Interferon Alfa-2b Alone or in Combination with Ribavirin as Initial Treatment for Chronic Hepatitis C

BACKGROUND Only 15 to 20 percent of patients with chronic hepatitis C have a sustained virologic response to interferon therapy. We compared the efficacy and safety of recombinant interferon alfa-2b alone with those of a combination of interferon alfa-2b and ribavirin for the initial treatment of patients with chronic hepatitis C. METHODS We randomly assigned 912 patients with chronic hepatitis C to receive standard-dose interferon alfa-2b alone or in combination with ribavirin (1000 or 1200 mg orally per day, depending on body weight) for 24 or 48 weeks. Efficacy was assessed by measurements of serum hepatitis C virus (HCV) RNA and serum aminotransferases and by liver biopsy. RESULTS The rate of sustained virologic response (defined as an undetectable serum HCV RNA level 24 weeks after treatment was completed) was higher among patients who received combination therapy for either 24 weeks (70 of 228 patients, 31 percent) or 48 weeks (87 of 228 patients, 38 percent) than among patients who received interferon alone for either 24 weeks (13 of 231 patients, 6 percent) or 48 weeks (29 of 225 patients, 13 percent) (P CONCLUSIONS In patients with chronic hepatitis C, initial therapy with interferon and ribavirin was more effective than treatment with interferon alone

Impact of body mass index on graft failure and overall survival following liver transplant

Goals: To assess the influence of body mass index (BMI) in the outcome of liver transplantation. Background: Body mass index appears to affect liver transplantation, independently of several risk factors. Study: A review of the United Network for Organ Sharing database included 32 515 liver transplants from 1992 through 2000 with at least one follow-up visit, of which 26 920 had information for determining BMI. The overall impact of elevated BMI ( \u3e 25), and the impact of increasingly elevated BMI (25-40+) on graft failure rates and overall survival rates are assessed using proportional hazards regression. Results: Controlling for follow-up time, age, gender, race, number of comorbidities, and status 1 designation, the impact of BMI on survival was mixed. The risk of death was elevated for patients with low BMI (\u3c 19) and BMI values of ≥40. Compared with patients with BMI of 19-22, those with BMI \u3e 25 had a decreased likelihood of death. This decrease was seen among patients with BMI of 25-34. Conclusion: BMI did not significantly affect rates of graft failure. Compared with patients with a BMI in the \u27normal\u27 range, those with moderately elevated BMI had decreased likelihood of death while patients with low BMI or extremely high BMI had increased likelihood of death. © Blackwell Munksgaard, 2004

Predictors of do-not-resuscitate order utilization in decompensated cirrhosis hospitalized patients: A nationwide inpatient cohort study

Introduction and objectives: Decompensated cirrhosis carries high inpatient morbidity and mortality. Consequently, advance care planning is an integral aspect of medical care in this patient population. Our study aims to identify do-not-resuscitate (DNR) order utilization and demographic disparities in decompensated cirrhosis patients. Patients or materials and methods: Nationwide Inpatient Sample was used to extract the cohort of patients from January 1st, 2016 to December 31st, 2017, based on the most comprehensive and recent data. The first cohort included hospitalized patients with decompensated cirrhosis. The second cohort included patients with decompensated cirrhosis with at least one contraindication for liver transplantation. Results: A cohort of 585,859 decompensated cirrhosis patients was utilized. DNR orders were present in 14.2% of hospitalized patients. DNR utilization rate among patients with relative contraindication for liver transplantation was 15.0%. After adjusting for co-morbid conditions, disease severity, and inpatient mortality, African-American and Hispanic patient populations had significantly lower DNR utilization rates. There were regional, and hospital-level differences noted. Moreover, advanced age, advanced stage of decompensated cirrhosis, inpatient mortality, and relative contraindications for liver transplantation (metastatic neoplasms, dementia, alcohol misuse, severe cardiopulmonary disease, medical non-adherence) were independently associated with increased DNR utilization rates. Conclusions: The rate of DNR utilization in patients with relative contraindications for liver transplantation was similar to patients without any relative contraindications. Moreover, there were significant demographic and hospital-level predictors of DNR utilization. This information can guide resource allocation in educating patients and their families regarding prognosis and outcome expectations