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Impaired quality of life varies among subsamples of patients with chronic hepatitis C
AASLDAl447
April 2000
genotype Ib) among the 62 had no more detectable HCV RNA at six months of treatment, 20 relapser and 19 non responder. We noticed 48% of asthenia, 27% of loss of weight, 21% of depression, 13.5% of dyspnea, 12% of arthritis, 9.8% of cutaneous manifestation, 8% of non specific abdominal pain, diarrhoea, or vomiting and 7% of palpitation. Only 10% of the patients performed an excellent tolerance of the therapy. Severe anaemia « lOgr/dl) was noted in 16% of the patients, leucopenia in 9.8% and thrompenia in 8.6%. No difference was observed in the prevalence of adverse events according to the response to treatment. The se adverse events conducted at a ribavirine dose reduction in II % of the patients and both drugs were discontinued in 14.8% patients. Conclusion: Combination therapy is an effective treatmen t but induced a lot of adverse effects. That is why it seems to be important to monitor adequate ly these patients.
6562 IMPAIRED QUALITY OF LIFE VARIES AMONG SUBSAMPLES OF PATIENTS WITH CHRONIC HEPATITIS C. Robin C. Hilsabeck, Tarek I. Hassanein, William Perry, UCSD Med Ctr. San Diego, CA. The SF-36 is a well-known measure of health-related quality of life (HRQOL) and has been increasingly used to assess patients with chronic Hepatitis C (CHC ). The SF-36 consists of 8 subscales and 2 composite scales (i.e., physical and menta l). Subscale scores range from 0 (very poor) to 100 (excellent), while the composite scales have a mean of 50 and a standard deviation of 10. Twenty- five patients from a university-based liver clinic completed the SF-36 . Our sample had a mean age of 48.76 (SD=6.77) years and a mean education of 13.96 (SD=2.73) years. Fifteen patients (60%) were male. 16 (64%) were Caucasian, and I I (72%) were single or divorced. Fourteen (56%) were unemployed or disabled, and their income level was < $10,000 per year. Seven patients (28%) reported disability secondary to a psychiatric condition. and 14 patients (56%) indicated a history of psychiatric problem prior to diagnosis of liver disease. Results: Mean SF-36 scores ranged from 36.88 (SD=22.93) on the Vitality subscale to 62.67 (SD= 18.97) on the Mental Health subscale. Our sample's SF-36 scores were 15-20 points lower than mean scores previously reported for patients with CHe. SF-36 scores were significantly related to work status, depression, fatigue. anxiety. number of psychosocial stressors, social support, marital satisfaction, anger-hostility, instrument al activities of daily living, perceived cognitive efficiency, and somatic symptoms. Summary: Our sample reported severe impairment on all subscales of the SF-36, and reported more impairment than previously studied CHC patients. Conclusion: Factors accounting for poorer HRQOL in subsamples of CHC patients need to be explored further.
6563 SEVERITY OF DEPRESSION AND ANXIETY IN PATIENTS WITH CHRONIC HEPATITIS C. Robin C. Hilsabeck, Tarek I. Hassanein, William Perry, UCSD Med Ctr, San Diego. CA. The presence of depression and anxiety in patients with chronic Hepatitis C (CHC) has been well documented. However, the severity of these disorders has not been addressed. Thirty-five CHC patients and II controls completed a demographic questionnaire, the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI). Results: Patients obtained mean BDI-I! and BAI scores of 16.45 (SD= 10.49) and 13.68 (SD= 11.51), respectively, both of which suggest mild symptoms, compared to controls, who obtained mean BOI-II and BAI scores of 4.6 (SD=3.10) and 4.0 (SD= 2.57), respectively. Th irteen patients (4 1.9%) reported both significant depression and anxiety. Six (19.4%) had significant anxiety only, and 3 (9.7%) had significant depression only. BDI-I! and BAI scores were not related to age, education, sex, marital status, or ethnicity, However, BAI scores were significantly related to income (r = -.53). BOl-II and BAI scores also were significantly related to fatigue, life satisfaction, perceived cognitive efficiency, social support, anger-hostility, and somatic symptoms. Summary: 1) Anxiety and depression are equally prevalent in CHC patients. 2) Comorbid depression and anxiety is more prevalent than either disorder alone. 3) Severity varies, with almost half of the patients indicating moderate to severe symptomatology. Conclusion: Considerations for therapy should include both the predominant disorder and the severity of symptoms. PATIENTS
Minimal Mild Moderate Severe
CONTROLS
BDl·II
BAl
BOI,II
BAl
15(48.4%) 3(9.7%) 9(29.0%) 4(12.9%)
12(387%) 4(1 2.9%) 10(32.3%) 5(16.1 %)
10(100%)
