Abstract Background: Refractory ascites is a common complication of decompensated cirrhosis. While some patients with this condition are candidates for liver transplant or transjugular intrahepatic portosystemic shunt (TIPS), most require repeated large-volume paracentesis (LVP). Tunnelled peritoneal catheters (TPCs) are an emerging option, though evidence in cirrhosis remains limited. This prospective single-arm exploratory pilot study evaluated symptoms, quality of life (QOL), nutrition, and clinical outcomes in patients with cirrhosis and TPC-managed RA. Methods: In 2016–2019, adults with cirrhosis and RA undergoing paracentesis every 1–2 weeks, with a life expectancy ≥6 months, were enrolled at a tertiary liver centre (12 enrolments, 11 unique patients). Patients eligible for liver transplant or TIPS, on immunosuppression, or with loculated ascites were excluded. Baseline assessments were performed at the final LVP before PleurX™ TPC insertion, with evaluations over 24 weeks. Results: Protein and calorie intake increased within 30 days of TPC insertion and remained at or above baseline. Appetite and handgrip strength improved, peaking at 17 weeks. Abdominal symptoms and QOL scores improved and remained higher than baseline at 6 months. Wellness scores were variable but remained at or above baseline through month 5. One participant (8.3%) developed peritonitis. Renal dysfunction requiring outpatient albumin occurred in 7 (58%) participants, and 2 (17%) were hospitalized with acute kidney injury; all improved with supportive management. Conclusions: In carefully selected patients with cirrhosis and RA, hypothesis-generating trends to improved symptoms and nutritional measures were seen with TPC. The frequency of renal dysfunction underscores the need for individualized management and further controlled studies.
Abstract Background: Timely initiation of treatment for hepatitis C virus (HCV) is essential for reducing both transmission and long-term health impacts. Decision support tools can assist patients by enhancing understanding, clarifying personal priorities, and guiding treatment selection. Methods: This exploratory, sequential mixed-methods study aimed to identify the key priorities for an HCV treatment decision aid and to co-create the tool with expert HCV nurses and people with lived and living experience. In phase 1, three focus groups with HCV nurse providers identified several central needs, while in phase 2, 30 participants with HCV experience reviewed the prototype tool using a questionnaire. Results: Phase 1 findings described the need for the tool to include support for newer providers; strategies to manage limited time, to address health literacy, and to tackle stigma and confidentiality concerns; and preferences related to layout, narrative elements, reminders, autonomy in treatment choices, side-effect information, provider communication, and linkage to care. In phase 2, Likert scale ratings (median scores range: 4–5) reflected strong endorsement, and qualitative responses emphasized four main areas: efficiency, clarity, content relevance, and visual design. Conclusions: Overall, the findings demonstrate that combining clinical expertise with lived experience can lead to the development of a meaningful patient-centred decision aid that supports informed choices about HCV treatment.
Abstract Background: Effective management of alcohol-associated liver disease (ALD) requires treatment of coexisting alcohol use disorder (AUD); however, <5% of patients receive evidence-based AUD pharmacotherapy in routine care. We evaluated early outcomes of an interdisciplinary group medical visit (GMV) clinic integrating hepatology, addiction medicine, and peer support in patients with ALD. Methods: We conducted a retrospective observational study of adults with ALD who attended an interdisciplinary GMV clinic at a tertiary care centre in Winnipeg, Manitoba, Canada, between January 2023 and April 2025. Outcomes included AUD treatment uptake, clinic engagement, alcohol use outcomes, and acute care utilization. Exploratory analyses examined outcomes by level of clinic engagement. Results: Of 112 patients scheduled, 70 (62.5%) attended at least one GMV and formed the analytic cohort (median age: 53 years; 62% male). Alcohol-associated cirrhosis was present in 69%, with decompensation in 65% and severe AUD in 61%; 85% of participants engaged in AUD treatment. Pharmacotherapy uptake increased from 32% pre-clinic to 71% following GMV participation ( p < 0.001), most commonly with naltrexone. Among patients who completed ≥3 GMVs (n = 32), 62.5% achieved abstinence at approximately 6 months. Abstinence at 6 months was higher among patients who attended ≥2 GMVs than among those who attended a single visit (52.6% versus 0%; p < 0.001). Acute care utilization declined by ∼67%, with reductions in emergency department visits and in-patient admissions. Conclusions: A GMV-based interdisciplinary model for ALD was associated with increased initiation of AUD pharmacotherapy, favourable early alcohol use outcomes, and reduced acute care utilization.
Abstract Background: Sepsis-associated liver injury (SALI) is a severe complication with a poor prognosis. We aimed to identify early indicators and construct a preliminary predictive model for SALI. Methods: We conducted a retrospective analysis of 173 septic patients admitted to the intensive care unit from 2021 to 2024. Factors independently associated with SALI were identified using multivariable logistic regression, and a predictive model was constructed. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration curve analysis, decision curve analysis, and clinical impact curve analysis. Results: Low serum 25-hydroxyvitamin D (25[OH]D) levels (adjusted odds ratio [AOR] 0.86), elevated total bile acids (TBA) (AOR 1.02), and an AST-to-platelet ratio index (APRI) >0.848 (AOR 9.81) were independently associated with SALI, while age >60 years showed an inverse association (AOR 0.35). A predictive model incorporating these variables achieved an area under the ROC curve (AUC) of 0.92 (95% CI 0.88–0.96), with favourable calibration and clinical net benefit in internal validation. Conclusions: Low serum 25(OH)D, elevated TBA, and APRI >0.85 were independently associated with SALI, whereas age >60 years was preliminarily found to be inversely associated with SALI. The model incorporating these variables exhibited favourable performance in internal validation. These findings are preliminary and require external prospective validation to confirm their generalizability.
Abstract Background: Direct-acting antiviral (DAA) therapies have transformed care for chronic hepatitis C (CHC); however, the effect of DAA therapy on patient-borne costs is unclear. These costs can pose a substantial burden for patients and their families—even in a publicly funded health system. We estimated the patient-borne costs associated with CHC and the impact of DAA therapy on these costs. Methods: We recruited patients with CHC who were prescribed DAA therapy at two specialized liver clinics and five low-barrier community clinics in Calgary, Montreal, and Toronto, Canada. We interviewed patients before and 1 year after treatment with DAAs. We administered a costs questionnaire eliciting patient-borne health care–associated costs and time costs for the previous 3 months. Results: One hundred and one patients completed the costs questionnaire before and 1 year after DAA treatment. Most (59%) were male, with an average age of 54 years. Ninety-five percent achieved a sustained virologic response (SVR) during the study. Patients spent an average of 41.3 hours attending health care appointments in the 3 months preceding their baseline questionnaire, compared with 14.9 hours at 1 year post-treatment. Valued at average 2020 Canadian wages (CAD$30.03/hour), this represented time costs of CAD$1,240 at baseline and CAD$449 post-treatment. Out-of-pocket health care costs for the previous 3 months averaged CAD$115 at baseline and CAD$43 at 1 year post-treatment. Conclusions: Our study suggests that patient-borne costs are substantially lower after DAA therapy. These costs may pose a significant burden for patients with CHC and should be incorporated into cost-effectiveness analyses of hepatitis C screening and treatment programs.
