RoB 2.0 tools. Meta-analyses were performed with a random-effects model. Results were reported following EQUATOR guidelines. RESULTS Of 3378 studies screened by title and abstract, 54 were included (34 randomized controlled trials, 5 prospective case-control studies, 13 retrospective case-control studies: in total 2308 patients BCAA supplementation, 2876 disease-controls). Risk of bias was high/serious for almost all studies. According to meta-analyses, long-term (at least 6 months) BCAA supplementation in cirrhotic patients significantly improved event-free survival (p = .008; RR .61 95% CI .42-.88) and tended to improve overall survival (p = .05; RR .58 95% CI .34-1.00). Two retrospective studies suggested the beneficial effects during sorafenib for hepatocellular carcinoma. Available studies reported no beneficial effects or contradictory results of BCAA after other specific therapeutic interventions (resection or radiological interventions for hepatocellular carcinoma, liver transplantation, paracentesis or variceal ligation). No convincing beneficial effects of BCAA supplementation on liver function, nutritional status or quality of life were found. No study reported serious side effects of BCAA. CONCLUSIONS Prophylactic BCAA supplementation appears safe and might improve survival in cirrhotic patients.
Collapse
Affiliation(s)
- Anne M van Dijk
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexandra S Bruins Slot
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Sebastiaan N Siegerink
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Najiba Chargi
- Department of Head and Neck Surgical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carina J R Verstraete
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joep de Bruijne
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank P Vleggaar
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Karel J van Erpecum
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
9
|
Fabes J, Ambler G, Shah B, Williams NR, Martin D, Davidson BR, Spiro M. Protocol for a prospective double-blind, randomised, placebo-controlled feasibility trial of octreotide infusion during liver transplantation. BMJ Open 2021; 11:e055864. [PMID: 34857585 PMCID: PMC8640665 DOI: 10.1136/bmjopen-2021-055864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Liver transplantation is a complex operation that can provide significant improvements in quality of life and survival to the recipients. However, serious complications are common and include major haemorrhage, hypotension and renal failure. Blood transfusion and the development of acute kidney injury lead to both short-term and long-term poor patient outcomes, including an increased risk of death, graft failure, length of stay and reduced quality of life. Octreotide may reduce the incidence of renal dysfunction, perioperative haemorrhage and enhance intraoperative blood pressure. However, octreotide does have risks, including resistant bradycardia, hyperglycaemia and hypoglycaemia and QT prolongation. Hence, a randomised controlled trial of octreotide during liver transplantation is needed to determine the cost-efficacy and safety of its use; this study represents a feasibility study prior to this trial. METHODS AND ANALYSIS We describe a multicentre, double-blind, randomised, placebo-controlled feasibility study of continuous infusion of octreotide during liver transplantation surgery. We will recruit 30 adult patients at two liver transplant centres. A blinded infusion during surgery will be administered in a 2:1 ratio of octreotide:placebo. The primary outcomes will determine the feasibility of this study design. These include the recruitment ratio, correct administration of blinded study intervention, adverse event rates, patient and clinician enrolment refusal and completion of data collection. Secondary outcome measures of efficacy and safety will help shape future trials by assessing potential primary outcome measures and monitoring safety end points. No formal statistical tests are planned. This manuscript represents study protocol number 1.3, dated 2 June 2021. ETHICS AND DISSEMINATION This study has received Research Ethics Committee approval. The main study outcomes will be submitted to an open-access journal. TRIAL SPONSOR The Joint Research Office, University College London, UK.Neither the sponsor nor the funder have any role in study design, collection, management, analysis and interpretation of data, writing of the study report or the decision to submit the report for publication. TRIAL REGISTRATION The study is registered with ClinicalTrials.gov (NCT04941911) with recruitment due to start in August 2021 with anticipated completion in July 2022. CLINICAL TRIALS UNIT Surgical and Interventional Group, Division of Surgery & Interventional Science, University College London.
Collapse
Affiliation(s)
- Jeremy Fabes
- Peninsula Medical School, University of Plymouth, Plymouth, Devon, UK
- Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Bina Shah
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Norman R Williams
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Daniel Martin
- Peninsula Medical School, University of Plymouth, Plymouth, Devon, UK
| | - Brian R Davidson
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Michael Spiro
- Division of Surgery & Interventional Science, University College London, London, UK
| |
Collapse
|
10
|
Patel AA, Woodrell C, Ufere NN, Hansen L, Tandon P, Verma M, Lai J, Pinotti R, Rakoski M. Developing Priorities for Palliative Care Research in Advanced Liver Disease: A Multidisciplinary Approach. Hepatol Commun 2021; 5:1469-1480. [PMID: 34510839 PMCID: PMC8435283 DOI: 10.1002/hep4.1743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/28/2021] [Accepted: 04/19/2021] [Indexed: 02/04/2023] Open
Abstract
Individuals with advanced liver disease (AdvLD), such as decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC), have significant palliative needs. However, little research is available to guide health care providers on how to improve key domains related to palliative care (PC). We sought to identify priority areas for future research in PC by performing a comprehensive literature review and conducting iterative expert panel discussions. We conducted a literature review using search terms related to AdvLD and key PC domains. Individual reviews of these domains were performed, followed by iterative discussions by a panel consisting of experts from multiple disciplines, including hepatology, specialty PC, and nursing. Based on these discussions, priority areas for research were identified. We identified critical gaps in the available research related to PC and AdvLD. We developed and shared five key priority questions incorporating domains related to PC. Conclusion: Future research endeavors focused on improving PC in AdvLD should consider addressing the five key priorities areas identified from literature reviews and expert panel discussions.
Collapse
Affiliation(s)
- Arpan A. Patel
- Vatche and Tamar Manoukian Division of Digestive DiseasesDepartment of MedicineDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCAUSA
- Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
| | - Christopher Woodrell
- Brookdale Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- James J. Peters Veterans Affairs Medical CenterBronxNYUSA
| | - Nneka N. Ufere
- Gastrointestinal UnitDepartment of MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Lissi Hansen
- School of NursingOregon Health Sciences UniversityPortlandORUSA
| | - Puneeta Tandon
- Department of MedicineCirrhosis Care ClinicEdmontonALCanada
- Liver Transplant UnitUniversity of AlbertaEdmontonALCanada
| | - Manisha Verma
- Department of Digestive Diseases and TransplantationEinstein Healthcare NetworkPhiladelphiaPAUSA
| | - Jennifer Lai
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy LibraryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Mina Rakoski
- Division of Gastroenterology and HepatologyLoma Linda University HealthLoma LindaCAUSA
| | | |
Collapse
|
11
|
Tandon P, Walling A, Patton H, Taddei T. AGA Clinical Practice Update on Palliative Care Management in Cirrhosis: Expert Review. Clin Gastroenterol Hepatol 2021; 19:646-656.e3. [PMID: 33221550 DOI: 10.1016/j.cgh.2020.11.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/07/2020] [Accepted: 11/14/2020] [Indexed: 02/07/2023]
Abstract
Care with palliative care principles (aka Palliative Care, PC) is an approach to care that focuses on improving the quality of life of patients and their caregivers who are facing life-limiting illness. It encompasses the assessment and management of symptoms and changes in functional status, the provision of advance care planning and goals of care discussions, prognostication and caregiver support. PC is applicable across the spectrum of cirrhosis regardless of transplant eligibility. Although a common misconception, PC is not synonymous with hospice care. Unfortunately, despite a high symptom burden and challenges with predicting disease course and mounting evidence to support the benefits of PC in patients with cirrhosis, comprehensive PC and referral to hospice are carried out infrequently and very late in the course of disease. In order to meet the needs of our increasingly prevalent cirrhosis population, it is important that all clinicians who care for these patients are able to work together to deliver PC as a standard of care. To date there are limited guidelines/guidance statements to direct clinicians in the area of PC and cirrhosis. Herein we present an evidence-based review of ten Best Practice Advice statements that address key issues pertaining to PC in patients with cirrhosis.
Collapse
Affiliation(s)
- Puneeta Tandon
- Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
| | - Anne Walling
- VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California
| | - Heather Patton
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California
| | - Tamar Taddei
- VA Connecticut Healthcare System, West Haven, and Department of Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
12
|
McSweeney L, Breckons M, Fattakhova G, Oluboyede Y, Vale L, Ternent L, Balp MM, Doward L, Brass CA, Beyer F, Sanyal A, Anstee QM. Health-related quality of life and patient-reported outcome measures in NASH-related cirrhosis. JHEP Rep 2020; 2:100099. [PMID: 32435754 PMCID: PMC7229498 DOI: 10.1016/j.jhepr.2020.100099] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/04/2020] [Accepted: 02/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is known to have a negative impact on patients' health-related quality of life (HRQoL), even before progression to cirrhosis has occurred. The burden of NASH-related cirrhosis from the patient perspective remains poorly understood. Herein, we aimed to identify the burden of disease and HRQoL impairment among patients with NASH-related compensated cirrhosis. METHODS This targeted literature review sought first to identify the humanistic burden of disease from the perspective of patients with diagnosed NASH-cirrhosis and, secondly, to identify generic or disease-specific patient-reported outcome measures (PROMs) used to assess the impact of NASH-cirrhosis. Searches were conducted in bibliographical databases, grey or unpublished literature, liver disease websites, support group websites and online blogs. A quality assessment of specific PROMs was conducted. RESULTS Patients with NASH-cirrhosis are reported to suffer from lower HRQoL than patients with non-cirrhotic NASH and the general population with respect to physical health/functioning, emotional health and worry, and mental health. Thirteen PROMs were identified, of which 4 were liver-disease specific: CLDQ, CLDQ-NAFLD, LDQoL and LDSI. The most commonly used measures do not comply with current industry or regulatory standards for PROMs and/or are not validated for use in a cirrhotic NASH population. CONCLUSIONS Patients with NASH-cirrhosis have lower HRQoL and poorer physical health than patients with non-cirrhotic NASH. However, the literature lacked detail of the everyday impact on patients' lives. Currently, a number of PROMs are available to measure the impact of the disease in patients with chronic liver conditions. The lack of studies that include qualitative insights in this population mandates further exploration and research. LAY SUMMARY It is not well understood how having non-alcoholic fatty liver disease (NAFLD)-related cirrhosis affects a person's everyday wellbeing and quality of life. Some research has been done with patients who have early stages of liver disease but not people with cirrhosis. We found that patients with NAFLD-related cirrhosis tended to have poorer health than patients without cirrhosis. But there was not very much information from patients themselves and there were no tools or questionnaires just for this group of patients.
