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Ng M, Carrieri PM, Awendila L, Socías ME, Knight R, Ti L. Hepatitis C Virus Infection and Hospital-Related Outcomes: A Systematic Review. Can J Gastroenterol Hepatol 2024; 2024:3325609. [PMID: 38487594 PMCID: PMC10940031 DOI: 10.1155/2024/3325609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
Background People living with hepatitis C infection (HCV) have a significant impact on the global healthcare system, with high rates of inpatient service use. Direct-acting antivirals (DAAs) have the potential to alleviate this burden; however, the evidence on the impact of HCV infection and hospital outcomes is undetermined. This systematic review aims to assess this research gap, including how DAAs may modify the relationship between HCV infection and hospital-related outcomes. Methods We searched five databases up to August 2022 to identify relevant studies evaluating the impact of HCV infection on hospital-related outcomes. We created an electronic database of potentially eligible articles, removed duplicates, and then independently screened titles, abstracts, and full-text articles. Results A total of 57 studies were included. Analysis of the included studies found an association between HCV infection and increased number of hospitalizations, length of stay, and readmissions. There was less consistent evidence of a relationship between HCV and in-hospital mortality. Only four studies examined the impact of DAAs, which showed that DAAs were associated with a reduction in hospitalizations and mortality. In the 14 studies available among people living with HIV, HCV coinfection similarly increased hospitalization, but there was less evidence for the other hospital-related outcomes. Conclusions There is good to high-quality evidence that HCV negatively impacts hospital-related outcomes, primarily through increased hospitalizations, length of stay, and readmissions. Given the paucity of studies on the effect of DAAs on hospital outcomes, future research is needed to understand their impact on hospital-related outcomes.
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Affiliation(s)
- Michelle Ng
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
| | - Patrizia Maria Carrieri
- Faculté de Médecine, Aix Marseille Université, 27 bd Jean Moulin 13385, Marseille Cedex 5, France
| | - Lindila Awendila
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, Canada V6Z 1Y6
| | - Maria Eugenia Socías
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, Canada V5Z 1M9
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, Canada H3N 1X9
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, Canada V5Z 1M9
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Sharma P, Xie J, Wang L, Zhang M, Magee J, Answine A, Barman P, Jo J, Sinha J, Schluger A, Perreault GJ, Walters KE, Cullaro G, Wong R, Filipek N, Biggins SW, Lai JC, VanWagner LB, Verna EC, Patel YA. Burden of early hospitalization after simultaneous liver-kidney transplantation: Results from the US Multicenter SLKT Consortium. Liver Transpl 2022; 28:1756-1765. [PMID: 35665591 PMCID: PMC11068063 DOI: 10.1002/lt.26523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 01/13/2023]
Abstract
The burden of early hospitalization (within 6 months) following simultaneous liver-kidney transplant (SLKT) is not known. We examined risk factors associated with early hospitalization after SLKT and their impact on patient mortality conditional on 6-month survival. We used data from the US Multicenter SLKT Consortium cohort study of all adult SLKT recipients between 2002 and 2017 who were discharged alive following SLKT. We used Poisson regression to model rates of early hospitalizations after SLKT. Cox regression was used to identify risk factors associated with mortality conditional on survival at 6 months after SLKT. Median age (N = 549) was 57.7 years (interquartile range [IQR], 50.6-63.9) with 63% males and 76% Whites; 33% had hepatitis C virus, 20% had non-alcohol-associated fatty liver disease, 23% alcohol-associated liver disease, and 24% other etiologies. Median body mass index (BMI) and Model for End-Stage Liver Disease-sodium scores were 27.2 kg/m2 (IQR, 23.6-32.2 kg/m2 ) and 28 (IQR, 23-34), respectively. Two-thirds of the cohort had at least one hospitalization within the first 6 months of SLKT. Age, race, hospitalization at SLKT, diabetes mellitus, BMI, and discharge to subacute rehabilitation (SAR) facility after SLKT were independently associated with a high incidence rate ratio of early hospitalization. Number of hospitalizations within the first 6 months did not affect conditional survival. Early hospitalizations after SLKT were very common but did not affect conditional survival. Although most of the risk factors for early hospitalization were nonmodifiable, discharge to SAR after initial SLKT was associated with a significantly higher incidence rate of early hospitalization. Efforts and resources should be focused on identifying SLKT recipients at high risk for early hospitalization to optimize their predischarge care, discharge planning, and long-term follow-up.
