Impact d’un environnement de soins comprenant un programme d’éducation thérapeutique sur la survie des personnes porteuses de cirrhose virale B et C : cohorte CIRVIR

Abstract : Backgrounds: Patient education (PE) for chronic carriers of viral hepatitis C has proved his utility but benefits of educational activities around viral cirrhosis remains unclear. Aims: This study aims to evaluate the impact of care environment including PE program on patients outcome with viral cirrhosis B and C. Methods: In a multicenter retrospective analytical study within the French CIRVIR group including 1671 patients, we compared the overall survival between patients from centers offering a PE program which integrates educational activities around cirrhosis (Group 1) and patients from centers which do not offer any PE program (Group 2). Patients from centers with a PE program which does not integrate educational activities around cirrhosis were excluded. The criteria for regular abdominal ultrasound monitoring, sustained virological response to anti-viral therapy, incidence of hepatic events, initial curative treatment with hepatocellular carcinoma (HCC), smoking cessation, alcohol and drug withdrawal, overweight improvement, mortality apart from liver cause and median follow-up were also compared in univariate analysis. Results: 280 patients divided into 6 centers in Group 1 and 459 patients divided into 15 centers in Group 2 within the CIRVIR cohort were enrolled between 2008 and 2012, followed up until 31 December 2016. 932 patients, among whom 148 patients from a center which refused to participate, were excluded. There was no significant difference in survival (85.7%, n=47 deaths with 6 years of follow-up for Group 1 and 87.8% with 6 years of follow-up, n=60 deaths for Group 2; p = 0.40), also adjusted with a propensity score (HR=0.85 [0.45 ; 1.63], p=0.63). The mean follow-up was significantly higher in Group 1 (75.5 months [IQR: 47.5 - 98.7] versus 67.3 months [IQR: 45.2 - 89.8]; p = 0.026). There was significantly higher initial HCC curative treatment in Group 1 than in Group 2 (32 of 44 patients or 78.1% versus 27 of 59 patients or 54%; p=0.017). There was no difference between the 2 groups as for the other criteria. Conclusions: This study does not find any effect on overall survival of environment care with PE focused on cirrhosis in patient with viral cirrhosis B and C. However, it suggests that this environment care is associated with a more frequent initial curative treatment of hepatocellular carcinoma. A prospective study comparing populations with strictly homogeneous medical care criteria could confirm this hypothesis.
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Master Thesis
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Aude Turcry. Impact d’un environnement de soins comprenant un programme d’éducation thérapeutique sur la survie des personnes porteuses de cirrhose virale B et C : cohorte CIRVIR. Médecine humaine et pathologie. 2017. ⟨dumas-01615582⟩

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