Collapse
Key Words
- CLDQ, chronic liver disease questionnaire
- COSMIN, The COnsensus-based Standards for the selection of health Measurement INstruments
- Cirrhosis
- EMA, European Medicines Agency
- FDA, United States Food and Drug Administration
- FIS, fatigue impact scale
- HRQoL, health-related quality of life
- LDQoL, liver disease quality of life questionnaire
- LDSI, liver disease symptom index
- MS, multiple sclerosis
- NAFL, non-alcoholic fatty liver
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- Non-alcoholic steatohepatitis
- PHAQ, patient-reported outcome measurement information system health assessment questionnaire
- PRO, patient-reported outcome
- PROM, patient-reported outcome measure
- QoL, quality of life
- RI, researcher interpretation
- SF-36, short form health profile 36
- health-related quality of life
- liver
- patient-reported outcome measures
Collapse
Affiliation(s)
- Lorraine McSweeney
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew Breckons
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Gulnar Fattakhova
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Ternent
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lynda Doward
- RTI-Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, UK
| | | | - Fiona Beyer
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, United States
| | - Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| |
Collapse
|
13
|
KASL clinical practice guidelines for liver cirrhosis: Varices, hepatic encephalopathy, and related complications. Clin Mol Hepatol 2020; 26:83-127. [PMID: 31918536 PMCID: PMC7160350 DOI: 10.3350/cmh.2019.0010n] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 02/06/2023] Open
|
14
|
Stine JG, Stukenborg GJ, Wang J, Adkins A, Niccum B, Zimmet A, Argo CK. Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing. Ann Hepatol 2020; 19:62-68. [PMID: 31558420 PMCID: PMC7252261 DOI: 10.1016/j.aohep.2019.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/28/2019] [Accepted: 06/21/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Liver transplantation candidates are among the most comorbid patients awaiting lifesaving intervention. Health related quality of life (HRQOL) measured by instruments that incorporate dynamic computerized adaptive testing, could improve their assessment. We aimed to determine the feasibility of administration of the Patient-Reported Outcomes Measurement Information System (PROMIS-CAT) in liver transplant candidates. MATERIALS AND METHODS Liver transplantation candidates were prospectively enrolled following a review of their available medical history. Subjects were given a tablet computer (iPad) to access the pre-loaded PROMIS CAT. RESULTS 109 candidates with mean age 55.6±8.6 years were enrolled in this pilot study. Mean MELD-Na score was 16.3±6.3; 92.6% had decompensated liver disease. Leading etiologies of cirrhosis included hepatitis C (34.8%), nonalcoholic steatohepatitis (25.7%) and alcohol (21.1%). Subjects with MELD-Na score>20 had the most significant impairment in HRQOL (anxiety/fear+5.9±2.7, p=0.0289, depression+5.1±2.5, p=0.0428, fatigue+4.3±2.6, p=0.0973) and physical impairment (-7.8±2.5, p=0.0022). Stage of cirrhosis and decompensated liver disease were predictive of impaired HRQOL but Child-Pugh Turcotte score was not. Hepatic encephalopathy was the strongest independent predictor of impaired HRQOL, with significant impairment across all domains of health. CONCLUSIONS Liver transplant candidates have significantly impaired HRQOL across multiple domains of health as measured by PROMIS-CAT. HRQOL impairment parallels disease severity. Future study is needed to determine how best HRQOL could be systematically included in liver transplantation listing policy, especially in those candidates with hepatic encephalopathy.
Collapse
Affiliation(s)
- Jonathan G. Stine
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Virginia, Charlottesville, VA, USA,Corresponding author at: Assistant Professor of Medicine and Public Health Sciences, Liver Center Research Director, The Pennsylvania State University-Milton S. Hershey Medical Center, Division of Gastroenterology and Hepatology, 200 Campus Drive, Suite 4200, UPC II, Mail Code HU33, Hershey, PA 17033, USA. (J.G. Stine)
| | - George J. Stukenborg
- Department of Public Health Science, University of Virginia, Charlottesville, VA, USA
| | - Jennifer Wang
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Alden Adkins
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Blake Niccum
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alex Zimmet
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Curtis K. Argo
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
15
|
Shahabeddin Parizi A, Krabbe PFM, Buskens E, Bakker SJL, Vermeulen KM. A Scoping Review of Key Health Items in Self-Report Instruments Used Among Solid Organ Transplant Recipients. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:171-181. [PMID: 30324230 PMCID: PMC6397139 DOI: 10.1007/s40271-018-0335-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The overall aim of this scoping review of the literature is twofold: (1) to provide an overview of all instruments that have been used to assess health-related quality of life (HRQoL) after solid organ transplantation and (2) to provide a list of health items they include to support future studies on the development of a new-generation HRQoL instrument. All studies that administered any form of HRQoL instrument to post-transplant solid organ recipients were identified in a comprehensive search of PubMed (MEDLINE), Embase, and Web of Science, with a cut-off date of May 2018. The search used various combinations of the following keywords: lung, heart, liver, kidney, or pancreas transplantation; quality of life; well-being; patient-reported outcome; instrument; questionnaire; and health survey. In total, 8013 distinct publications were identified and 1218 of these were selected for review. Among the instruments applied, 53 measured generic, 51 organ-specific, 271 domain-specific, and 43 transplant-specific HRQoL. A total of 78 distinct health items grouped into 16 sub-domains were identified and depicted graphically. The majority of publications did not report a logical rationale for the choice of specific HRQoL instrument. The most commonly used types of instruments were generic health instruments, followed by domain-specific instruments. Despite the availability of transplant-specific instruments, few studies applied these types of instruments. Based on the 78 items, further research is planned to develop a patient-centered, transplant-specific HRQoL instrument that is concise, easy to apply (mobile application), and specifically related to the health issues of solid organ recipients.
Collapse
Affiliation(s)
- Ahmad Shahabeddin Parizi
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Paul F M Krabbe
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
16
|
Fagiuoli S, Caporaso N, Morisco F, Buelli F, Gualberti G, Saragaglia V, Chessa L, Corti G, Maida I, Mastroianni CM, Pirisi M, Russo FP, Farina F, Giannitrapani L, Toniutto P, Tarquini P, Tundo P, Vecchiet J, Vinci M, Taliani G. HepaDisk - A new quality of life questionnaire for HCV patients. Dig Liver Dis 2019; 51:1008-1015. [PMID: 30661988 DOI: 10.1016/j.dld.2018.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since most patients with hepatitis C virus (HCV) infection now receive treatment irrespective of liver disease severity, special attention to patient quality of life (QoL), including psycho-social aspects, is required. No QoL questionnaire is specific for patients with HCV. AIMS To develop and validate a short Italian questionnaire (HepaDisk) assessing the QoL of patients affected by HCV with intuitive graphic results that is understandable by patients and physicians. METHODS A questionnaire, drafted by a steering committee, underwent a Delphi survey. A multicenter, observational study was conducted to validate the developed HepaDisk versus other tools (CLDQ-I, SF-36, WPAI:HCV), and to evaluate its correlation with disease severity in Italian patients with HCV. RESULTS The 10-item questionnaire was validated in 214 patients. HepaDisk showed a high correlation with CLDQ overall score and WPAI:HCV activity impairment (Spearman's rank correlation: 0.651 and 0.595, respectively) and a lower correlation with SF-36. Strong internal consistency (Cronbach coefficient: 0.912), good test-retest reliability (Pearson's correlation coefficient: 0.789; 95% CI, 0.714-0.865), and responsiveness to changes among improved patients were demonstrated. CONCLUSION HepaDisk is a reliable and user-friendly tool that can monitor disease impact on patient QoL over time, providing a visual representation easily understandable by both patients and physicians.
Collapse
Affiliation(s)
- Stefano Fagiuoli
- Gastroenterology, Hepatology and Transplantation Unit, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Nicola Caporaso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | | | | | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Giampaolo Corti
- University Hospital Careggi, University of Florence, Florence, Italy
| | - Ivana Maida
- University Hospital of Sassari, Sassari, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Mario Pirisi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesco P Russo
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, Padua, Italy
| | | | - Lydia Giannitrapani
- Internal Medicine Unit, University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | | | - Paolo Tundo
- Infectious Diseases Unit, Presidio Ospedaliero S. Caterina Novella Galatina, Galatina (LE), Italy
| | - Jacopo Vecchiet
- Infectious Diseases Unit, Clinical Hospital SS Annunziata, Chieti, Italy
| | - Maria Vinci
- Niguarda Great Metropolitan Hospital, Milan, Italy
| | - Gloria Taliani
- Cronic Infectious Diseases Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | |
Collapse
|
17
|
Ha Y, Hwang S, Chon YE, Kim MN, Lee JH, Hwang SG. Validation of the Liver Disease Quality of Life Instrument 1.0 in Patients with Chronic Hepatitis B: A Prospective Study. J Clin Med 2019; 8:jcm8050656. [PMID: 31083480 PMCID: PMC6572606 DOI: 10.3390/jcm8050656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/05/2022] Open
Abstract
The purpose of this study was to report on the clinical usefulness of the Liver Disease Quality of Life Instrument (LDQOL) 1.0, which was prospectively measured in chronic hepatitis B patients. We regularly followed up with patients with chronic hepatitis B between 2008 and 2010 who were enrolled in the study, and the LDQOL 1.0 was filled out until 2015. The reliability and construct validity were evaluated by Cronbach’s α values and analysis of variance. Cox proportional hazards models were used to identify questionnaire components associated with death and decompensation. The LDQOL 1.0 scores were compared between groups of patients with different clinical characteristics. A total of 192 patients (27.1% with cirrhosis) were enrolled. The LDQOL 1.0 was reliable with high internal consistency based on the Cronbach’s α value. Most of each component was significantly associated with liver disease-related parameters, such as disability days, self-rated severity of liver disease symptoms, and Child-Pugh class. The change in concentration score between the first and last visit significantly predicted death (hazard ratio (HR), 0.44) and decompensation (HR, 0.97; p < 0.05 for both). Patients who achieved complete viral suppression did not show better scores than those who did not. In conclusion, the LDQOL 1.0 was prospectively validated in patients with chronic hepatitis B. Complete viral suppression did not influence the improvement of quality of life scores. The change in concentration scores over time was predictive of death and decompensation.
Collapse
Affiliation(s)
- Yeonjung Ha
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Sohyun Hwang
- Department of Pathology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Young Eun Chon
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Mi Na Kim
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Joo Ho Lee
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| | - Seong Gyu Hwang
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro,Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
| |
Collapse
|
18
|
Vieira DA, da Cunha LR, da Silva CB, Almeida MTB, Gomes AD, de Faria CLL, Teixeira R, Neves FS, Rocha GA, de Melo FF, de Magalhães Queiroz DM, Silva LD. The combined polymorphisms of interleukin-6-174GG genotype and interleukin-10 ATA haplotype are associated with a poor quality of life in patients with chronic hepatitis C. Qual Life Res 2019; 28:1531-1542. [PMID: 30734130 DOI: 10.1007/s11136-019-02129-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Chronic hepatitis C (CHC) is associated with a decreased health-related quality of life (HRQOL). More recent studies have pointed toward a genetic basis of patient-reported quality of life outcomes. Taking into account that the influence of single-nucleotide polymorphisms (SNPs) on the HRQOL of CHC patients has not been studied, we investigated the combined IL10-1082G/A, - 819C/T, and - 592C/A SNPs, and IL6-174G/C SNP. We also evaluated the association between demographic, clinical, psychiatric, virological, and genetic variables with domains and summaries of HRQOL in CHC patients. METHODS 132 consecutive CHC patients and 98 controls underwent psychiatric evaluation by using the Mini International Neuropsychiatric Interview. HRQOL was assessed by a generic questionnaire, the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and by the specific Liver Disease Quality of Life Questionnaire (LDQOL). IL6 and IL10 polymorphisms were evaluated by Taqman SNP genotyping assay. Multivariate analysis was used to evaluate the associations. RESULTS Major depressive disorder was associated with lower SF-36 and LDQOL scores in seven and ten domains, respectively. Diabetes and hypertension were also associated with reduced HRQOL. CHC patients carrying the combination of IL10 ATA haplotype/IL6-GG genotype had lower scores in the SF-36-physical functioning domain, and reduced scores in the LDQOL effects of liver disease on activities of daily living, quality of social interaction, and sexual function domains than the non-carriers of the combined haplotype/genotype. CONCLUSION This is the first study to demonstrate that combined IL6 high-producer GG genotype and IL10 low-producer ATA haplotype is associated with poorer HRQOL in CHC patients.
