Linda Henry

Systematic review: patient‐reported outcomes in chronic hepatitis C ‐ the impact of liver disease and new treatment regimens

Treatment for chronic hepatitis C (CH‐C) is rapidly changing and moving away from an interferon and ribavirin‐based therapy to interferon‐free ribavirin‐free all oral regimens. These regimens are simpler and shorter to administer with very high efficacy rates and better side effect profiles. As advances in the treatment of CH‐C occur, it is imperative to capture both clinical outcomes (efficacy and safety) as well as patient‐reported outcomes (PROs). In fact, PROs assesses and quantifies the impact of these regimens on patient experience. PROs assess patients health‐related quality of life (HRQOL) especially in the realms of fatigue and neuropsychiatric issues such as depression which can affect treatment adherence and work productivity.

Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in the United States and the Rest of the World

Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease with increasing prevalence, which can progress to cirrhosis and liver failure. Because of the obesity epidemic and increasing prevalence of metabolic syndrome, NAFLD and its progressive form, nonalcoholic steatohepatitis, are seen more commonly in different parts of the world. This article reviews the worldwide epidemiology of NAFLD and nonalcoholic steatohepatitis. The PubMed database was used to identify studies related to epidemiology of NAFLD in the adult population. It is estimated that the epidemic of obesity will continue to fuel the burden of NAFLD and its long-term complications.

The impact of type 2 diabetes and obesity on the long-term outcomes of more than 85 000 liver transplant recipients in the US.

Type 2 diabetes is known to negatively impact the outcome of chronic liver disease.

Economic and Quality-of-Life Implications of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a very common chronic liver disease worldwide, is on the rise following the trend of increasing prevalence of obesity, is the second most common indication for liver transplantation, and is an important cause for hepatocellular carcinoma. Despite the increasing recognition of NAFLD as an important chronic liver disease, little has been published on the economic and health-related quality of life (HR-QOL) impact of NAFLD. We reviewed the current literature related to the economics and HR-QOL of NAFLD and found that increased costs and decreased HR-QOL were associated with NAFLD.

Hepatitis C infection: A multi-faceted systemic disease with clinical, patient reported and economic consequences

Hepatitis C virus infection (HCV) affects approximately 170-200 million individuals globally. HCV is one of the primary causes of hepatocellular carcinoma (HCC) and cirrhosis and has been identified as the leading indication for liver transplantation in most Western countries. Because HCV is a systemic disease with hepatic, extrahepatic, economic and patient reported consequences, it is important for healthcare practitioners to understand the comprehensive and multi-faceted picture of this disease. In this context, it is important to fully appreciate the impact of HCV on the individual patient and the society. With the recent advent of the new generation of direct antiviral agents, the long standing goal of eradicating HCV in most infected patients has been accomplished. Therefore, now more than ever, it is critical to assess the total benefits of sustained virological response in a comprehensive manner. This should not be limited to the clinical benefits of HCV cure, but also to account for the improvement of patient reported health and economic outcomes of HCV cure. It is only through this comprehensive approach to HCV and its treatment that we will understand the full impact of this disease and the tremendous gains that have been achieved with the new antiviral regimens.

The association of hepatitis C virus infection and post‐liver transplant diabetes: data from 17 000 HCV‐infected transplant recipients

Hepatitis C virus (HCV) is associated with metabolic manifestations including insulin resistance and diabetes through various mechanisms. Whether HCV infection is associated with an increased risk of post‐transplant diabetes in liver transplant recipients is unclear.

The use of spirometry testing prior to cardiac surgery may impact the Society of Thoracic Surgeons risk prediction score: a prospective study in a cohort of patients at high risk for chronic lung disease.

