Chronic hepatitis D associated with worse patient-reported outcomes than chronic hepatitis B

Abstract

Background & Aims Health-related quality of life (HRQoL) determined by patient-reported outcomes (PROs) is impaired in chronic hepatitis B (CHB) and C patients, but there are no data regarding patients with chronic hepatitis D (CHD). The aim of this study was to assess PRO scores in untreated patients with CHD and compare them with those obtained for patients with CHB. Methods Patients with CHD completed 3 PRO instruments (Chronic Liver Disease Questionnaire [CLDQ], Functional Assessment of Chronic Illness Therapy–Fatigue [FACIT-F], and Work Productivity and Activity Impairment [WPAI]), and the results were compared with those of patients mono-infected with CHB. Results In total, 125 patients were included: 43 with CHD and 82 with CHB. Overall, baseline PROs showed differences between both groups. Several assessments, such as the worry score from CLDQ ( p = 0.0118), functional well-being from FACIT-F ( p = 0.0281), and activity impairment from WPAI ( p = 0.0029) showed a significant trend to worse scores in patients with CHD than with CHB. In addition, the linear regression model supports the finding that having CHD as opposed to having CHB was a predictor of a higher worry score (CLDQ) and a higher activity impairment (WPAI). Conclusions In this first assessment in CHD, PROs recorded in patients with CHD showed a significant impairment in some domains of HRQoL questionnaires in comparison with those with CHB. Studies in larger cohorts with lengthier follow-up are needed to fully assess patient-reported quality of life over the course of CHD. Lay summary Chronic hepatitis D (CHD) is a viral disease that causes rapid evolution to liver cirrhosis, amongst other severe complications, when compared to patients with chronic hepatitis B (CHB). Health-related quality of life in chronic hepatitis C and CHB has been reported widely, but no studies have been performed on patient-reported outcomes in patients with CHD. Results showed that CHD patients reported worse outcomes in psychological domains such as worry and emotional well-being, as well as in physical domains such as abdominal symptoms, physical well-being, and activity impairment in comparison with patients with CHB.

Quality of life assessment in chronic viral hepatitis

“…Despite all this, there are still difficulties in its diagnosis and in the absence of its standardized treatment [20,21]. As a result of a review of the existing literature, we found reports of health-related quality of life in chronic hepatitis B and HCV-infection, but no studies of outcomes reported by patients with chronic viral hepatitis D. But few studies have shown that HDV infected patients reported worse outcomes in psychological areas, such as anxiety and emotional well-being, as well as in physical areas, such as abdominal symptoms, physical well-being and impaired activity, compared with patients with chronic viral hepatitis D [22].…”

“…It has the form of a scale from 0 to 160, in which the higher the score, the higher the HRQoL [40]. Thus, in a recent study, the overall FACIT-F score in patients with chronic viral hepatitis D was 129.4±24.5 and 136.8±14.2 in patients with chronic viral hepatitis B (p=0.4416), which indicated poorer physical well-being (p=0.0036) and emotional well-being (p=0.0541) in patients with HDV-infection [22]. The WPAI questionnaire identifies specific health problems and is used to assess violations of patients' daily activities and labor productivity associated with HDV or HBV infections in patients.…”

“…The WPAI questionnaire identifies specific health problems and is used to assess violations of patients' daily activities and labor productivity associated with HDV or HBV infections in patients. It includes two domains, the first domain «Violation of labor productivity» characterizes the sum of the domains "absenteeism" (loss of hours of work) and "presenteeism" (self-report on a decrease in productivity during work), it is evaluated only if the patient is working, the second domain «Violation of activity» determines the violation of daily activities in all participants, regardless of their employment status [22]. WPAI results are expressed as a percentage, with higher numbers indicating greater degradation and lower performance [22].…”

“…It includes two domains, the first domain «Violation of labor productivity» characterizes the sum of the domains "absenteeism" (loss of hours of work) and "presenteeism" (self-report on a decrease in productivity during work), it is evaluated only if the patient is working, the second domain «Violation of activity» determines the violation of daily activities in all participants, regardless of their employment status [22]. WPAI results are expressed as a percentage, with higher numbers indicating greater degradation and lower performance [22]. In many studies, the 5D-itch scale has been used, which includes a description of the perception of itching caused by the disease, as well as to monitor the results of the treatment [41].…”

Delta hepatitis epidemiology and the global burden of disease

“…They fared worse in both their emotional and physical well-being, demonstrated the important impact of HDV on patient overall well-being. 35…”