Younossi Z M, Stepanova M, Henry L, Younossi I, Weinstein A, Nader F, Hunt S
Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
J Viral Hepat. 2016 Aug;23(8):623-30. doi: 10.1111/jvh.12528. Epub 2016 Mar 14.
Patients with HCV infection have reduced work productivity (WP), in terms of both presenteeism (impairment in work productivity while working) and absenteeism (productivity loss due to absence from work). The aim of this study was to identify clinical and patient-reported factors that are predictive of WP in HCV-infected patients. HCV-infected patients enrolled in clinical trials completed 3 PRO questionnaires (CLDQ-HCV, SF-36 and FACIT-F) and one work productivity (WPAI:SHP) questionnaire. In employed subjects, work productivity and its absenteeism and presenteeism components were calculated using WPAI:SHP instrument. Of 4121 HCV-infected patients with work productivity data, 2480 (60.2%) reported to be employed, and of those, 2190 had completed all PRO questionnaires before treatment initiation. Of the study cohort, 519/2190 (23.7%) had severe work impairment. In multiple linear regression analysis, work productivity was predicted by lower scores in activity/energy domain of CLDQ-HCV, physical well-being domain of FACIT-F, worry domain of CLDQ-HCV and role physical domain of SF-36 (all P < 0.0005). Furthermore, presenteeism was independently predicted by the activity/energy of CLDQ-HCV, physical well-being of FACIT-F, worry domain of CLDQ-HCV, role physical scale of SF-36 and fatigue scale of FACIT-F (P < 0.002). Finally, absenteeism was independently predicted by physical well-being scale of FACIT-F and role physical scale of SF-36 (all P < 0.002). Clinically, work productivity impairment was predicted by the presence of cirrhosis, anxiety, depression and clinically overt fatigue (P < 0.01). Thus, the most important drivers of WP in HCV are impairment of physical aspects of PROs and clinical history of depression, anxiety, fatigue and cirrhosis.
丙型肝炎病毒（HCV）感染患者的工作效率会降低，这体现在出勤主义（工作时工作效率受损）和旷工（因缺勤导致的生产效率损失）两方面。本研究的目的是确定可预测HCV感染患者工作效率的临床因素和患者报告因素。参与临床试验的HCV感染患者完成了3份患者报告结局（PRO）问卷（慢性肝病问卷-丙型肝炎病毒（CLDQ-HCV）、36项简明健康状况调查（SF-36）和功能性评估癌症治疗-通用量表（FACIT-F））以及1份工作效率（工作效率和活动障碍问卷：特定健康问题（WPAI:SHP））问卷。在就业受试者中，使用WPAI:SHP工具计算工作效率及其旷工和出勤主义成分。在4121例有工作效率数据的HCV感染患者中，2480例（60.2%）报告有工作，其中2190例在治疗开始前完成了所有PRO问卷。在研究队列中，519/2190（23.7%）有严重的工作障碍。在多元线性回归分析中，工作效率可通过CLDQ-HCV的活动/能量领域、FACIT-F的身体健康领域、CLDQ-HCV的担忧领域和SF-36的角色身体领域得分较低来预测（所有P<0.0005）。此外，出勤主义可通过CLDQ-HCV的活动/能量、FACIT-F的身体健康、CLDQ-HCV的担忧领域、SF-36的角色身体量表和FACIT-F的疲劳量表独立预测（P<0.002）。最后，旷工可通过FACIT-F的身体健康量表和SF-36的角色身体量表独立预测（所有P<0.002）。临床上，工作效率受损可通过肝硬化、焦虑、抑郁和临床明显疲劳的存在来预测（P<0.01）。因此，HCV患者工作效率的最重要驱动因素是PRO身体方面的损害以及抑郁、焦虑、疲劳和肝硬化的临床病史。