OBJECTIVESnChronic lung disease is a significant comorbidity in patients undergoing cardiac surgery. Chronic lung disease is currently being classified and reported to the Society of Thoracic Surgeons database by using either clinical interview or spirometric testing. We sought to compare the chronic lung disease classification captured by the 2 methods.nnnMETHODSnWe performed a prospectively designed study in which patients presenting for cardiac surgery, excluding emergent patients, were screened for a history of asthma, a history of 10 or more pack-years of smoking, a persistent cough, and the use of oxygen. Each selected patient underwent spirometry. The presence and severity of chronic lung disease was coded per Society of Thoracic Surgeons guidelines by using the 2 methods of clinical report and spirometric results. The chronic lung disease classifications were compared, and differences were determined by using concordance and discordance rates. The results were then used to construct Society of Thoracic Surgeons-predicted risk models.nnnRESULTSnThe discordant rate was 39.1%, with underestimation of the severity of chronic lung disease in 94% of misclassified patients. This affected the Society of Thoracic Surgeons-predicted risk models for prolonged ventilation, morbidity/mortality, and mortality by increasing the predicted risk when spirometry was used for morbidity/mortality by an average of 1.5 +/- 1.2 percentage points (P < .001) and prolonged ventilation time by an average of 1.3 +/- 1.4 percentage points (P < .001).nnnCONCLUSIONnThe use of patient history for symptoms, medication, and/or oxygen use as the only method to determine chronic lung disease for this subgroup of patients led to underreporting of chronic lung disease and underestimation of the risk for adverse outcomes. Therefore data submission to the Society of Thoracic Surgeons database should be designed to capture and correct for potential bias in the definition of chronic lung disease because the rate of spirometry in different centers in defining chronic lung disease is not regulated.

Risk of de novo post-transplant type 2 diabetes in patients undergoing liver transplant for non-alcoholic steatohepatitis

BackgroundNon-alcoholic steatohepatitis (NASH) is often seen together with components of metabolic syndrome. The aim of this study was to assess the risk of de novo post-transplant type 2 diabetes (DM) in liver transplant recipients with NASH.MethodsAll adult patients from the Scientific Registry of Transplant Recipients (2003–2012) transplanted for NASH or cryptogenic cirrhosis (the NASH cohort) without pre-transplant DM were included in this retrospective cross-sectional study.ResultsTotal 2,916 NASH subjects and 14,268 controls with non-HCV related cirrhosis or hepatocellular carcinoma were included. Patients with NASH were, on average, 6xa0years older, more likely female and overweight/obese. By 5xa0years post-transplant, 39.8xa0% NASH vs. 27.0xa0% controls developed at least one onset of de novo DM; this was observed starting 6xa0months post-transplant: 22.9xa0% vs. 16.7xa0% (relative risk 1.38). Later in follow-up, the relative risk of de novo DM was also higher in NASH: 1.46 by 3xa0years, 1.47 by 5xa0years (all pu2009<u20090.0001). After exclusion of DM that resolved after the first year, long-term DM remained higher in the NASH cohort: 7.6xa0% vs. 4.3xa0%, pu2009<u20090.0001. In multivariate analysis, after adjustment for confounders including the use of immunosuppressants, having NASH was independently associated with development of de novo post-transplant DM: adjusted hazard ratio (95xa0% CI)u2009=u20091.29 (1.18–1.42), pu2009<u20090.0001.ConclusionsLiver transplant recipients with NASH have a higher risk of de novo post-transplant DM. This suggests the presence of an underlying metabolic disorder beyond fatty liver that may be causative for both NASH and type 2 diabetes.

Overall health-related quality of life in patients with end-stage liver disease

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Monitoring and treatment of inactive chronic hepatitis B: Is it cost‐effective?

I n this issue of HEPATOLOGY, an interesting article by Toy et al. addresses the clinical effect and costeffectiveness of managing inactive chronic hepatitis B (CHB) carriers. Current clinical practice in China for hepatitis B virus (HBV) is prevention by vaccinating all infants and children against hepatitis B. In fact, this is a common practice in most of the developing and emerging countries, especially Africa and parts of eastern Asia. However, according to the researchers, despite a universal vaccination policy against hepatitis B in China, hepatitis B remains a major health threat to the general population. Using computer simulation and Markov modeling, the researchers assessed the cost-effectiveness of a strategy of lifelong monitoring for inactive CHB and treatment of eligible patients in Shanghai, China. In comparison with the current clinical practice in Shanghai, the strategy of “monitor and treat” was shown to be cost-effective with an incremental cost-effectiveness ratio (ICER) of