9 (81.8%) 2(1 8. 2%)
o o o
o o
6564 LIFE AND ILL NESS SATISFACTION FOR PATIENTS WITH CHRONIC HEPATITIS C. Robin C. Hilsabeck, Tarek I. Hassanein, William Perry, UCSD Med Ctr, San Diego, CA. Recent research has focused on health-related quality of life (HRQOL) in patients with chronic Hepatitis C (CHC), but global life satisfaction and the possibility of positive consequences of chronic disease (e.g., valuing life) have not yet been examined. Thirty-five patients with CHC completed several QOL measures, including the Satisfaction With Life Scale (SWLS) and Satisfaction With Illness Scale (SWIS). Results: The mean SWLS score was 19.62 (SD = 8.02), suggesting patients are slightly dissatisfied to neutral about their degree of global life satisfaction. In contrast, the mean SWIS score was 32.72 (SD = 5.81), suggesting patients have encountered positive consequences of CHC and are extremely satisfied with these experiences. SWLS and SWIS scores were not significantly related to age, education, sex, marital status, ethnicity, optimism, marital satisfaction, social support, or spirituality. SWLS scores were moderately related to income and to measures of HRQOL, depression, anxiety, hope, and perceived health competence. Only total somatic symptoms correlated significantly with SWIS scores (r = .47). Conclusions: I) More than half of the patients reported global life satisfaction in spite of impaired HRQOL. 2) Over 90% indicated experiencing positive consequences of CHC. Interestingly, patients reporting more somatic symptoms tended to report more positive consequences of their illness. 4) Examin ation of the relationships of these constructs to outcome and compliance is recommended .
Extremely Dissatisfied Dissatisfied Slightly Dissatisfied Neutral Slightly Satisfied Satisfied Extremely Satisfied
SWLS
SWlS
13.8% 6.9% 21.1% 3.4% 27.6% 17.2% 6.9%
0.0% 00% 6.9% 0.0% 24.1 % 37.9% 31.0%
6565 THE INFLUENCE OF DONOR AGE TO LIVING DONOR LIVER TRANSPLANTATION. Masaru Hirata, Yasushi Harihara, Toshirou Kitamura, Shinya Hisatomi, Masato Kato, Kouichi Mizuta, Yasuhiko Sugawara, Keiichi Kubota, Tadatoshi Takayama, Hideo Kawarazaki, Kouhei Hashizume, Masatoshi Makuuchi, Univ of Tokyo, Tokyo, Japan. Background: Because of the increase of the demand for solid organ transplantation, the percentage of organs from older donors also increases recently. However, there have been few studies about the influence of donor age to liver transplantation. We investigated the impact of donor age to liver function and the regeneration of the liver after living-donor liver transplantation. [Patients] Patients consisted of 65 liver transplant recipients who underwent living donor liver transplantation from January 1996 to July 1999. Out of 65 recipients, 38 patients were under 10 years old (younger recipients) and 27 patients were over 10 years old (older recipients). In younger recipients, the old donor subgroup was defined as the donor age older than 31 years (17 cases, average donor age; 39.1 :!: 6.8 years), and the young donor subgroup was defined as the donor age equal or younger than 3 1 years (2 1 cases, average donor age; 28.9 :!: 1.5 years). In older recipients, the old donor subgroup was defined as the donor age older than 39 years (14 cases, average donor age; 48.5 :!: 5.7 years), and the young donor SUbgroup was defined as the donor age equal or younger than 39 years (13 cases, average donor age; 28.7 :!: 6.2 years). Method: Serial change of total bilirubin (just before transplantation, one week after, one month after) and the regeneration rate (R rate) of the recipients one month after transplantation was compared between old donor subgroup and young donor subgroup among each group. The graft volume one month after transplantation (V I) was calculated by CT volumetry. The R rate was defined as (V I - VO) I VO. VO means the graft volume at the operation. Results: Among younge r recipients, serial change of total bilirubin (mg/dl) was 17.1, 3.7,0.9 in old donor subgroup and 15.5, 3.4,1.1 in young donor subgroup. Among older recipients, serial change of total bilirubin was 13.6, 6.3,4.3 in old donor subgroup and 11.0. 7.4, 3.4 in young donor subgroup. There was no statistically significant difference about serial change of total bilirubin among both of younger and older recipients. The R rate among younger recipients was 22.1% in old donor subgroup, which was significantly lower than 52.6% in young donor subgroup. The R rate among older recipients was 96.0% in old donor subgroup, which was significantly lower than 133.7% in young donor subgroup. Conciusion:When the donor age was older, the regeneration rate of the liver was lower than that of younger donor group.