Collapse
Affiliation(s)
- Diego Alves Vieira
- Faculdade de Medicina, Outpatient Clinic of Viral Hepatitis, Instituto Alfa de Gastroenterologia, Universidade Federal de Minas Gerais (UFMG), Av Alfredo Balena 190 s/216, Belo Horizonte, Minas Gerais, 30130-100, Brazil.,Sciences Applied to Adult Health Care Post-Graduate Programme, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Luciana Rodrigues da Cunha
- Faculdade de Medicina, Outpatient Clinic of Viral Hepatitis, Instituto Alfa de Gastroenterologia, Universidade Federal de Minas Gerais (UFMG), Av Alfredo Balena 190 s/216, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Cliviany Borges da Silva
- Faculdade de Medicina, Outpatient Clinic of Viral Hepatitis, Instituto Alfa de Gastroenterologia, Universidade Federal de Minas Gerais (UFMG), Av Alfredo Balena 190 s/216, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Maria Thereza Bastos Almeida
- Medical undergraduate student, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Adriana Dias Gomes
- Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - César Lúcio Lopes de Faria
- Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rosângela Teixeira
- Faculdade de Medicina, Outpatient Clinic of Viral Hepatitis, Instituto Alfa de Gastroenterologia, Universidade Federal de Minas Gerais (UFMG), Av Alfredo Balena 190 s/216, Belo Horizonte, Minas Gerais, 30130-100, Brazil.,Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, 30130-100, Brazil
| | - Fernando Silva Neves
- Sciences Applied to Adult Health Care Post-Graduate Programme, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Gifone Aguiar Rocha
- Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Fabrício Freire de Melo
- Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Luciana Diniz Silva
- Faculdade de Medicina, Outpatient Clinic of Viral Hepatitis, Instituto Alfa de Gastroenterologia, Universidade Federal de Minas Gerais (UFMG), Av Alfredo Balena 190 s/216, Belo Horizonte, Minas Gerais, 30130-100, Brazil. .,Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, 30130-100, Brazil.
| |
Collapse
|
19
|
Forestier B, Anthoine E, Reguiai Z, Fohrer C, Blanchin M. A systematic review of dimensions evaluating patient experience in chronic illness. Health Qual Life Outcomes 2019; 17:19. [PMID: 30665417 PMCID: PMC6341593 DOI: 10.1186/s12955-019-1084-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/07/2019] [Indexed: 12/23/2022] Open
Abstract
Background Living with a chronic disease often means experiencing chronic treatments and regular multidisciplinary monitoring as well as a profound life-changing experience which may impact all aspects of a patients life. The patient experience of chronic disease is frequently assessed by patient reported measures (PRMs) which incorporate patients perspectives to better understand how illness, treatment and care impact the entirety of a patient’s life. The purpose of this review was to collect and review different kinds of available PRM instruments validated for chronic patients, to produce an inventory of explored concepts in these questionnaires and to identify and classify all dimensions assessing chronic patients experience. Methods A systematic review of PRM instruments validated for chronic patients was conducted from three databases (Medline, the Cochrane library, and Psycinfo). Articles were selected after a double reading and questionnaires were classified according to their targeted concept. Then, all dimensions of the questionnaires were clustered into different categories. Results 107 primary validation studies of PRM questionnaires were selected. Five kinds of instruments were recorded: 1) Questionnaires assessing health related quality of life or quality of life; 2) Instruments focusing on symptoms and functional status; 3) Instruments exploring patients’ feelings and attitude about illness; 4) Questionnaires related to patients’ experience of treatment or healthcare; 5) Instruments assessing patients attitudes about treatment or healthcare. Twelve categories of dimensions were obtained from these instruments. Conclusions This review provided an overview of some of the dimensions used to explore chronic patient experience. A large PRM diversity exists and none of the reviewed and selected questionnaires covered all identified categories of dimensions of patient experience of chronic disease. Furthermore, the definition of explored concepts varies widely among researchers and complex concepts often lack a clear definition in the reviewed articles. Before attempting to measure chronic patient experience, researchers should construct appropriate instruments focusing on well-defined concepts and dimensions encompassing patient’s personal experience, attitude and adaptation to illness, treatment or healthcare. Electronic supplementary material The online version of this article (10.1186/s12955-019-1084-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bastien Forestier
- UMR U1246 SPHERE "methodS in Patient centered outcomes & HEalth REsearch", Université de Nantes, Université de Tours, INSERM, Nantes, France.,Pôle de santé publique, CHU de Nantes, Nantes, France
| | - Emmanuelle Anthoine
- UMR U1246 SPHERE "methodS in Patient centered outcomes & HEalth REsearch", Université de Nantes, Université de Tours, INSERM, Nantes, France.,Pôle de santé publique, CHU de Nantes, Nantes, France
| | - Ziad Reguiai
- Service de dermatologie, Polyclinique Courlancy, Reims, France
| | - Cécile Fohrer
- Service d'hématologie clinique, CHU de Strasbourg, Strasbourg, France
| | - Myriam Blanchin
- UMR U1246 SPHERE "methodS in Patient centered outcomes & HEalth REsearch", Université de Nantes, Université de Tours, INSERM, Nantes, France.
| |
Collapse
|
20
|
Mejía G, Gómez MT, Moreno-Medina K. Evaluación de la calidad de vida relacionada con la salud pre y post trasplante hepático, en pacientes de un hospital de alta complejidad. PSYCHOLOGIA 2019. [DOI: 10.21500/19002386.3721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
El trasplante hepático es la alternativa terapéutica indicada en pacientes con enfermedad hepática terminal para mejorar su sobrevida y calidad de vida. El objetivo de este estudio fue evaluar la calidad de vida relacionada con la salud (CVRS) de pacientes con cirrosis hepática antes y después de trasplante hepático. Se incluyeron 33 personas adultas que estaban en lista de espera para trasplante en la institución, se aplicó una serie de cuestionarios antes y después del trasplante: para evaluar la calidad de vida se utilizaron el LDQOL-1 (específico para enfermedad y trasplante hepático) y SF36 (para población general); para evaluar los síntomas depresivos y ansiosos, se utilizaron el BDI y STAI, respectivamente. Los resultados señalan una mejoría en la CVRS, así como disminución de los síntomas ansiosos y depresivos posterior al trasplante.
Collapse
|
21
|
Peng JK, Hepgul N, Higginson IJ, Gao W. Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis. Palliat Med 2019; 33:24-36. [PMID: 30345878 PMCID: PMC6291907 DOI: 10.1177/0269216318807051] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND: End-stage liver disease is a common cause of morbidity and mortality worldwide, yet little is known about its symptomatology and impact on health-related quality of life. AIM: To describe symptom prevalence and health-related quality of life of patients with end-stage liver disease to improve care. DESIGN: Systematic review. DATA SOURCES: We searched eight electronic databases from January 1980 to June 2018 for studies investigating symptom prevalence or health-related quality of life of adult patients with end-stage liver disease. No language restrictions were applied. Meta-analyses were performed where appropriate. RESULTS: We included 80 studies: 35 assessing symptom prevalence, 41 assessing health-related quality of life, and 4 both. The instruments assessing symptoms varied across studies. The most frequently reported symptoms were as follows: pain (prevalence range 30%–79%), breathlessness (20%–88%), muscle cramps (56%–68%), sleep disturbance (insomnia 26%–77%, daytime sleepiness 29.5%–71%), and psychological symptoms (depression 4.5%–64%, anxiety 14%–45%). Erectile dysfunction was prevalent (53%–93%) in men. The health-related quality of life of patients with end-stage liver disease was significantly impaired when compared to healthy controls or patients with chronic liver disease. Compared with compensated cirrhosis, decompensation led to significant worsening of both components of the 36-Item Short Form Survey although to a larger degree for the Physical Component Summary score (decrease from average 6.4 (95% confidence interval: 4.0–8.8); p < 0.001) than for the Mental Component Summary score (4.5 (95% confidence interval: 2.4–6.6); p < 0.001). CONCLUSION: The symptom prevalence of patients with end-stage liver disease resembled that of patients with other advanced conditions. Given the diversity of symptoms and significantly impaired health-related quality of life, multidisciplinary approach and timely intervention are crucial.
Collapse
Affiliation(s)
- Jen-Kuei Peng
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,2 Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,3 Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Nilay Hepgul
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Irene J Higginson
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Wei Gao
- 1 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| |
Collapse
|
22
|
Sanchez-Jimenez B, Chavez-Tapia NC, Jakobsen JC, Nikolova D, Gluud C. Antibiotic prophylaxis for people with cirrhosis and variceal bleeding. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd013214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Beatriz Sanchez-Jimenez
- Mexican Institute of Social Security; Medical Resident; Paseo Tollocan Toluca Mexico City Mexico 50150
| | - Norberto C Chavez-Tapia
- Medica Sur Clinic & Foundation; Department of Biomedical Research, Gastroenterology & Liver Unit; Puente de Pïedra 150 Mexico City Distrito Federal Mexico 14050
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Sjaelland Denmark DK-2100
- Holbaek Hospital; Department of Cardiology; Holbaek Denmark 4300
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Sjaelland Denmark DK-2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Sjaelland Denmark DK-2100
| |
Collapse
|
23
|
Sanchez-Jimenez B, Chavez-Tapia NC, Jakobsen JC, Nikolova D, Gluud C. Antibiotic prophylaxis versus placebo or no intervention for people with cirrhosis and variceal bleeding. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd013175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Beatriz Sanchez-Jimenez
- Mexican Institute of Social Security; Medical Resident; Paseo Tollocan Toluca Mexico Mexico 50150
| | - Norberto C Chavez-Tapia
- Medica Sur Clinic & Foundation; Department of Biomedical Research, Gastroenterology & Liver Unit; Puente de Pïedra 150 Mexico City Distrito Federal Mexico 14050
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Sjaelland Denmark DK-2100
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Sjaelland Denmark DK-2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Sjaelland Denmark DK-2100
| |
Collapse
|
24
|
Jang ES, Kim YS, Kim KA, Lee YJ, Chung WJ, Kim IH, Lee BS, Jeong SH. Factors Associated with Health-Related Quality of Life in Korean Patients with Chronic Hepatitis C Infection Using the SF-36 and EQ-5D. Gut Liver 2018; 12:440-448. [PMID: 29588435 PMCID: PMC6027832 DOI: 10.5009/gnl17322] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 11/07/2017] [Indexed: 12/14/2022] Open
Abstract
Background/Aims This study aimed to describe the health-related quality of life (HRQoL) outcomes for Korean chronic hepatitis C patients and to investigate the impact of patient and virus-related factors on HRQoL. Methods HRQoL was assessed in 235 hepatitis C virus (HCV)-infected patients from seven nationwide tertiary hospital, including those with liver cirrhosis and hepatocellular carcinoma (HCC), using the Shor-Form 36 (SF-36) version 2 and the European quality of life questionnaire-5 dimensions (EQ-5D-3L). Results The SF-36 physical (48.8±8.3) and mental (46.2±11.7) component summary scores of the HCV-infected patients were below normal limits. Of the eight domains, general health, vitality, and mental health tended to show low scores. Patients with decompensated cirrhosis had the lowest HRQoL, while HCC and chronic hepatitis patients had similar HRQoL results. The EQ-5D index was low (0.848±0.145) in the HCV infected patients. Multivariable analysis showed age ≤65 years, high monthly family income (>$2,641), low comorbidity score, and sustained virologic response (SVR) were independently associated with favorable HRQoL. Conclusions HRQoL in Korean patients with chronic HCV infection was low and was affected by cirrhosis severity, SVR, and comorbidity as well as income, which had the strongest effect. Therefore, HRQoL may be improved by antiviral therapy with reasonable costs to prevent cirrhosis progression.