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Affiliation(s)
- Pratima Sharma
- Division of Gastroenterology and Hepatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jiaheng Xie
- Department of Biostatistics, University of Michigan School of Public Health, Anna Arbor, Michigan, USA
| | - Leyi Wang
- Department of Biostatistics, University of Michigan School of Public Health, Anna Arbor, Michigan, USA
| | - Min Zhang
- Department of Biostatistics, University of Michigan School of Public Health, Anna Arbor, Michigan, USA
| | - John Magee
- Department of Surgery, Michigan Medicine, University of Michigan, Anna Arbor, Michigan, USA
| | - Adeline Answine
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pranab Barman
- Division of Gastroenterology and Hepatology, University of California, San Diego, California, USA
| | - Jennifer Jo
- Department of Internal Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jasmine Sinha
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Aaron Schluger
- Department of Internal Medicine, Westchester Medical Center, Westchester, New York, USA
| | - Gabriel J. Perreault
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Kara E. Walters
- Division of Gastroenterology, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Giuseppe Cullaro
- Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
| | - Randi Wong
- Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
| | - Natalia Filipek
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Scott W. Biggins
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington, USA
| | - Jennifer C. Lai
- Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
| | - Lisa B. VanWagner
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth C. Verna
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Yuval A. Patel
- Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina, USA
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Outcomes of Liver Transplant Recipients With Acute-on-Chronic Liver Failure Based on EASL-CLIF Consortium Definition: A Single-center Study. Transplant Direct 2020; 6:e544. [PMID: 32309630 PMCID: PMC7145003 DOI: 10.1097/txd.0000000000000984] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022] Open
Abstract
The impact of acute-on-chronic liver failure (ACLF) defined by European Association for the Study of the Liver-Chronic Liver Failure in liver transplant (LT) recipients has not been well characterized. The aim of the study was to assess early posttransplant morbidity and survival of ACLF patients. Methods Eight hundred twenty-five consecutive LT patients (04/2006-03/2013) were included in a retrospective analysis. Of the 690 evaluable patients, 589 had no ACLF, and the remaining 101 were grouped into ACLF Grades 1-3 (ACLF Grade 1: 50 [49.5%], ACLF Grade 2: 32 [31.7%], and ACLF Grade 3: 19 [18.8%]). Results LT recipients transplanted in the context of ACLF had significantly increased serum creatinine (2.27 ± 1.16 versus 0.98 ± 0.32; P < 0.0001), and inferior 1-year graft (90% versus 78%; P < 0.0001) and patient survival (92% versus 82%; P = 0.0004) by Kaplan-Meier survival analysis; graft and patient survival correlated negatively with increasing severity of ACLF. One-year graft and patient survival were lower in those with high ACLF (Grade 2 and 3) irrespective of Model for End-Stage Liver Disease compared with other groups. The ACLF group had longer intensive care unit stays (10.6 ± 19.5 versus 4.2 ± 9; P < 0.0001), hospital stays (20.9 ± 25.9 versus 11.7 ± 11.4; P < 0.0001), and increased surgical re-exploration (26.7 % versus 14.6%, P = 0.002). Conclusions Patients with ACLF undergoing LT have significantly higher resource utilization, inferior graft survival and patient survival, and renal dysfunction at 1 year. The combination of ACLF and Model for End-Stage Liver Disease can be considered when determining the suitability for potential transplantation.
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Hwang S, Choi-Kwon S. [Nutritional Status of Liver Transplantation Recipients and Factors Influencing Nutritional Status]. J Korean Acad Nurs 2019; 49:340-348. [PMID: 31266930 DOI: 10.4040/jkan.2019.49.3.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to investigate the nutritional status of liver transplantation (LT) recipients and explore certain factors that influence nutritional status, including dietary patterns and physical activities. METHODS This was a cross-sectional, descriptive study. The subjects included 211 LT recipients at a medical center outpatient clinic located in Seoul, Korea. The nutritional status, dietary patterns, and physical activities of each subject were measured using the body mass index (BMI), Mini Dietary Assessment (MDA), and Global Physical Activity Questionnaire. Independent t-test, one-way analysis of variance, and multiple linear regression analysis were used to analyze the data. RESULTS The percentages of living and deceased donor LTs were 81.0% and 19.0%, respectively. The mean BMIs pre- and post-LT were 23.88 and 23.16 kg/m², respectively, and the average MDA score was 36.55. More than 60.0% of the subjects had a moderate or high level of physical activity. In multivariate analysis, a higher BMI before LT (β=.72, p<.001), a lower Model for End-stage Liver Disease (MELD) score (β=-.18, p<.001), and being male (β=-.10, p=.024) contributed to better nutritional status post-LT. Patients within six months of LT were less engaged in muscle exercises than those post six months of LT (p=.020). CONCLUSION LT recipients in Korea have good nutritional status and a good level of physical activity. To improve recipients' post-LT nutritional status, the pre-LT nutritional status should be considered, particularly in those with a higher MELD score. In addition, physical activity including muscle-strengthening exercises should be encouraged from an earlier stage.
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Affiliation(s)
- SinYoung Hwang
- College of Nursing, Seoul National University, Seoul, Korea
| | - Smi Choi-Kwon
- College of Nursing, Seoul National University, Seoul, Korea.
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