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Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C
R J Fontana1, C A Moyer, S Sonnad
1Department of Internal Medicine, Consortium for Health Outcomes Innovation and Cost-Effectiveness Studies University of Michigan Medical School, Huron Gastroenterology Associates, Ann Arbor, USA.
Insights
Active medical conditions, not liver disease severity, significantly impact health-related quality of life (HRQOL) in chronic hepatitis C (HCV) patients. Painful comorbidities and depression were key factors affecting HRQOL scores.
Area of Science:
- Hepatology
- Quality of Life Research
- Internal Medicine
Background:
- Chronic hepatitis C (HCV) patients report reduced health-related quality of life (HRQOL) irrespective of liver disease severity.
- Existing HRQOL instruments may be insensitive, or extrahepatic factors may influence patient well-being.
Purpose of the Study:
- To investigate the correlation between past substance abuse, active medical comorbidities, psychiatric conditions, and HRQOL scores in HCV patients.
- To identify factors contributing to diminished HRQOL beyond liver disease severity.
Main Methods:
- Utilized the modified SF-36 and Health Utilities Index (HUI) Mark III to assess HRQOL in 107 patients with prior interferon treatment failure.
- Collected data on medical history, including substance abuse and active comorbidities.
Main Results:
- Patients exhibited significantly reduced HRQOL scores compared to healthy controls.
- Liver disease parameters and substance abuse history did not correlate with HRQOL.
- Active medical comorbidities, particularly painful conditions and depression, were strongly associated with lower HRQOL and HUI scores.
Conclusions:
- Active medical and psychiatric comorbidities significantly influence HRQOL in chronic HCV patients.
- These comorbidities may explain the reduction and variability in HRQOL scores observed in this population.
- Further research is needed to validate these findings in treatment-naive HCV patients.
Objectives:
Patients with chronic hepatitis C (HCV) consistently report a reduction in multiple domains of health-related quality of life (HRQOL) that does not correlate with liver disease severity. This may in part be due to the use of insensitive HRQOL instruments or extrahepatic factors that independently influence HRQOL. We hypothesized that a past history of substance abuse or active medical and psychiatric comorbidities would correlate with HRQOL scores.
Methods:
In 107 patients who had failed previous interferon therapy, HRQOL was measured by using the modified SF-36, a disease-specific instrument, and the Health Utilities Index (HUI) Mark III, a generic instrument.
Results:
Multiple SF-36 subscale and summary scores as well as the HUI Mark III attributes of emotion and pain were significantly reduced in the study population compared with healthy controls (p < 0.001). Serum alanine aminotransferase and HCV RNA levels, HCV genotype, liver histology, and HCV risk factors as well as demographic variables did not correlate with modified SF-36 and HUI scores. In addition, a history of alcohol abuse or dependency and intravenous drug use or dependency, identified in 52 and 51% of participants, respectively, did not correlate with HRQOL scores. However, the presence of one or more active medical comorbidities, defined as a chronic medical condition requiring treatment and monitoring, was significantly associated with both the modified SF-36 scores and HUI attribute deficits (p < 0.001). In particular, painful medical comorbidities or depressed mood requiring treatment were significantly associated with modified SF-36 scores and with HUI attribute deficits and utility scores (p < 0.001).
Conclusions:
Active medical and psychiatric comorbidities may account for some of the reduction and variability in HRQOL scores in patients with chronic HCV who have failed previous interferon therapy. Future studies that control for the presence of active comorbidities in large groups of treatment naive patients with varying severity of chronic HCV are needed to confirm these findings.