- Email: [email protected]
P1106 : Alcohol-related liver disease patients’ beliefs about their illness and factors that influence their self-management - A patient survey
POSTERS P1106 ALCOHOL-RELATED LIVER DISEASE PATIENTS’ BELIEFS ABOUT THEIR ILLNESS AND FACTORS THAT INFLUENCE THEIR SELF-MANAGEMENT – A PATIENT SURVEY M. Lau-Walker1 , J. Presky2 , I. Webzell2 , T. Murrells1 , N. Heaton2 . 1 Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, 2 Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, United Kingdom E-mail: [email protected] Background and Aims: Research in a variety of long term illnesses suggests patients’ illness beliefs are a more influential factor for patient recovery than the severity of the illness. However, research into illness belief and medication adherence of patients with alcohol-related liver disease (ALD) is sparse. This study aims to determine the association between illness belief and selfmanagement and, more specifically, adherence to medication and provide the evidence-base for the development of an effective and personalised framework to support self-management in patients with alcohol-related liver disease. Methods: A cohort of 159 patients with ALD patients who attended the Liver Outpatient Clinic at the King’s College Hospital NHS Foundation Trust (October 2012 to November 2013) completed a set of validated instruments measuring illness beliefs, selfmanagement, beliefs about medication, emotional states and quality of life. Results: The mean age of enrolled patients was 52 years (range 27–80), 67% male, 26% live on their own, 61% had no previous history of other chronic illness. Their average MELD and Audit C scores were 11.0 (range 6–28) and 3.5 (range 0–12) respectively. Multiple regression analyses were performed on Anxiety (variation explained by Illness perception components adjusting for the demographic and illness characteristic = 42%) and Depression HAD scores (40%), Self-management Chronic illness (47%) and Liver summary scores (25%) and Quality of life ED-5Q your state of health today (25%). The two most consistent illness belief components across all outcome measures were ‘comprehension’ and ‘identity’. Regression analysis found that the illness perception components were statistically associated with beliefs about medicines questionnaire (BMQ) components: ‘comprehension’ associated with ‘concern’ (p = 0.005); ‘identity’ associated with ‘necessity’ and ‘concern’ (p = 0.005; p = 0.043 respectively), and ‘treatment control’ associated with ‘necessity’ and ‘differential’ (p = 0.047; p = 0.039 respectively). Conclusions: Interventions designed to improve the understanding of patients with ALD of their illness and strategies to manage their symptoms are likely to improve their self-management, quality of life and reduce anxiety and depression. More specifically, medication adherence in patients with alcoholic liver disease is likely to be improved by an intervention that improves ALD patient’s understanding, management of symptoms and sense of control.
P1107 UNCONSIDERED MISUSE OF ACETAMINOPHEN IS ONE OF THE CAUSAL COFACTORS OF ACUTE LIVER FAILURE IN ADULTS WITH SEVERE DENGUE FEVER M. Gelu-Simeon1 , C. Francoz2 , P. Ichai3 , A. Cabie4 , E. Saillard5 , C. Hermann6 , P. Bedossa7 , M. Sebagh8 , F. Durand9 , D. Samuel10 , J. Bernuau11 . 1 Hepatogatroenterology, CHU de Pointe-` a-Pitre, 97139 Pointe-` a-Pitre – Guadeloupe, 2 Hepatology, Hˆ opital Beaujon, 92118 Clichy, 3 Hepatology, Hˆ opital Paul-Brousse, Villejuif, 4 Infectious Diseases, CHU de Fort-de-France, 97200 Fort-de-France Martinique, 5 Hepatogastroent´erologie, CHU de Pointe-` a-Pitre, 97139 Pointea `-Pitre, 6 Laboratoire de Virologie, CHU de Pointe-` a-Pitre, 97139 Pointe-` a-Pitre, 7 Pathology, Hˆ opital Beaujon, 92118 Clichy, 8 Pathology, Hˆ opital Paul-Brousse, 94800 Villejuif, 9 Hepatologie, Hˆ opital Beaujon, 92118 Clichy, 10 Hepatology, Hˆ opital Paul-Brousse, 94800 Villejuif, 11 Hepatology and Obstetrics, Hˆ opital Beaujon, 92118 Clichy, France E-mail: [email protected] Background and Aims: In recent years, dengue fever extended over various areas beyond tropical and subtropical areas. Fifty to hundred millions cases of dengue occur annually. Acetaminophen (ACT), no more than 4g daily, is officially recommended as an antipyretic. Adults with dengue often have discrete liver blood tests abnormalities but uncommonly develop acute liver failure (ALF). Our aims were to itemize potential cofactors, and determine whether ACT toxicity could be a causal factor, of ALF in patients with dengue. Methods: Review of previously published and strictly selected case reports of adults with dengue and ALF (DALF), and of the files of similar patients who were refered to us. Results: Among 61 cases of adults with DALF, the survival rate was 82% or 50%, depending on whether they were, or were not, given intravenous N-acetylcysteine (IV NAC). Itemized causal factors of DALF include viral infection of liver tissue, virus-related immunopathological mechanisms, acute hypovolemia due to acute plasma leakage, the systemic inflammatory response syndrome and acute episodes of hyperthermia. ACT hepatotxicity was only recently mentioned. Seven adults with dengue, recent ingestion of ACT and serum aminotransferase activity above 25 times the normal value, were hospitalized in 2 liver intensive care units. Four patients with severe coagulopathy but without grade III-IV encephalopathy when they received IV NAC, survived; 2 of them had recent unintentional acetaminophen overdose, one developed DALF, the other with centrilobular liver necrosis did not; the 2 other patients, developed mediolobular liver necrosis-associated DALF and one required liver transplantation (LT). Among the 3 patients with grade III-IV encephalopathy and hypotension when they received IV NAC, all died after protracted shock; 2 of them had massive liver necrosis, including one rechallenged with ACT despite increased serum aminotransferases after unrecognized ACT unintentional overdose. Conclusions: in adults with DALF, various morphological kinds of liver necrosis suggest various etiologies, life-saving LT may be required, and unconsidered misuse of ACT may cause ACTinduced hepatotoxicity and DALF. Accordingly, IV NAC is beneficial to hospitalized patients with dengue and serum aminotransferases raised 25 times above normal without encephalopathy. P1108 ELEVATED ACETALDEHYDE LEVELS ARE DETRIMENTAL TO THE HEPATIC ANTIOXIDANT SYSTEM V.B. Patel1 , R. Ghazali1 , K. Mehta1 , V. Preedy2 . 1 Biomedical Sciences, University of Westminster, 2 Nutrition & Dietetics, King’s College London, London, United Kingdom E-mail: [email protected] Background and Aims: Acute (binge) and chronic alcohol drinking is a major public health issue leading to alcoholic liver disease.