April 2000
genotype Ib) among the 62 had no more detectable HCV RNA at six months of treatment, 20 relapser and 19 non responder. We noticed 48% of asthenia, 27% of loss of weight, 21% of depression, 13.5% of dyspnea, 12% of arthritis, 9.8% of cutaneous manifestation, 8% of non specific abdominal pain, diarrhoea, or vomiting and 7% of palpitation. Only 10% of the patients performed an excellent tolerance of the therapy. Severe anaemia « lOgr/dl) was noted in 16% of the patients, leucopenia in 9.8% and thrompenia in 8.6%. No difference was observed in the prevalence of adverse events according to the response to treatment. The se adverse events conducted at a ribavirine dose reduction in II % of the patients and both drugs were discontinued in 14.8% patients. Conclusion: Combination therapy is an effective treatmen t but induced a lot of adverse effects. That is why it seems to be important to monitor adequate ly these patients.
6562 IMPAIRED QUALITY OF LIFE VARIES AMONG SUBSAMPLES OF PATIENTS WITH CHRONIC HEPATITIS C. Robin C. Hilsabeck, Tarek I. Hassanein, William Perry, UCSD Med Ctr. San Diego, CA. The SF-36 is a well-known measure of health-related quality of life (HRQOL) and has been increasingly used to assess patients with chronic Hepatitis C (CHC ). The SF-36 consists of 8 subscales and 2 composite scales (i.e., physical and menta l). Subscale scores range from 0 (very poor) to 100 (excellent), while the composite scales have a mean of 50 and a standard deviation of 10. Twenty- five patients from a university-based liver clinic completed the SF-36 . Our sample had a mean age of 48.76 (SD=6.77) years and a mean education of 13.96 (SD=2.73) years. Fifteen patients (60%) were male. 16 (64%) were Caucasian, and I I (72%) were single or divorced. Fourteen (56%) were unemployed or disabled, and their income level was < $10,000 per year. Seven patients (28%) reported disability secondary to a psychiatric condition. and 14 patients (56%) indicated a history of psychiatric problem prior to diagnosis of liver disease. Results: Mean SF-36 scores ranged from 36.88 (SD=22.93) on the Vitality subscale to 62.67 (SD= 18.97) on the Mental Health subscale. Our sample's SF-36 scores were 15-20 points lower than mean scores previously reported for patients with CHe. SF-36 scores were significantly related to work status, depression, fatigue. anxiety. number of psychosocial stressors, social support, marital satisfaction, anger-hostility, instrument al activities of daily living, perceived cognitive efficiency, and somatic symptoms. Summary: Our sample reported severe impairment on all subscales of the SF-36, and reported more impairment than previously studied CHC patients. Conclusion: Factors accounting for poorer HRQOL in subsamples of CHC patients need to be explored further.
6563 SEVERITY OF DEPRESSION AND ANXIETY IN PATIENTS WITH CHRONIC HEPATITIS C. Robin C. Hilsabeck, Tarek I. Hassanein, William Perry, UCSD Med Ctr, San Diego. CA. The presence of depression and anxiety in patients with chronic Hepatitis C (CHC) has been well documented. However, the severity of these disorders has not been addressed. Thirty-five CHC patients and II controls completed a demographic questionnaire, the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI). Results: Patients obtained mean BDI-I! and BAI scores of 16.45 (SD= 10.49) and 13.68 (SD= 11.51), respectively, both of which suggest mild symptoms, compared to controls, who obtained mean BOI-II and BAI scores of 4.6 (SD=3.10) and 4.0 (SD= 2.57), respectively. Th irteen patients (4 1.9%) reported both significant depression and anxiety. Six (19.4%) had significant anxiety only, and 3 (9.7%) had significant depression only. BDI-I! and BAI scores were not related to age, education, sex, marital status, or ethnicity, However, BAI scores were significantly related to income (r = -.53). BOl-II and BAI scores also were significantly related to fatigue, life satisfaction, perceived cognitive efficiency, social support, anger-hostility, and somatic symptoms. Summary: 1) Anxiety and depression are equally prevalent in CHC patients. 2) Comorbid depression and anxiety is more prevalent than either disorder alone. 3) Severity varies, with almost half of the patients indicating moderate to severe symptomatology. Conclusion: Considerations for therapy should include both the predominant disorder and the severity of symptoms. PATIENTS
Minimal Mild Moderate Severe
CONTROLS
BDl·II
BAl
BOI,II
BAl
15(48.4%) 3(9.7%) 9(29.0%) 4(12.9%)
12(387%) 4(1 2.9%) 10(32.3%) 5(16.1 %)
10(100%)
9 (81.8%) 2(1 8. 2%)
o o o
o o
