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The liver is one of the most
complex organs in the human body. It is the body’s largest organ and
responsible for more than 5,000 life-sustaining functions. The liver is
primarily responsible for converting food into energy. Additionally, the
liver filters the body from hundreds of potential toxins and synthesizes
a variety of factors necessary to sustain life. When the liver is
diseased, the entire body is affected.
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PLoS One.
2018 Aug
1;13(8):e0196908.
doi:
10.1371/journal.pone.0196908.
eCollection
2018.
A comprehensive
assessment of
patient reported
symptom burden,
medical
comorbidities, and
functional well
being in patients
initiating direct
acting antiviral
therapy for chronic
hepatitis C: Results
from a large US
multi-center
observational study.
Evon DM1,
Stewart PW2,
Amador J2,
Serper M3,
Lok AS4,
Sterling RK5,
Sarkar S6,
Golin CE7,8,
Reeve BB9,
Nelson DR10,
Reau N11,
Lim JK12,
Reddy KR3,
Di Bisceglie AM13,
Fried MW1.
Abstract
BACKGROUND:
Symptom
burden,
medical
comorbidities,
and
functional
well-being
of patients
with chronic
hepatitis C
virus (HCV)
initiating
direct
acting
antiviral (DAA)
therapy in
real-world
clinical
settings are
not known.
We
characterized
these
patient-reported
outcomes (PROs)
among HCV-infected
patients and
explored
associations
with
sociodemographic,
liver
disease, and
psychiatric/substance
abuse
variables.
METHODS AND
FINDINGS:
PROP UP is a
large US
multicenter
observational
study that
enrolled
1,600
patients
with chronic
HCV in
2016-2017.
Data
collected
prior to
initiating
DAA therapy
assessed the
following
PROs: number
of medical
comorbidities;
neuropsychiatric,
somatic,
gastrointestinal
symptoms (PROMIS
surveys);
overall
symptom
burden
(Memorial
Symptom
Assessment
Scale); and
functional
well-being (HCV-PRO).
Candidate
predictors
included
liver
disease
markers and
patient-reported
sociodemographic,
psychiatric,
and
alcohol/drug
use
features.
Predictive
models were
explored
using a
random
selection of
700
participants;
models were
then
validated
with data
from the
remaining
900
participants.
The cohort
was 55%
male, 39%
non-white,
48% had
cirrhosis
(12% with
advanced
cirrhosis);
52% were
disabled or
unemployed;
63% were on
public
health
insurance or
uninsured;
and over 40%
had markers
of
psychiatric
illness. The
median
number of
medical
comorbidities
was 4
(range:
0-15), with
sleep
disorders,
chronic
pain,
diabetes,
joint pain
and muscle
aches being
present in
20-50%.
Fatigue,
sleep
disturbance,
pain and
neuropsychiatric
symptoms
were present
in over 60%
and
gastrointestinal
symptoms in
40-50%. In
multivariable
validation
models, the
strongest
and most
frequent
predictors
of worse
PROs were
disability,
unemployment,
and use of
psychiatric
medications,
while liver
markers
generally
were not.
CONCLUSIONS:
This large
multi-center
cohort study
provides a
comprehensive
and
contemporary
assessment
of the
symptom
burden and
comorbid
medical
conditions
in patients
with HCV
treated in
real world
settings.
Pain,
fatigue, and
sleep
disturbance
were common
and often
severe.
Sociodemographic
and
psychiatric
markers were
the most
robust
predictors
of PROs.
Future
research
that
includes a
rapidly
changing
population
of HCV-infected
individuals
needs to
evaluate how
DAA therapy
affects PROs
and
elucidate
which
symptoms
resolve with
viral
eradication.
TRIAL
REGISTRATION:
(Clinicaltrial.gov:
NCT02601820).
Read the complete
study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070182/
Disability Ratings
Does Your Medical
Record Show Hep C
Related Diseases?
The Liver and
Hepatitis C
Reminder: The
VA will give a
Military Disability
Rating for each
service-connected
condition a service
member has, but the
DoD will only rate
service-connected
conditions that make
a service member
Unfit for Duty.
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