Collapse
Affiliation(s)
- Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kyung-Ah Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Youn Jae Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woo Jin Chung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - In Hee Kim
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University College of Medicine, Jeonju, Korea
| | - Byung Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
25
|
Macken L, Mason L, Evans C, Gage H, Jordan J, Austin M, Parnell N, Cooper M, Steer S, Boles J, Bremner S, Lambert D, Crook D, Earl G, Timeyin J, Verma S. Palliative long-term abdominal drains versus repeated drainage in individuals with untreatable ascites due to advanced cirrhosis: study protocol for a feasibility randomised controlled trial. Trials 2018; 19:401. [PMID: 30053891 PMCID: PMC6062920 DOI: 10.1186/s13063-018-2779-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 06/29/2018] [Indexed: 01/28/2023] Open
Abstract
Background UK deaths due to chronic liver diseases such as cirrhosis have quadrupled over the last 40 years, making this condition now the third most common cause of premature death. Most patients with advanced cirrhosis (end-stage liver disease [ESLD]) develop ascites. This is often managed with diuretics, but if refractory, then the fluid is drained from the peritoneal cavity every 10–14 days by large volume paracentesis (LVP), a procedure requiring hospital admissions. As the life expectancy of patients with ESLD and refractory ascites (if ineligible for liver transplantation) is on average ≤ 6 months, frequent hospital visits are inappropriate from a palliative perspective. One alternative is long-term abdominal drains (LTADs), used successfully in patients whose ascites is due to malignancy. Although inserted in hospital, these drains allow ascites management outside of a hospital setting. LTADs have not been formally evaluated in patients with refractory ascites due to ESLD. Methods/design Due to uncertainty about appropriate outcome measures and whether patients with ESLD would wish or be able to participate in a study, a feasibility randomised controlled trial (RCT) was designed. Patients were consulted on trial design. We plan to recruit 48 patients with refractory ascites and randomise them (1:1) to either (1) LTAD or (2) current standard of care (LVP) for 12 weeks. Outcomes of interest include acceptability of the LTAD to patients, carers and healthcare professionals as well as recruitment and retention rates. The Integrated Palliative care Outcome Scale, the Short Form Liver Disease Quality of Life questionnaire, the EuroQol 5 dimensions instrument and carer-reported (Zarit Burden Interview) outcomes will also be assessed. Preliminary data on cost-effectiveness will be collected, and patients and healthcare professionals will be interviewed about their experience of the trial with a view to identifying barriers to recruitment. Discussion LTADs could potentially improve end-of-life care in patients with refractory ascites due to ESLD by improving symptom control, reducing hospital visits and enabling some self-management. Our trial is designed to see if such patients can be recruited, as well as to inform the design of a subsequent definitive trial. Trial registration ISRCTN, ISRCTN30697116. Registered on 7 October 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2779-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lucia Macken
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Main Teaching Building, North South Road, University of Sussex, Falmer, Brighton, East Sussex, BN1 9PX, UK.,Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals Trust, Royal Sussex County Hospital, Eastern Rd, Brighton, East Sussex, BN2 5BE, UK
| | - Louise Mason
- Department of Palliative Medicine, Brighton and Sussex University Hospitals Trust, Royal Sussex County Hospital, Eastern Rd, Brighton, East Sussex, BN2 5BE, UK
| | - Catherine Evans
- King's College, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, UK
| | - Heather Gage
- Surrey Health Economics Centre, School of Economics, Faculty of Arts and Social Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Jake Jordan
- Surrey Health Economics Centre, School of Economics, Faculty of Arts and Social Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Mark Austin
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals Trust, Royal Sussex County Hospital, Eastern Rd, Brighton, East Sussex, BN2 5BE, UK
| | - Nick Parnell
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals Trust, Royal Sussex County Hospital, Eastern Rd, Brighton, East Sussex, BN2 5BE, UK
| | - Max Cooper
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Main Teaching Building, North South Road, University of Sussex, Falmer, Brighton, East Sussex, BN1 9PX, UK
| | - Shani Steer
- Brighton & Sussex Clinical Trials Unit, Room 204 Bevendean House, University of Brighton, Falmer, BN1 9PH, UK
| | - Justine Boles
- Brighton & Sussex Clinical Trials Unit, Room 204 Bevendean House, University of Brighton, Falmer, BN1 9PH, UK
| | - Stephen Bremner
- Brighton & Sussex Clinical Trials Unit, Room 204 Bevendean House, University of Brighton, Falmer, BN1 9PH, UK.,Department of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, Brighton, BN1 9PH, UK
| | - Debbie Lambert
- Brighton & Sussex Clinical Trials Unit, Room 204 Bevendean House, University of Brighton, Falmer, BN1 9PH, UK
| | - David Crook
- Brighton & Sussex Clinical Trials Unit, Room 204 Bevendean House, University of Brighton, Falmer, BN1 9PH, UK
| | - Gemma Earl
- Brighton & Sussex Clinical Trials Unit, Room 204 Bevendean House, University of Brighton, Falmer, BN1 9PH, UK
| | - Jean Timeyin
- Brighton & Sussex Clinical Trials Unit, Room 204 Bevendean House, University of Brighton, Falmer, BN1 9PH, UK
| | - Sumita Verma
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Main Teaching Building, North South Road, University of Sussex, Falmer, Brighton, East Sussex, BN1 9PX, UK. .,Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospitals Trust, Royal Sussex County Hospital, Eastern Rd, Brighton, East Sussex, BN2 5BE, UK.
| |
Collapse
|
26
|
Tapper EB, Kanwal F, Asrani SK, Ho C, Ovchinsky N, Poterucha J, Flores A, Smith JE, Ankoma-Sey V, Luxon B, Volk ML. Patient-reported outcomes in cirrhosis: A scoping review of the literature. Hepatology 2018; 67:2375-2383. [PMID: 29272043 DOI: 10.1002/hep.29756] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 01/05/2023]
Abstract
UNLABELLED Patients with cirrhosis seek improvement in their symptoms, functioning, quality of life, and satisfaction with the care they receive. However, these patient-reported outcomes (PROs) are not routinely measured for clinical care, research, or quality improvement. The members of the American Association for the Study of Liver Diseases Practice Metrics Committee, charged with developing quality indicators for clinical practice, performed a scoping review of PROs in cirrhosis. The aim is to synthesize a comprehensive set of PROs for inclusion into a standard patient-centered outcome set. We searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Trial Library since inception, with final searches run between April 20 and June 1, 2017. Studies were included if they reported the construction and/or validation of a PRO instrument for patients with cirrhosis or if they assessed the clinical (case-mix) variables determining responses to established PRO scales. Eleven studies were selected that yielded 259 items specific to patients with cirrhosis. After removing duplicates, 152 unique items were isolated. These items were consolidated into seven domains: physical symptoms, physical function, mental health, general function, cognition, social life, and satisfaction with care. The seven domains included 52 subdomains (e.g., physical domain, abdominal pain subdomain). Twelve variables were identified that independently modified established PRO scales. These included clinical factors (severity of liver disease and its complications, medication burden, and comorbidities), specific PROs (cramps, pruritis), and surrogate outcome measures (falls, hospitalization). CONCLUSION This scoping review identified and categorized a large existing set of PRO concepts that matter to patients with cirrhosis; these outcomes may now be translated into usable measures both for the assessment of the quality of cirrhosis care in clinical practice and to perform research from the patient's perspective. (Hepatology 2018;67:2375-2383).
Collapse
Affiliation(s)
- Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Sumeet K Asrani
- Division of Hepatology, Baylor University Medical Center, Dallas, TX
| | - Chanda Ho
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA
| | - Nadia Ovchinsky
- Division of Pediatric Gastroenterology, Children's Hospital at Montefiore, Bronx, NY
| | - John Poterucha
- Division of Gastroenterology, Mayo School of Medicine, Rochester, MN
| | - Avegail Flores
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
| | - Judith E Smith
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI
| | | | - Bruce Luxon
- Department of Medicine, Georgetown University, Washington, DC
| | - Michael L Volk
- Division of Gastroenterology and Transplantation Institute, Loma Linda University, Loma Linda, CA
| |
Collapse
|
27
|
Aguiar MIFD, Alves NP, Braga VAB, Souza ÂMAE, Araújo MÂM, Almeida PCD. ASPECTOS PSICOSSOCIAIS DA QUALIDADE DE VIDA DE RECEPTORES DE TRANSPLANTE HEPÁTICO. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180003730016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: avaliar a dimensão psicossocial da qualidade de vida de pacientes antes e depois do transplante hepático. Método: estudo descritivo, transversal, com abordagem quantitativa, com 150 pacientes submetidos ao transplante de fígado em seguimento a partir do sexto mês, no ambulatório de um centro de referência em transplante hepático. A coleta de dados foi realizada a partir da aplicação de um instrumento com dados sociodemográficos/clínicos e do questionário Liver Disease Quality of Life. Foi utilizada análise estatística descritiva, teste t de Student para comparação das médias dos domínios e Games-Howell para comparações múltiplas. Resultados: houve melhoria nos níveis de qualidade de vida pós-transplante nos quatro domínios avaliados (<0,0001), com maior elevação de escores para os domínios: preocupação (55,5 vs 87,9) e estigma da doença hepática (58,6 vs 93,7). Conclusão: o estudo demonstrou que os pacientes submetidos ao transplante hepático obtiveram uma melhoria significativa da percepção da qualidade de vida no que diz respeito à dimensão psicossocial, sendo mais perceptiva nos domínios preocupação e estigma da doença hepática.
Collapse
|
28
|
Langberg KM, Kapo JM, Taddei TH. Palliative care in decompensated cirrhosis: A review. Liver Int 2018; 38:768-775. [PMID: 29112338 DOI: 10.1111/liv.13620] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/30/2017] [Indexed: 12/16/2022]
Abstract
Decompensated cirrhosis is an illness that causes tremendous suffering. The incidence of cirrhosis is increasing and rates of liver transplant, the only cure, remain stagnant. Palliative care is focused on improving quality of life for patients with serious illness by addressing advanced care planning, alleviating physical symptoms and providing emotional support to the patient and family. Palliative care is used infrequently in patients with decompensated cirrhosis. The allure of transplant as a potential treatment option for cirrhosis, misperceptions about the role of palliative care and difficulty predicting prognosis in liver disease are potential contributors to the underutilization of palliative care in this patient population. Studies have demonstrated some benefit of palliative care in patients with decompensated cirrhosis but the literature is limited to small observational studies. There is evidence that palliative care consultation in other patient populations lowers hospital costs and ICU utilization and improves symptom control and patient satisfaction. Prospective randomized control trials are needed to investigate the effects of palliative care on traditional- and patient-reported outcomes as well as cost of care in decompensated cirrhosis for transplant eligible and ineligible patient populations.
