Characterisation of co-morbidities in patients with alcoholic liver disease and engaging them in treatment.
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1 Characterisation of co-morbidities in patients with alcoholic liver disease and engaging them in treatment. Khairunnessa Rahman, Dheeraj Shukla, Leigh Dahlenburg, Andrew Bailey, Robert Gribble, Paul Haber and Devanshi Seth Drug Health Services, RPAH; Centenary Institute; University of Sydney
2 Trivia Economic burden of Alcoholic Liver disease (ALD) million AUD million AUD 3. 4 billion AUD 4. None of the above
3 Alcoholic Liver Disease (ALD): a significant disease burden Alcoholic Liver Disease (ALD) is the most prominent endpoint of alcohol excess. Neglected clinical area with an estimated total economic burden of AUD3.8 billion per year. Associated with a significant mortality and 2 of 3 ALD patients have associated morbidity. Co-morbidities in these patients remain undefined. No effective treatment to date except abstinence and liver transplant. There is lack of appropriate strategies to achieve abstinence in this population.
4 Aims of the study To characterise co-morbidities in patients with alcoholic liver disease. To determine if co-morbidities act as barrier to the treatment. To engage patients into multi-disciplinary treatment for comorbidities to improve overall clinical outcome.
5 Methods Recruitment: Liver and Drug Health Clinics at RPAH (HREC/10/RPAH/421) Eligibility: ALD with comorbid conditions (HepC, HCC, mental health) Semi-structured interviews & self administered questionnaires: Alcohol history (TFLB), AUDIT, dependence (SADD), craving (PENN), recognition (DRINC), readiness to change (SOCRATES) Demographics Physical examination Clinical, Biochemical, Anthropomorphic Mental health assessment Mini International Neuropsychiatric Interview (MINI): major depression, manic episode, PTSD, alcohol dependence, suicidality, general anxiety and antisocial behaviour Anxiety & depression (HADS), quality of life (WHOQOL), mental state (MMSE) Routine Reviews: Researchers, Clinical Psychologist, Hepatologist Identify patients with co-morbid conditions Participants with mental health issues approached for recruitment into the multidisciplinary clinic
6 Recruitment
7 Disease Progression Actively drinking (%) Not actively drinking (%) P value Ascites 9/15 (60) 30/36 (83.3) 0.08 Encephalopathy 6/15 (40) 19/36 (52.8) 0.42 O. Varices 6/15 (40) 24/36 (66.7) 0.08 HCC 4/15 (26.7) 12/36 (33.3) 0.65 Deceased 1/18 (5.6) 4/39 (10.3) 0.57
8 Biochemical Markers Actively drinking Mean (SD) N=15 Not actively drinking Mean (SD) N=36 P value MELD (7.3) 17.3 (8.32) 0.19 INR 1.2 (0.27) 1.5 (0.47) 0.02* Albumin 37.5 (6.4) 33.1 (7.3 ) 0.04* Bilirubin 37.9 (44.1) (163) 0.15 Creatinine (46.2) (45.8) 0.65
9 Alcohol: Features of Dependence Alcohol dependence (SADD) Alcohol Craving (PENN ) Recognition (SOCRATES) Actively drinking Mean (SD) N=11 Not actively drinking Mean (SD) N=26, 29, 20 P value (10.07) 5.54 (12.03) 0.02* (9.18) 4.69 (8.90) 0.002* (9.71) (8.34) 0.02*
10 Alcohol and mental health problems Actively drinking (%) Not actively drinking (%) P value Major depression 6/15 (40) 4/32 (12.5) 0.03* (current) Post traumatic stress 6/15 (40) 4/32 (12.5) 0.03* disorder (PTSD) Antisocial personality 3/15 (20) 3/32 (9.4) 0.32 Generalised anxiety disorder 4/15 (26) 3/32 (9.4) 0.13
11 Disease Progression HCV (%) Non HCV (%) P value Ascites 18/27 (66.7) 21/26 (87.5) 0.08 Encephalopathy 11/27 (40.7) 14/24 (58.3) 0.22 O.Varices 18/27 (66.7) 12/24 (50) 0.24 HCC 13/27 (48.1) 3/24 (12.5) 0.005* Deceased 3/31 (9.7) 2/26 (7.7) 0.80
12 Biochemical markers HCV Mean (SD) N=28 NON HCV Mean (SD) N=26 P value MELD (9.03) (6.87) 0.36 INR 1.5 (0.51) 1.5 (0.32) 0.17 Albumin 34.4 (8.01) (6.5) 0.62 Bilirubin (186.4) (43.30) 0.16 Creatinine (30.22) (57.74) 0.32
13 Alcohol: Features of Dependence Alcohol dependence (SADD) HCV Mean (SD) N=19,21,14 NON HCV Mean (SD) N=18,19,17 P value 7.32 (10.32) 9.72 (14.19) 0.56 Craving (PENN) 6.19 (9.03) 9.11 (11.12) 0.37 Recognition (SOCRATES) (9.36) (9.98) 0.76
14 Alcohol and Mental health problems HCV (%) NON HCV (%) P value Major depression (current) Post traumatic stress disorder (PTSD) 6/24 (25) 4/23 (17.4) /24 (29.2) 3/23 (13) 0.19 Antisocial personality 5/24 (20.8) 1/23 (4.3) 0.09 Generalised Anxiety disorder 4/24 (16.7) 3/23 (13) 0.73
15 MELD predictors? Adjusted R 2 R 2 change Sig F change 1. HCV, Sex Actively drinking Packyears, SADD, AUDIT, SOCRATES SBQR, Depression, Anxiety
16 Quality of Life (QOL) predictors? QOL predictors? Adjusted R 2 R 2 change 1. MELD, HCV, sex Actively drinking Packyears, SADD, AUDIT, SOCRATES, Sig F change 4. SBQR, Depression, Anxiety
17 Summary and Conclusion Study is ongoing - preliminary analysis 6 out of the 41on which complete date was available were found eligible for the treatment and so far 4 have been consented for the treatment Prevalence of alcohol dependence, depression and PTSD are higher in patients who are actively drinking Prevalence of HCC was significantly higher in patients with HepC Psychological intervention may help improve QOL in ALD patients
18 Acknowledgement Dr Devanshi Seth Prof Paul Haber Khairunnessa Rahman Andrew Bailey Dr Leigh Dahlenburg Dr Kirsten Morley Funding Foundation for Alcohol Research and Education (FARE) NSW Health, Mental Health, Drug & Alcohol (MHDAO) All participants without whom this study could not have been made possible
19 Discussion and comments
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