6564 LIFE AND ILL NESS SATISFACTION FOR PATIENTS WITH CHRONIC HEPATITIS C. Robin C. Hilsabeck, Tarek I. Hassanein, William Perry, UCSD Med Ctr, San Diego, CA. Recent research has focused on health-related quality of life (HRQOL) in patients with chronic Hepatitis C (CHC), but global life satisfaction and the possibility of positive consequences of chronic disease (e.g., valuing life) have not yet been examined. Thirty-five patients with CHC completed several QOL measures, including the Satisfaction With Life Scale (SWLS) and Satisfaction With Illness Scale (SWIS). Results: The mean SWLS score was 19.62 (SD = 8.02), suggesting patients are slightly dissatisfied to neutral about their degree of global life satisfaction. In contrast, the mean SWIS score was 32.72 (SD = 5.81), suggesting patients have encountered positive consequences of CHC and are extremely satisfied with these experiences. SWLS and SWIS scores were not significantly related to age, education, sex, marital status, ethnicity, optimism, marital satisfaction, social support, or spirituality. SWLS scores were moderately related to income and to measures of HRQOL, depression, anxiety, hope, and perceived health competence. Only total somatic symptoms correlated significantly with SWIS scores (r = .47). Conclusions: I) More than half of the patients reported global life satisfaction in spite of impaired HRQOL. 2) Over 90% indicated experiencing positive consequences of CHC. Interestingly, patients reporting more somatic symptoms tended to report more positive consequences of their illness. 4) Examin ation of the relationships of these constructs to outcome and compliance is recommended .
Extremely Dissatisfied Dissatisfied Slightly Dissatisfied Neutral Slightly Satisfied Satisfied Extremely Satisfied
SWLS
SWlS
13.8% 6.9% 21.1% 3.4% 27.6% 17.2% 6.9%
0.0% 00% 6.9% 0.0% 24.1 % 37.9% 31.0%
6565 THE INFLUENCE OF DONOR AGE TO LIVING DONOR LIVER TRANSPLANTATION. Masaru Hirata, Yasushi Harihara, Toshirou Kitamura, Shinya Hisatomi, Masato Kato, Kouichi Mizuta, Yasuhiko Sugawara, Keiichi Kubota, Tadatoshi Takayama, Hideo Kawarazaki, Kouhei Hashizume, Masatoshi Makuuchi, Univ of Tokyo, Tokyo, Japan. Background: Because of the increase of the demand for solid organ transplantation, the percentage of organs from older donors also increases recently. However, there have been few studies about the influence of donor age to liver transplantation. We investigated the impact of donor age to liver function and the regeneration of the liver after living-donor liver transplantation. [Patients] Patients consisted of 65 liver transplant recipients who underwent living donor liver transplantation from January 1996 to July 1999. Out of 65 recipients, 38 patients were under 10 years old (younger recipients) and 27 patients were over 10 years old (older recipients). In younger recipients, the old donor subgroup was defined as the donor age older than 31 years (17 cases, average donor age; 39.1 :!: 6.8 years), and the young donor subgroup was defined as the donor age equal or younger than 3 1 years (2 1 cases, average donor age; 28.9 :!: 1.5 years). In older recipients, the old donor subgroup was defined as the donor age older than 39 years (14 cases, average donor age; 48.5 :!: 5.7 years), and the young donor SUbgroup was defined as the donor age equal or younger than 39 years (13 cases, average donor age; 28.7 :!: 6.2 years). Method: Serial change of total bilirubin (just before transplantation, one week after, one month after) and the regeneration rate (R rate) of the recipients one month after transplantation was compared between old donor subgroup and young donor subgroup among each group. The graft volume one month after transplantation (V I) was calculated by CT volumetry. The R rate was defined as (V I - VO) I VO. VO means the graft volume at the operation. Results: Among younge r recipients, serial change of total bilirubin (mg/dl) was 17.1, 3.7,0.9 in old donor subgroup and 15.5, 3.4,1.1 in young donor subgroup. Among older recipients, serial change of total bilirubin was 13.6, 6.3,4.3 in old donor subgroup and 11.0. 7.4, 3.4 in young donor subgroup. There was no statistically significant difference about serial change of total bilirubin among both of younger and older recipients. The R rate among younger recipients was 22.1% in old donor subgroup, which was significantly lower than 52.6% in young donor subgroup. The R rate among older recipients was 96.0% in old donor subgroup, which was significantly lower than 133.7% in young donor subgroup. Conciusion:When the donor age was older, the regeneration rate of the liver was lower than that of younger donor group.