Collapse
Affiliation(s)
- Karl M Langberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer M Kapo
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Tamar H Taddei
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| |
Collapse
|
29
|
Evon DM, Amador J, Stewart P, Reeve BB, Lok AS, Sterling RK, Di Bisceglie AM, Reau N, Serper M, Sarkar S, Lim JK, Golin CE, Fried MW. Psychometric properties of the PROMIS short form measures in a U.S. cohort of 961 patients with chronic hepatitis C prescribed direct acting antiviral therapy. Aliment Pharmacol Ther 2018; 47:1001-1011. [PMID: 29377191 PMCID: PMC5842131 DOI: 10.1111/apt.14531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/10/2017] [Accepted: 01/02/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND To better understand symptoms experienced by patients infected with chronic hepatitis C virus (HCV), valid and reliable patient-reported outcome (PRO) measures are needed. AIM To assess the reliability and validity of 10 patient-reported outcomes measurement information system (PROMIS) measures and the Headache Impact Test-6 (HIT-6) in a large national sample of patients with HCV. METHODS Pre-treatment data from 961 patients with HCV starting direct acting antiviral therapy at 11 U.S. liver centers were analyzed. Internal reliability was evaluated using Cronbach's alpha coefficient; frequency distributions were examined for floor and ceiling effects; structural validity was investigated via item-response-theory models; convergent validity was evaluated using correlations with theoretically-similar items from the HCV-PRO and memorial symptom assessment scale (MSAS); and known-groups validity was investigated by observing PRO differences by liver disease status and number of comorbidities. RESULTS The HIT-6 and the majority of the PROMIS measures yielded excellent reliability (alphas ≥ 0.87). Ceiling effects were infrequent ( < 4%), while 30%-59% of patients reported no symptoms (floor effects). The data supported structural validity of the HIT-6 and most PROMIS measures. The PROMIS measures showed moderate to strong correlations with theoretically-similar items from the HCV-PRO and MSAS (0.39-0.77). Trends were observed between worse PRO scores and advanced cirrhosis and greater number of comorbidities, lending support for known-groups validity. CONCLUSIONS The psychometric properties of the HIT-6 and PROMIS measures performed satisfactorily in this large cohort of patients with HCV starting direct acting antiviral therapy. Opportunities exist for further refinement of these PROs. Evaluation of performance over time and in under-represented subgroups is needed.
Collapse
Affiliation(s)
- Donna M. Evon
- Division of Gastroenterology and Hepatology, University of North Carolina
| | - Jipcy Amador
- Department of Biostatistics, University of North Carolina
| | - Paul Stewart
- Department of Biostatistics, University of North Carolina
| | | | - Anna S. Lok
- Division of Gastroenterology and Hepatology, University of Michigan
| | | | | | - Nancy Reau
- Department of Internal Medicine, Rush Medical College
| | - Marina Serper
- Department of Medicine, the University of Pennsylvania
| | - Souvik Sarkar
- Department of Internal Medicine, University of California, Davis
| | | | - Carol E. Golin
- Division of General Medicine and Clinical Epidemiology, University of North Carolina,Department of Health Behavior, University of North Carolina
| | - Michael W. Fried
- Division of Gastroenterology and Hepatology, University of North Carolina
| |
Collapse
|
30
|
Hashim A, O’Sullivan M, Williams H, Verma S. Developing a community HCV service: project ITTREAT (integrated community-based test - stage - TREAT) service for people who inject drugs. Prim Health Care Res Dev 2018; 19:110-120. [PMID: 29199921 PMCID: PMC6452958 DOI: 10.1017/s1463423617000731] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/05/2017] [Accepted: 10/08/2017] [Indexed: 12/19/2022] Open
Abstract
Background and aims Majority of the individuals with hepatitis C virus (HCV) infection in England are people who inject drugs, a vulnerable and disenfranchised cohort with poor engagement with secondary care. Our aim is to describe our experiences in setting up a successful nurse led HCV service at a substance misuse service (SMS). METHODS We justify the need for a community HCV service and review the different community based models. Our experiences in engaging with stakeholders, obtaining funding, service set up, challenges faced and key recommendations are discussed. Finally, a summary of interim clinical outcomes is presented. RESULTS A successful community based "one-stop" nurse led HCV service was set up in Dec 2013 at a large SMS. It provides all aspects of care (blood borne virus screening, non-invasive assessment of hepatic fibrosis, Hepatology input, HCV treatment, peer mentor, social and psychiatrist support, and opiod substitution) at one site. Interim clinical data indicate high service uptake with HCV treatment outcomes comparable to secondary care. CONCLUSIONS The advent of direct acting antivirals provides a unique opportunity for HCV elimination in England by 2030. Our "one-stop" integrated and multidisciplinary community HCV model suggests that HCV care can be successfully delivered outside of a hospital setting and warrants national adoption.
Collapse
Affiliation(s)
- Ahmed Hashim
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK
| | - Margaret O’Sullivan
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK
- Pavilions Drug & Alcohol Services, Richmond House, Brighton, UK
| | - Hugh Williams
- Pavilions Drug & Alcohol Services, Richmond House, Brighton, UK
- Surrey and Borders Partnership NHS foundation trust
| | - Sumita Verma
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
- Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK
| |
Collapse
|
31
|
Polis S, Fernandez R. Impact of physical and psychological factors on health-related quality of life in adult patients with liver cirrhosis: a systematic review protocol. ACTA ACUST UNITED AC 2018; 13:39-51. [PMID: 26447006 DOI: 10.11124/jbisrir-2015-1987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
REVIEW QUESTION/OBJECTIVE What is the impact of physical and psychological factors on health-related quality of life in adult patients diagnosed with liver cirrhosis? BACKGROUND All chronic liver diseases stimulate a degree of repetitive hepatocyte injury that alters the normal liver architecture and ends in cirrhosis.Liver cirrhosis and hepatocellular carcinoma secondary to livercirrhosis are a major public health burden, reporting increasing mortality and morbidity both in Australia and globally.The four leading causes of cirrhosis include harmful alcohol consumption, viral hepatitis B and C and metabolic syndromes related to non-alcoholic fatty liver disease and obesity.A cirrhotic liver is characterized by the presence of regenerative nodules surrounded by fibrous bands that inhibit the passing of molecules between blood and functional units of liver hepatocytes, leading to liver dysfunction.Additionally, the presence of fibrous bands disrupts the normal vascular architecture, increasing resistance within the liver sinusoids and contributing to increased portal vein pressure.The early stages of cirrhosis are referred to as compensated liver disease with no reported symptoms or evidence of impaired liver function.However, the signs and symptoms of liver failure, as well as the mortality rate, increase as the severity of cirrhosis increases.Transition from compensated to decompensated cirrhosis is marked by one or more physiological changes. The physiological changes include increased portal vein pressure, impaired synthetic function, electrolyte imbalance and malnourishment.These physiological changes trigger the development of physical signs and symptoms and impact on the psychological wellbeing of the individual living with cirrhosis. The physical signs and symptoms include esophageal varices, ascites, hepatic encephalopathy, jaundice, irregular sleep patterns, muscle cramps, pruritus, fatigue, impaired mobility, breathlessness, abdominal discomfort, gastrointestinal symptoms, change of body image and pitting edema.Psychological symptoms include stress, depression and anxiety.Living with liver cirrhosis has a marked impact on the quality of life of the individual. Health-related quality of life (HRQOL) is the individual's perception of their physical, cognitive, emotional and social functioning.Studies report that physical and psychological factors affect the quality of life of patients with cirrhosis which can be problematic and debilitating.There is strong evidence which indicates that disease severity is associated with an impairment of the patient's HRQOL.For example, gross ascites causes abdominal discomfort, breathlessness, increased stress and anxiety related to body image, immobility and an increased likelihood of falls. In addition, the management of ascites involves frequent invasive procedures, an increase in pill burden and implementation of dietary restrictions, all of which impact on HRQOL.Despite the clear relationship between HRQOL and severity of disease, there has been no systematic review undertaken to determine the physical, psychological and physiological factors that affect the HRQOL of patients with liver cirrhosis. This systematic review will therefore identify the best available evidence related to the impact of physical, psychological and physiological factors on the health-related quality of life of adult patients with liver cirrhosis. The results of the review will increase clinicians' knowledge and highlight areas of clinical management that may require additional strategies and treatment plans to improve symptom relief and HRQOL.
Collapse
Affiliation(s)
- Suzanne Polis
- 1 St George Hospital, Kogarah, Sydney, New South Wales2 Center for Evidence based Initiatives in Health Care: an Affiliate Center of the Joanna Briggs Institute3 School of Nursing and Midwifery, University of Wollongong, New South Wales
| | | |
Collapse
|
32
|
Symptom Domain Groups of the Patient-Reported Outcomes Measurement Information System Tools Independently Predict Hospitalizations and Re-hospitalizations in Cirrhosis. Dig Dis Sci 2017; 62:1173-1179. [PMID: 28258378 DOI: 10.1007/s10620-017-4509-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patient-Reported Outcomes Measurement Information System (PROMIS) tools can identify health-related quality of life (HRQOL) domains that could differentially affect disease progression. Cirrhotics are highly prone to hospitalizations and re-hospitalizations, but the current clinical prognostic models may be insufficient, and thus studying the contribution of individual HRQOL domains could improve prognostication. AIM Analyze the impact of individual HRQOL PROMIS domains in predicting time to all non-elective hospitalizations and re-hospitalizations in cirrhosis. METHODS Outpatient cirrhotics were administered PROMIS computerized tools. The first non-elective hospitalization and subsequent re-hospitalizations after enrollment were recorded. Individual PROMIS domains significantly contributing toward these outcomes were generated using principal component analysis. Factor analysis revealed three major PROMIS domain groups: daily function (fatigue, physical function, social roles/activities and sleep issues), mood (anxiety, anger, and depression), and pain (pain behavior/impact) accounted for 77% of the variability. Cox proportional hazards regression modeling was used for these groups to evaluate time to first hospitalization and re-hospitalization. RESULTS A total of 286 patients [57 years, MELD 13, 67% men, 40% hepatic encephalopathy (HE)] were enrolled. Patients were followed at 6-month (mth) intervals for a median of 38 mths (IQR 22-47), during which 31% were hospitalized [median IQR mths 12.5 (3-27)] and 12% were re-hospitalized [10.5 mths (3-28)]. Time to first hospitalization was predicted by HE, HR 1.5 (CI 1.01-2.5, p = 0.04) and daily function PROMIS group HR 1.4 (CI 1.1-1.8, p = 0.01), independently. In contrast, the pain PROMIS group were predictive of the time to re-hospitalization HR 1.6 (CI 1.1-2.3, p = 0.03) as was HE, HR 2.1 (CI 1.1-4.3, p = 0.03). CONCLUSIONS Daily function and pain HRQOL domain groups using PROMIS tools independently predict hospitalizations and re-hospitalizations in cirrhotic patients.
Collapse
|
33
|
Cho HJ, Park E. Quality of Life of Chronic Hepatitis C Patients and Its Associated Factors. Osong Public Health Res Perspect 2017; 8:124-129. [PMID: 28540156 PMCID: PMC5441437 DOI: 10.24171/j.phrp.2017.8.2.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 02/06/2023] Open
Abstract
Objectives This study aimed to investigate the factors affecting the health-related quality of life (HRQOL) of patients with chronic hepatitis C (CHC). Methods This study is based on a descriptive survey and involved 125 gastroenterology outpatients visiting a university hospital in South Korea as the participants. HRQOL was assessed using the Liver Disease Quality of Life 1.0, which consisted of Short Form-36 (SF-36) and the Liver Disease Targeted Scale. Data were collected from December 2015 to April 2016, which were then analyzed through multiple regression analysis. Results HRQOL had a statistically significant correlation with age, sex, educational level, living type, employment status, monthly income level, and comorbidity status. This study showed that age > 51 years, female sex, high educational level, living alone, unemployment status, low monthly income, and presence of comorbidity had negative effects on the HRQOL of patients with CHC (R2 = 8.7%–34.6%). Conclusion Based on the result of this study, intervention for patients with CHC needs to be developed to enhance their HRQOL. The findings can serve as a useful reference for nursing personnel in the development of therapeutic plans to upgrade the care of CHC patients.
