Donna M Evon1, Hsing-Hua S Lin2, Robert J Fontana3, Mandana Khalili4, Colina Yim5, Abdus S Wahed2, Jay H Hoofnagle6. 1. Department of Medicine, University of North Carolina at Chapel Hill. 2. Departments of Epidemiology and Biostatistics, University of Pittsburgh. 3. Department of Internal Medicine, University of Michigan. 4. Department of Medicine, University of California at San Francisco. 5. Toronto Centre for Liver Disease, University of Toronto. 6. Liver Disease Research Branch, NIDDK, NIH.
Abstract
BACKGROUND: Symptoms of chronic hepatitis B (CHB) are not well characterized. AIMS: To evaluate CHB symptoms and associations with disease activity and clinical outcomes. METHODS: Longitudinal data from 1,576 participants in the Hepatitis B Research Network Cohort Study who completed symptom assessments were analyzed. A composite symptom score was calculated using a Symptom Checklist (0=none to 40=extreme). Multivariable mixed models assessed variables associated with symptom change over time. Latent class symptom trajectories were evaluated. The cumulative probability of long-term clinical outcomes (new onset cirrhosis, hepatic decompensation, hepatocellular carcinoma, liver transplantation, death) was examined by baseline symptom groups. RESULTS: Participants median age was 42 (range:18-80), 51% were male, 75% Asian, (68% of whom were born outside North America) with a median follow-up of 4.2 years. On average, symptoms did not significantly change over time. The multivariable model identified several variables associated with higher symptoms during follow-up: being female, non-Asian, born in the US/Canada, lower education, higher AST, lower platelets, and more comorbidities. Two patient subgroups were identified based on longitudinal symptom trajectories: a low symptom group (92%, n=1,451) with symptom scores averaging 2.4 over time and a moderate symptom group (8%, n=125) with symptom scores averaging 11.5. During follow-up, 7.3% in the moderate symptom group, but only 3.2% of the low symptom group, developed adverse outcomes (p=0.02). CONCLUSIONS: In this large cohort of CHB patients, symptoms were generally mild and stable over time. However, in some patients with moderate symptoms at baseline, deleterious clinical outcomes were more frequent in follow-up.
BACKGROUND: Symptoms of chronic hepatitis B (CHB) are not well characterized. AIMS: To evaluate CHB symptoms and associations with disease activity and clinical outcomes. METHODS: Longitudinal data from 1,576 participants in the Hepatitis B Research Network Cohort Study who completed symptom assessments were analyzed. A composite symptom score was calculated using a Symptom Checklist (0=none to 40=extreme). Multivariable mixed models assessed variables associated with symptom change over time. Latent class symptom trajectories were evaluated. The cumulative probability of long-term clinical outcomes (new onset cirrhosis, hepatic decompensation, hepatocellular carcinoma, liver transplantation, death) was examined by baseline symptom groups. RESULTS: Participants median age was 42 (range:18-80), 51% were male, 75% Asian, (68% of whom were born outside North America) with a median follow-up of 4.2 years. On average, symptoms did not significantly change over time. The multivariable model identified several variables associated with higher symptoms during follow-up: being female, non-Asian, born in the US/Canada, lower education, higher AST, lower platelets, and more comorbidities. Two patient subgroups were identified based on longitudinal symptom trajectories: a low symptom group (92%, n=1,451) with symptom scores averaging 2.4 over time and a moderate symptom group (8%, n=125) with symptom scores averaging 11.5. During follow-up, 7.3% in the moderate symptom group, but only 3.2% of the low symptom group, developed adverse outcomes (p=0.02). CONCLUSIONS: In this large cohort of CHB patients, symptoms were generally mild and stable over time. However, in some patients with moderate symptoms at baseline, deleterious clinical outcomes were more frequent in follow-up.
Authors: A M Di Bisceglie; M Lombardero; J Teckman; L Roberts; H L A Janssen; S H Belle; J H Hoofnagle Journal: J Viral Hepat Date: 2016-12-05 Impact factor: 3.728
Authors: Marc G Ghany; Robert Perrillo; Ruosha Li; Steven H Belle; Harry L A Janssen; Norah A Terrault; Margaret C Shuhart; Daryl T-Y Lau; W Ray Kim; Michael W Fried; Richard K Sterling; Adrian M Di Bisceglie; Steven-Huy B Han; Lilia Milkova Ganova-Raeva; Kyong-Mi Chang; Anna Suk-Fong Lok Journal: Clin Gastroenterol Hepatol Date: 2014-07-08 Impact factor: 11.382