Journal of Hepatology 2015 vol. 62 | S263–S864
S765
P1107 UNCONSIDERED MISUSE OF ACETAMINOPHEN IS ONE OF THE CAUSAL COFACTORS OF ACUTE LIVER FAILURE IN ADULTS WITH SEVERE DENGUE FEVER M. Gelu-Simeon1 , C. Francoz2 , P. Ichai3 , A. Cabie4 , E. Saillard5 , C. Hermann6 , P. Bedossa7 , M. Sebagh8 , F. Durand9 , D. Samuel10 , J. Bernuau11 . 1 Hepatogatroenterology, CHU de Pointe-` a-Pitre, 97139 Pointe-` a-Pitre – Guadeloupe, 2 Hepatology, Hˆ opital Beaujon, 92118 Clichy, 3 Hepatology, Hˆ opital Paul-Brousse, Villejuif, 4 Infectious Diseases, CHU de Fort-de-France, 97200 Fort-de-France Martinique, 5 Hepatogastroent´erologie, CHU de Pointe-` a-Pitre, 97139 Pointea `-Pitre, 6 Laboratoire de Virologie, CHU de Pointe-` a-Pitre, 97139 Pointe-` a-Pitre, 7 Pathology, Hˆ opital Beaujon, 92118 Clichy, 8 Pathology, Hˆ opital Paul-Brousse, 94800 Villejuif, 9 Hepatologie, Hˆ opital Beaujon, 92118 Clichy, 10 Hepatology, Hˆ opital Paul-Brousse, 94800 Villejuif, 11 Hepatology and Obstetrics, Hˆ opital Beaujon, 92118 Clichy, France E-mail: [email protected] Background and Aims: In recent years, dengue fever extended over various areas beyond tropical and subtropical areas. Fifty to hundred millions cases of dengue occur annually. Acetaminophen (ACT), no more than 4g daily, is officially recommended as an antipyretic. Adults with dengue often have discrete liver blood tests abnormalities but uncommonly develop acute liver failure (ALF). Our aims were to itemize potential cofactors, and determine whether ACT toxicity could be a causal factor, of ALF in patients with dengue. Methods: Review of previously published and strictly selected case reports of adults with dengue and ALF (DALF), and of the files of similar patients who were refered to us. Results: Among 61 cases of adults with DALF, the survival rate was 82% or 50%, depending on whether they were, or were not, given intravenous N-acetylcysteine (IV NAC). Itemized causal factors of DALF include viral infection of liver tissue, virus-related immunopathological mechanisms, acute hypovolemia due to acute plasma leakage, the systemic inflammatory response syndrome and acute episodes of hyperthermia. ACT hepatotxicity was only recently mentioned. Seven adults with dengue, recent ingestion of ACT and serum aminotransferase activity above 25 times the normal value, were hospitalized in 2 liver intensive care units. Four patients with severe coagulopathy but without grade III-IV encephalopathy when they received IV NAC, survived; 2 of them had recent unintentional acetaminophen overdose, one developed DALF, the other with centrilobular liver necrosis did not; the 2 other patients, developed mediolobular liver necrosis-associated DALF and one required liver transplantation (LT). Among the 3 patients with grade III-IV encephalopathy and hypotension when they received IV NAC, all died after protracted shock; 2 of them had massive liver necrosis, including one rechallenged with ACT despite increased serum aminotransferases after unrecognized ACT unintentional overdose. Conclusions: in adults with DALF, various morphological kinds of liver necrosis suggest various etiologies, life-saving LT may be required, and unconsidered misuse of ACT may cause ACTinduced hepatotoxicity and DALF. Accordingly, IV NAC is beneficial to hospitalized patients with dengue and serum aminotransferases raised 25 times above normal without encephalopathy. P1108 ELEVATED ACETALDEHYDE LEVELS ARE DETRIMENTAL TO THE HEPATIC ANTIOXIDANT SYSTEM V.B. Patel1 , R. Ghazali1 , K. Mehta1 , V. Preedy2 . 1 Biomedical Sciences, University of Westminster, 2 Nutrition & Dietetics, King’s College London, London, United Kingdom E-mail: [email protected] Background and Aims: Acute (binge) and chronic alcohol drinking is a major public health issue leading to alcoholic liver disease.
Journal of Hepatology 2015 vol. 62 | S263–S864
S765