Collapse
Affiliation(s)
- Hoo Jeung Cho
- Clinical Research Center, Pusan National University Hospital, Busan, Korea
| | - Euna Park
- Department of Nursing, Pukyong National University, Busan, Korea
| |
Collapse
|
34
|
Mühlbacher AC, Bridges JFP, Bethge S, Dintsios CM, Schwalm A, Gerber-Grote A, Nübling M. Preferences for antiviral therapy of chronic hepatitis C: a discrete choice experiment. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:155-165. [PMID: 26846922 DOI: 10.1007/s10198-016-0763-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 01/11/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND The German Institute for Quality and Efficiency in Health Care (IQWiG) uses patient-relevant outcomes to inform decision-makers. OBJECTIVE IQWiG conducted a pilot study to examine whether discrete choice experiments (DCEs) can be applied in health economic evaluations in Germany to identify, weight, and prioritize multiple patient-relevant outcomes, using the example of antiviral therapy for chronic hepatitis C (HCV). A further objective was to contribute to a more structured approach towards eliciting and comparing preferences across key stakeholders. METHODS In autumn 2010, a DCE questionnaire was sent to patients with chronic HCV to estimate preferences across seven outcomes ("attributes"), including treatment efficacy [sustained viral response (SVR) at 6 months], adverse effects (flu-like symptoms, gastrointestinal symptoms, psychiatric symptoms, and skin symptoms/alopecia), and measures of treatment burden (duration of therapy, frequency of injections). A linear model and an effects coded full model were applied to assess the relative importance of the attributes. RESULTS In total N = 326 patients were included. A clear preference for SVR was shown; frequency of injections and duration of therapy shared the second rank, while psychiatric symptoms ranked third. The duration of flu-like symptoms was the least important attribute. CONCLUSION Our findings indicate that it is possible to perform a DCE at the national level in a health technology assessment agency. The weighting of multiple outcomes allows an indication-specific and evidence-based measure to be used in health economic evaluations. In decision-making in health care, the approach generally allows for consideration of patient-relevant trade-offs regarding the benefits and harms of medical interventions.
Collapse
Affiliation(s)
- Axel C Mühlbacher
- Institute for Health Economics and Health Care Management (IGM), University of Applied Sciences Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany.
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - John F P Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susanne Bethge
- Institute for Health Economics and Health Care Management (IGM), University of Applied Sciences Neubrandenburg, Brodaer Straße 2, 17033, Neubrandenburg, Germany
| | - Ch-Markos Dintsios
- Strategic Market Access Intelligence, Bayer Health Care, Leverkusen, Germany
- Department of Public Health, Faculty of Medicine, Heinrich-Heine University, Düsseldorf, Germany
| | - Anja Schwalm
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | | | | |
Collapse
|
35
|
Casanovas T, Herdman M, Chandía A, Peña MC, Fabregat J, Vilallonga JS. Identifying Improved and Non-improved Aspects of Health-related Quality of Life After Liver Transplantation Based on the Assessment of the Specific Questionnaire Liver Disease Quality of Life. Transplant Proc 2016; 48:132-7. [PMID: 26915858 DOI: 10.1016/j.transproceed.2015.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/10/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The specific questionnaire Liver Disease Quality of Life (LDQOL) is a valid tool for measuring quality of life (QOL) and has been used to show that liver transplantation (LT), which is an effective treatment for end-stage liver disease, may improve QOL. OBJECTIVES This study aims to identify aspects of QOL that improve after LT and those that do not. PATIENTS AND METHODS Patients accepted for LT were invited to answer the LDQOL at baseline and after transplantation at 6 and 12 months. LDQOL contains the 36-item Short Form Health Survey (SF-36) and 12 specific dimensions. Responsiveness was assessed using the paired Student t test. RESULTS The study included a cohort of 156 patients, 73% males, of an average age of 53 (26-67) years, with the following common indications: tumor (35%), hepatitis C (23%), and alcohol-related (21%) liver disease. Mean scores showed a statistically significant (P < .05) improvement after 1 year in 6 of 8 SF-36 dimensions, in the physical component summary score, and in 7 of 12 disease-specific dimensions. The two dimensions that showed no improvement in the SF-36 dimensions were "social functioning" and "vitality," whereas the specific dimensions to not improve were "sleep problems," "social interaction," "activities of daily living," and "concerns about the future." CONCLUSION Findings suggest that perceived QOL after LT improves but could be further enhanced with the use of specific programs for amending sleep disorders and physical aspects.
Collapse
Affiliation(s)
- T Casanovas
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
| | - M Herdman
- Insight Consulting and Research, Mataró, Spain
| | - A Chandía
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - M C Peña
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - J Fabregat
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | |
Collapse
|
36
|
Abstract
As technology introduces more advanced therapies, individuals have realized that quantity or length of life may not always be the ultimate goal in treating disease. The quality of life at times is as important as length of life. In this article, we review the literature regarding quality of life after intestinal transplantation. Published data on patient survival are briefly reviewed and the available studies investigating quality of life are examined. Few studies have been performed to date, but the limitations and implications of the available studies are summarized.
Collapse
Affiliation(s)
- Debra Sudan
- University of Nebraska Medical Center, Omaha, Neb., USA
| |
Collapse
|
37
|
Heyes CM, Schofield T, Gribble R, Day CA, Haber PS. Reluctance to Accept Alcohol Treatment by Alcoholic Liver Disease Transplant Patients: A Qualitative Study. Transplant Direct 2016; 2:e104. [PMID: 27795986 PMCID: PMC5068203 DOI: 10.1097/txd.0000000000000617] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/11/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) is the optimum treatment for patients with end-stage alcoholic liver disease (ALD). However, despite a recognized risk of relapse to harmful drinking, ALD transplant patients are reluctant to use speciality alcohol treatment to support their abstinence, even when offered within the LT context. This study aimed to understand and identify factors contributing to alcohol treatment reluctance by ALD patients undergoing transplantation. METHODS We conducted an in-depth qualitative study of ALD transplant patients. Minimally structured face-to-face interviews explored participants' alcohol-related experiences and their reasons for not using alcohol treatment during the course of their transplantation. Thematic analysis was used to analyze and interpret interview data to understand treatment reluctance based on participants' experiences. RESULTS Five major themes were identified among 3 subgroups of patients (pretransplant and posttransplant abstainers and posttransplant relapsers): (i) the "contract" of mandatory abstinence, (ii) the "gap in the program" involving the lack of candour between patient and staff about alcohol-related matters and the lack of addiction services, (iii) a preference by participants to self-manage their alcohol use disorder, (iv) social support as a facilitator of abstinence and the risk of relapse when social support is diminished, and (v) the fear of stigmatization. Each of these factors were dynamically interrelated and differed slightly for each subgroup. CONCLUSIONS The LT services may benefit from the inclusion of integrated specialist addiction services in their model of care. Such an approach may enhance the acceptability of alcohol treatment and reduce the risk of relapse among ALD transplant participants, especially for those whose social supports have diminished.
Collapse
Affiliation(s)
- Cathy M. Heyes
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, Australia
| | - Toni Schofield
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, NSW, Australia
| | - Robert Gribble
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Consultation Liaison Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Carolyn A. Day
- Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW, Australia
| | - Paul S. Haber
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, Australia
- Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW, Australia
| |
Collapse
|
38
|
Mühlbacher A, Bethge S. First and Foremost Battle the Virus: Eliciting Patient Preferences in Antiviral Therapy for Hepatitis C Using a Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:776-787. [PMID: 27712705 DOI: 10.1016/j.jval.2016.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/04/2016] [Accepted: 04/14/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND There has been tremendous progress regarding treatment options for hepatitis C virus (HCV) infection. Several interferon-free regimens are awaiting regulatory approval. These innovations promise substantial reductions in the burden of disease and side effects as well as a decrease in treatment duration. OBJECTIVES The aim of this quantitaitive study was to elicit patient preferences for attributes of innovative antiviral therapies for hepatitis C. METHODS A systematic literature search and 14 semi-structured interviews were performed, resulting in eight patient-relevant characteristics. For the discrete choice experiment, an experimental design (3×3 + 5×6) was generated using Ngene software. The survey was conducted in August 2014 through computer-assisted personal interviews. The data were effects-coded in a random parameter logit estimation. RESULTS Participants were patients with HCV (N = 561; 58.1% men) in different treatment states. The analysis revealed a predominance of the attribute "reaching sustained virological response." When considering confidence intervals, the results showed three different preference ranks. At first place was "sustained virological response" (level difference [LD] 3.98), second was "anemia" (LD 1.10), followed by "number of interferon injections" (LD 0.92), "rash" (LD 0.82), "nausea and/or diarrhea" (LD 0.79), and "duration of antiviral therapy" (LD 0.78). The last position was occupied by both "tiredness/fatigue" (LD 0.31) and "headache" (LD 0.34). CONCLUSIONS From the patients' point of view, sustained virological response is the most essential criterion for choosing an HCV therapy. It was ranked at the highest, dominating all side effects and modes of administration. Furthermore, this study proved that patients consider both the probability of occurrence and the severity of treatment-induced side effects. Results clearly point to valuation of probabilities that is separate from that of severity.
Collapse
Affiliation(s)
- Axel Mühlbacher
- Health Economics and Healthcare Management, Hochschule Neubrandenburg, Neubrandenburg, Germany.
| | - Susanne Bethge
- Health Economics and Healthcare Management, Hochschule Neubrandenburg, Neubrandenburg, Germany
| |
Collapse
|
39
|
Armstrong AR, Herrmann SE, Chassany O, Lalanne C, Da Silva MH, Galano E, Carrieri PM, Estellon V, Sogni P, Duracinsky M. The International development of PROQOL-HCV: An instrument to assess the health-related quality of life of patients treated for Hepatitis C virus. BMC Infect Dis 2016; 16:443. [PMID: 27553866 PMCID: PMC4994204 DOI: 10.1186/s12879-016-1771-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 08/10/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) compromises Health-related Quality of Life (HRQL) with detriments to Physical, Mental and Social health domains. Treatment with interferon and ribavirin is associated with side effects which further impair HRQL. New treatments appear potent, effective and tolerable. However, Patient Reported Outcomes instruments that capture the impact on HRQL for people with hepatitis C are largely non-specific and will be needed in the new treatment era. Therefore, we developed a conceptually valid multidimensional model of HCV-specific quality of life and pilot survey instrument, the Patient Reported Outcome Quality of Life survey for HCV (PROQOL-HCV). METHODS HCV patients from France (n = 30), Brazil (n = 20) and Australia (n = 20) were interviewed to investigate HCV-HRQL issues raised in the scientific literature and by treatment specialists. Interviews were recorded, transcribed and translated into English and French. RESULTS Fifteen content dimensions were derived from the qualitative analysis, refined and fitted to four domains: (1) Physical Health included: fatigue, pain, sleep, sexual impairment and physical activity; (2) Mental Health: psychological distress, psychosocial impact, and cognition; (3) Social Health: support, stigma, social activity, substance use; (4) TREATMENT: management, side effects, and fear of treatment failure. The impact of some dimensions extended beyond their primary domain including: physical activity, cognition, sleep, sexual impairment, and the three treatment dimensions. A bank of 300 items was constructed to reflect patient reports and, following expert review, reduced to a 72-item pilot questionnaire. CONCLUSION We present a conceptually valid multidimensional model of HCV-specific quality of life and the pilot survey instrument, PROQOL-HCV. The model is widely inclusive of the experience of hepatitis C and the first to include the treatment dimension.
Collapse
Affiliation(s)
- Andrew Richard Armstrong
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Australian Institute of Family Studies, Melbourne, Australia
| | - Susan Elizabeth Herrmann
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia Australia
| | - Olivier Chassany
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
- URC-ECO, Hopital Hotel-Dieu, AP-HP, Paris, France
| | - Christophe Lalanne
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Eliana Galano
- Centro de Referência e Treinamento DST/Aids, Rue santa Cruz, Sao Paulo, Brazil
| | | | | | - Philippe Sogni
- Service d’Hépatologie, Hopital Cochin, AP-HP, Paris, France
| | - Martin Duracinsky
- EA 7334 REMES, Patient-Centered Outcomes Research, University Paris-Diderot, Sorbonne Paris Cité, Paris, France
- URC-ECO, Hopital Hotel-Dieu, AP-HP, Paris, France
- Service de Médecine Interne et d’Immunologie Clinique, Hopital Bicetre, AP-HP, Kremlin-Bicetre, France
| |
Collapse
|
40
|
Barboza KC, Salinas LM, Sahebjam F, Jesudian AB, Weisberg IL, Sigal SH. Impact of depressive symptoms and hepatic encephalopathy on health-related quality of life in cirrhotic hepatitis C patients. Metab Brain Dis 2016; 31:869-80. [PMID: 27032930 DOI: 10.1007/s11011-016-9817-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/01/2016] [Indexed: 02/06/2023]
Abstract
Depression, common in chronic medical conditions, and hepatic encephalopathy (HE), a reversible neuropsychiatric syndrome due to liver dysfunction, are associated with impaired health-related quality of life (HRQOL) in cirrhosis and hepatitis C (HCV). This study investigated the impact of depression and HE on HRQOL in cirrhotic patients with HCV. A convenience sample of 43 ambulatory patients, with varying degrees of cirrhosis secondary to HCV, was prospectively enrolled in this study. Participants were assessed for any current depressive, fatigue, and daytime sleepiness symptoms and underwent a psychometric evaluation to determine the presence of HE symptoms. Participants reported current HRQOL on general health and liver disease-specific questionnaires. Diagnosis and current health status were confirmed via medical records. The associations between disease severity, depressive symptoms, HE, fatigue, and daytime sleepiness were measured. Predictors of HRQOL in this sample were determined. Depressive symptoms (70 %) and HE (77 %) were highly prevalent in this sample, with 58 % actively experiencing both conditions at the time of study participation. A significant positive association was found between depressive symptoms and HE severity (P = .05). Depressive symptoms were significantly associated with fatigue (P < .001), daytime sleepiness (P < .001), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). HE was significantly associated with fatigue (P = .02), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). Depressive symptoms and HE were significant predictors of reduced HRQOL (P < .001), with depressive symptoms alone accounting for 58.8 % of the variance. Depressive symptoms and HE accounted for 68.0 % of the variance. Findings suggest a possible pathophysiological link between depression and HE in cirrhosis, and potentially a wider-reaching benefit of treating minimal and overt HE than previously appreciated.
Collapse
Affiliation(s)
- Katherine C Barboza
- Department of Medicine, New York University Langone Medical Center, New York City, NY, USA.
| | - Lilian M Salinas
- Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York City, NY, USA
| | - Farhad Sahebjam
- Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York City, NY, USA
| | - Arun B Jesudian
- Center for Liver Disease and Transplantation, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Ilan L Weisberg
- Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York City, New York, USA
| | - Samuel H Sigal
- Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York City, NY, USA
| |
Collapse
|
41
|
Aguiar MIFD, Braga VAB, Garcia JHP, Lima CAD, Almeida PCD, Souza AMAE, Rolim ILTP. Quality of life in liver transplant recipients and the influence of sociodemographic factors. Rev Esc Enferm USP 2016; 50:411-8. [DOI: 10.1590/s0080-623420160000400006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/20/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To verify the influence of sociodemographic factors on the quality of life of patients after liver transplant. METHOD Cross-sectional study with 150 patients who underwent liver transplant at a referral center. A sociodemographic instrument and the Liver Disease Quality of Life questionnaire were applied. The analysis of variance (ANOVA) was performed, as well as multiple comparisons by the Tukey test and Games-Howell tests when p <0.05. RESULTS Old age had influence on domains of symptoms of liver disease (p = 0.049), sleep (p = 0.023) and sexual function (p = 0.03). Men showed better significant mean values than women for the loneliness dimension (p = 0.037). Patients with higher educational level had higher values for the domain of stigma of liver disease (p = 0.014). There was interference of income in the domains of quality of social interaction (p = 0.033) and stigma of the disease (p = 0.046). CONCLUSION In half of the quality of life domains, there was influence of some sociodemographic variable.
Collapse
|
42
|
Factors that Influence Health-Related Quality of Life in Patients with Primary Sclerosing Cholangitis. Dig Dis Sci 2016; 61:1692-9. [PMID: 26743764 DOI: 10.1007/s10620-015-4013-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 12/14/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is an incurable, cholestatic liver disease often coincident with inflammatory bowel disease (IBD). AIMS To evaluate the impact of liver disease and IBD on health-related quality of life (HRQoL) in PSC. METHODS A mixed-methods, cross-sectional study was performed at a tertiary center. Short Form-36 (SF-36) scores were compared between PSC, Canadian normative data, and disease controls. Disease-specific instruments scores [PBC-40, Short IBD questionnaire, Liver Disease Quality of Life Questionnaire (LDQOL)] were compared between PSC and disease controls. Multivariable regression identified factors independently associated with final SF-36 component scores. Qualitative evaluation of patient questionnaires was performed using a content analysis framework. RESULTS One hundred and sixty-two surveys were completed (99 PSC, 26 primary biliary cirrhosis, 16 non-autoimmune cholestatic liver disease, and 21 IBD). PSC patients had significantly lower SF-36 scores than Canadian controls, but similar scores to disease controls. LDQOL most accurately predicted HRQoL. Factors negatively associated with physical HRQoL included shorter IBD duration, liver disease symptoms, and decompensated cirrhosis. Mental HRQoL was influenced by liver disease and IBD symptoms, pruritus, social isolation, and depression. Nearly 75 % expressed existential anxiety regarding disease progression and diminished life expectancy, with 25 % disclosing social isolation. CONCLUSIONS Patients with PSC have significantly lower HRQoL than healthy controls. Both symptoms of IBD and chronic liver disease impact HRQoL in patients with PSC, which lead to significant psychologic burden that is expressed by existential anxieties and social isolation. A PSC-specific HRQoL tool is critical to adequately quantify the distinct impact of IBD and cholestatic liver disease.
Collapse
|
43
|
Bedell A, Taft TH, Keefer L, Pandolfino J. Development of the Northwestern Esophageal Quality of Life Scale: A Hybrid Measure for Use Across Esophageal Conditions. Am J Gastroenterol 2016; 111:493-9. [PMID: 26881974 PMCID: PMC5247632 DOI: 10.1038/ajg.2016.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/24/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Measures of health-related quality of life (HRQOL) in chronic esophageal conditions such as gastroesophageal reflux disease, eosinophilic esophagitis, and achalasia are widely used to measure this important patient-reported outcome. We seek to leverage these existing measures to create a hybrid measure of esophageal illness HRQOL (the Northwestern Esophageal Quality of Life-NEQOL), allowing for broad use across diseases while maintaining sensitivity to nuances of a specific condition. METHODS A three-step, mixed-methods process per FDA guidelines for patient-reported outcome (PRO) development was followed: review and consolidation of existing HRQOL measure items into a single questionnaire, reliability and validity analyses (principle components factor analysis, Cronbach alpha, Guttman split-half, inter-item correlation, test-retest correlation, and Pearson's correlation with related constructs) based on responses from a representative sample of esophageal illness patients, and individual structured cognitive interviews with patients for item refinement and reduction. RESULTS An initial 30-item measure was created. Two-hundred twelve patients completed the reliability and validity portion of the study, and 15 completed cognitive interviews. Factor analysis and item-reduction resulted in 11 items being removed from the NEQOL prior to patient interviews. Construct validity was supported by moderate and significant correlations with psychological distress and general HRQOL. Test-retest reliability was excellent. Following patient interviews, an additional 5 items were removed because of floor effects or participant feedback yielding a 14-item, single scale measure of HRQOL. CONCLUSIONS Although more research is warranted, the NEQOL is a reliable and a valid hybrid measure of disease-specific HRQOL across several chronic esophageal conditions.
Collapse
Affiliation(s)
- Alyse Bedell
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tiffany H. Taft
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laurie Keefer
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John Pandolfino
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
44
|
[Prospective validation of the Spanish version of the Short Form-Liver Disease Quality of life]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 39:243-54. [PMID: 26708525 DOI: 10.1016/j.gastrohep.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/06/2015] [Accepted: 08/20/2015] [Indexed: 01/22/2023]
Abstract
UNLABELLED Health-Related Quality of Life (HRQL) assessed by a specific, validated, brief test is an important measure of the health status perceived by patients diagnosed with chronic liver disease. AIM To prospectively validate the SF-LDQOL (Short Form-Liver Disease Quality of Life) instrument in Spanish, in patients diagnosed with liver disease of diverse etiologies and distinct severity levels, attended at the Hospital Universitari de Bellvitge (Barcelona). METHODS This observational, longitudinal study was conducted by using the SF-LDQOL in outpatients diagnosed with chronic liver disease. This instrument contains the generic SF-36 test, and 9 liver disease-specific dimensions. We also evaluated socio-demographic features, the number of missing responses, and internal consistency (Cronbach's alpha), as well as Pearson's correlation between SF-36 and SF-LDQOL scores on specific dimensions by means of a multi-trait multi-method technique. The sample consisted of 340 patients. RESULTS In 6 out of 9 liver disease-specific dimensions, reliability coefficients for internal consistency exceeded 0.70. The convergent validity of these items was acceptable in 8 out of 9 dimensions, with a scaling success of 100% in each item. Missing items were under 1.5% in all dimensions, except for Sexual Functioning. CONCLUSIONS The Spanish version of the SF-LDQOL has, in general, good psychometric properties, making it a useful instrument for clinical practice in a population of patients diagnosed with chronic liver disease, with or without liver transplantation.
Collapse
|
45
|
Thursz M, Forrest E, Roderick P, Day C, Austin A, O'Grady J, Ryder S, Allison M, Gleeson D, McCune A, Patch D, Wright M, Masson S, Richardson P, Vale L, Mellor J, Stanton L, Bowers M, Ratcliffe I, Downs N, Kirkman S, Homer T, Ternent L. The clinical effectiveness and cost-effectiveness of STeroids Or Pentoxifylline for Alcoholic Hepatitis (STOPAH): a 2 × 2 factorial randomised controlled trial. Health Technol Assess 2015; 19:1-104. [PMID: 26691209 PMCID: PMC4781103 DOI: 10.3310/hta191020] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Alcoholic hepatitis (AH) is a distinct presentation of alcoholic liver disease arising in patients who have been drinking to excess for prolonged periods, which is characterised by jaundice and liver failure. Severe disease is associated with high short-term mortality. Prednisolone and pentoxifylline (PTX) are recommended in guidelines for treatment of severe AH, but trials supporting their use have given heterogeneous results and controversy persists about their benefit. OBJECTIVES The aim of the clinical effectiveness and cost-effectiveness of STeroids Or Pentoxifylline for Alcoholic Hepatitis trial was to resolve the clinical dilemma on the use of prednisolone or PTX. DESIGN The trial was a randomised, double-blind, 2 × 2 factorial, multicentre design. SETTING Sixty-five gastroenterology and hepatology inpatient units across the UK. PARTICIPANTS Patients with a clinical diagnosis of AH who had a Maddrey's discriminant function value of ≥ 32 were randomised into four arms: A, placebo/placebo; B, placebo/prednisolone; C, PTX/placebo; and D, PTX/prednisolone. Of the 5234 patients screened for the trial, 1103 were randomised and after withdrawals, 1053 were available for primary end-point analysis. INTERVENTIONS Those allocated to prednisolone were given 40 mg daily for 28 days and those allocated to PTX were given 400 mg three times per day for 28 days. OUTCOMES The primary outcome measure was mortality at 28 days. Secondary outcome measures included mortality or liver transplant at 90 days and at 1 year. Rates of recidivism among survivors and the impact of recidivism on mortality were assessed. RESULTS At 28 days, in arm A, 45 of 269 (16.7%) patients died; in arm B, 38 of 266 (14.3%) died; in arm C, 50 of 258 (19.4%) died; and in arm D, 35 of 260 (13.5%) died. For PTX, the odds ratio for 28-day mortality was 1.07 [95% confidence interval (CI) 0.77 to 1.40; p = 0.686)] and for prednisolone the odds ratio was 0.72 (95% CI 0.52 to 1.01; p = 0.056). In the logistic regression analysis, accounting for indices of disease severity and prognosis, the odds ratio for 28-day mortality in the prednisolone-treated group was 0.61 (95% CI 0.41 to 0.91; p = 0.015). At 90 days and 1 year there were no significant differences in mortality rates between the treatment groups. Serious infections occurred in 13% of patients treated with prednisolone compared with 7% of controls (p = 0.002). At the 90-day follow-up, 45% of patients reported being completely abstinent, 9% reported drinking within safety limits and 33% had an unknown level of alcohol consumption. At 1 year, 37% of patients reported being completely abstinent, 10% reported drinking within safety limits and 39% had an unknown level of alcohol consumption. Only 22% of patients had attended alcohol rehabilitation treatment at 90 days and 1 year. CONCLUSIONS We conclude that prednisolone reduces the risk of mortality at 28 days, but this benefit is not sustained beyond 28 days. PTX had no impact on survival. Future research should focus on interventions to promote abstinence and on treatments that suppress the hepatic inflammation without increasing susceptibility to infection. TRIAL REGISTRATION This trial is registered as EudraCT 2009-013897-42 and Current Controlled Trials ISRCTN88782125. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 102. See the NIHR Journals Library website for further project information. The NIHR Clinical Research Network provided research nurse support and the Imperial College Biomedical Research Centre also provided funding.
Collapse
Affiliation(s)
- Mark Thursz
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ewan Forrest
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Paul Roderick
- Primary Care & Population Sciences, University of Southampton, Southampton, UK
| | - Christopher Day
- Institute of Cellular Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Austin
- Department of Gastroenterology, Derby Royal Hospital, Derby, UK
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Stephen Ryder
- Department of Hepatology, Nottingham University Hospitals NHS Trust and National Institute for Health Research Biomedical Research Unit, Queens Medical Centre, Nottingham, UK
| | - Michael Allison
- Department of Hepatology, Addenbrookes Hospital, Cambridge, UK
| | - Dermot Gleeson
- Department of Hepatology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Anne McCune
- Department of Hepatology, Bristol Royal Infirmary, Bristol, UK
| | - David Patch
- Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
| | - Mark Wright
- Department of Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Steven Masson
- Institute of Cellular Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul Richardson
- Department of Hepatology, Royal Liverpool Hospital, Liverpool, UK
| | - Luke Vale
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Mellor
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Louise Stanton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Megan Bowers
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Ian Ratcliffe
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Nichola Downs
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Scott Kirkman
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Ternent
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
46
|
Šumskienė J, Kupčinskas L, Šumskas L. Health-related quality of life measurement in chronic liver disease patients. MEDICINA-LITHUANIA 2015; 51:201-8. [PMID: 26424183 DOI: 10.1016/j.medici.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Health-related quality of life (HRQOL) is an important health indicator in medical outcome research and clinical practice. This issue tends to attract even more attention with the recent improvements of patient survival after liver transplantation. This review article aims at providing a deeper insight into practices used for evaluating HRQOL in chronic liver diseases (CLDs) and especially cirrhosis patients during different stages of the disease including liver transplantation. MATERIALS AND METHODS A systematic review of the MEDLINE database and Cochrane library was conducted. A search using the Medical Subject Headings (MeSH) major terms "liver disease" AND "quality of life" was applied for the period from 1966 to 2012. RESULTS Our review identified 1483 publications. The searched showed that significant increase of publications (from 362 to 1018) was observed during last decade (period 2003-2012) in comparison with previous. The majority of publications were in English (n=1179). The literature search and analysis provided information on the most common generic and disease-specific HRQOL instruments, which are used in CLD patients: Medical Outcomes Study Short Form-36, the National Institute of Diabetes and Digestive and Kidney Diseases Quality of Life questionnaire, the Chronic Liver Disease questionnaire, the Liver Disease Quality of Life questionnaire, and other. CONCLUSIONS Quality of life instruments are potentially powerful tools for evaluating the functional status, presenting gains of treatment and reflecting patients' ability to return to a normal lifestyle in CLD patients. More attention should be paid by clinicians for integrated use of clinical tests together with HRQOL instruments in liver transplantation for establishing the reference levels of mental, physical, and role-social functioning.
Collapse
Affiliation(s)
- Jolanta Šumskienė
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Šumskas
- Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute of Health Research, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| |
Collapse
|
47
|
Microglia-dependent alteration of glutamatergic synaptic transmission and plasticity in the hippocampus during peripheral inflammation. J Neurosci 2015; 35:4942-52. [PMID: 25810524 DOI: 10.1523/jneurosci.4485-14.2015] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Peripheral inflammatory diseases are often associated with behavioral comorbidities including anxiety, depression, and cognitive dysfunction, but the mechanism for these is not well understood. Changes in the neuronal and synaptic functions associated with neuroinflammation may underlie these behavioral abnormalities. We have used a model of colonic inflammation induced by 2,4,6-trinitrobenzenesulfonic acid in Sprague Dawley rats to identify inflammation-induced changes in hippocampal synaptic transmission. Hippocampal slices obtained 4 d after the induction of inflammation revealed enhanced Schaffer collateral-induced excitatory field potentials in CA1 stratum radiatum. This was associated with larger-amplitude mEPSCs, but unchanged mEPSC frequencies and paired-pulse ratios, suggesting altered postsynaptic effects. Both AMPA- and NMDA-mediated synaptic currents were enhanced, and analysis of AMPA-mediated currents revealed increased contributions of GluR2-lacking receptors. In keeping with this, both transcripts and protein levels of the GluR2 subunit were reduced in hippocampus. Both long-term potentiation (LTP) and depression (LTD) were significantly reduced in hippocampal slices taken from inflamed animals. Chronic administration of the microglial/macrophage activation inhibitor minocycline to the inflamed animals both lowered the level of the cytokine tumor necrosis factor α in the hippocampus and completely abolished the effect of peripheral inflammation on the field potentials and synaptic plasticity (LTP and LTD). Our results reveal profound synaptic changes caused by a mirror microglia-mediated inflammatory response in hippocampus during peripheral organ inflammation. These synaptic changes may underlie the behavioral comorbidities seen in patients.
Collapse
|
48
|
Saffari M, Alavian SM, Naderi MK, Pakpour AH, Al Zaben F, Koenig HG. Cross-Cultural Adaptation and Psychometric Assessment of the Liver Disease Symptom Index 2.0 to Measure Health-Related Quality of Life Among Iranian Patients With Chronic Hepatitis B. J Transcult Nurs 2015; 27:496-508. [PMID: 25801763 DOI: 10.1177/1043659615577698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE There are only a few measures to assess quality of life among patients with liver disorders. The aim of this study was to determine the psychometric properties of the Liver Disease Symptom Index Version 2.0 (LDSI 2.0), a disease specific measure of health-related quality of life (HRQOL), in Persian-speaking patients with chronic hepatitis B. METHOD Using a cross-sectional design, 312 patients were recruited. Data were collected from the patients using the LDSI 2.0, Chronic Liver Disease Questionnaire, and EuroQol. Convergent and discriminant validity were investigated. Known-groups validity and factor structure of the scale were also determined. Receiver operating characteristics was used to discriminate patients based on their general health status. RESULTS Significant correlations were found between HRQOL measures. Disease duration, disease stage, and serum aspartate aminotransferase differentiated patients. Factor analysis determined a seven-factor solution that explained 70% of the total variance. Area under the curve in receiver operating characteristics analysis was 0.706; 95% confidence interval = [0.648, 0.764]. CONCLUSIONS The LDSI2.0 is an appropriate HRQOL scale for use among Iranian patients with chronic hepatitis B based on its solid psychometric properties in this population.
Collapse
Affiliation(s)
- Mohsen Saffari
- Baqiyatallah University of Medical Sciences Tehran, Iran
| | | | | | | | | | - Harold G Koenig
- King Abdulaziz University, Jeddah, Saudi Arabia Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
49
|
Agrawal S, Umapathy S, Dhiman RK. Minimal hepatic encephalopathy impairs quality of life. J Clin Exp Hepatol 2015; 5:S42-8. [PMID: 26041957 PMCID: PMC4442849 DOI: 10.1016/j.jceh.2014.11.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 11/26/2014] [Indexed: 01/18/2023] Open
Abstract
Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of neurocognitive impairment in cirrhosis. It is a frequent occurrence in patients of cirrhosis and is detectable only by specialized neurocognitive testing. MHE is a clinically significant disorder which impairs daily functioning, driving performance, work capability and learning ability. It also predisposes to the development of overt hepatic encephalopathy, increased falls and increased mortality. This results in impaired quality of life for the patient as well as significant social and economic burden for health providers and care givers. Early detection and treatment of MHE with ammonia lowering therapy can reverse MHE and improve quality of life.
Collapse
Affiliation(s)
| | | | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| |
Collapse
|
50
|
Prevalence and predictors of sleep disturbance among liver diseases in long-term transplant survivors. Can J Gastroenterol Hepatol 2015; 29:440-4. [PMID: 26176212 PMCID: PMC4699607 DOI: 10.1155/2015/359640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with cirrhosis are known to experience sleep disturbance, which negatively impacts health-related quality of life. OBJECTIVE To assess the prevalence and predictors of sleep disturbance before and after liver transplantation (LT). METHODS Both pre- and post-LT patients were administered the Basic Nordic Sleep Questionnaire. The primary outcome was overall sleep satisfaction; the secondary outcomes were sleep latency and sleep duration. RESULTS Eighty-three patients participated pre-LT and 273 post-LT. Overall, participants having completed both pre- and post-LT questionnaires reported satisfactory sleep 61% of the time before LT and 65% of the time after LT. However, on review of all questionnaires, patients with alcoholic liver disease (ETOH) experienced dramatically less sleep disturbance (OR 0.13 [95% CI 0.03 to 0.60]) post-LT, whereas those with hepatitis C remained without improvement (OR 0.90 [95% CI [0.38 to 2.15]). On logistic regression, patients with ETOH had statistically less sleep satisfaction pre-LT (OR 5.8 [95% CI 1.0 to 40.5]) and significantly better sleep satisfaction post-LT (OR 0.50 [95% CI 0.20 to 1.00]) compared with those with hepatitis C. In addition, both ETOH and other conditions had significantly better sleep latency than hepatitis C patients. CONCLUSIONS Sleep parameters for patients who undergo LT for hepatitis C do not improve following LT as much as they do in patients transplanted for ETOH. Following LT, patients transplanted for ETOH are significantly more satisfied with their sleep than those transplanted for hepatitis C. Physicians should address and manage sleep quality after LT, so as to ultimately improve quality of life.
Collapse
|