D-LIVER project aims to help patients with chronic liver disease

A European ICT for Health project aims to improve the quality of life of patients with chronic liver disease, by developing a remote support system to monitor their condition at home.

Some 29 million Europeans suffer from chronic liver disease. It is one of the most common causes of death in the EU and doctors believe that tens of thousands of early deaths could be avoided with the right healthcare once the condition is diagnosed.

The D-LIVER project aims to help patients with advanced liver disease, many on long waiting lists for transplants, by saving them painstaking regular trips to hospital for tests and appointments with consultants. It is developing an ICT-enabled remote support system for the patients to use in their homes. The D-LIVER system will allow them to test for a variety of biochemical and physical parameters fundamental to understanding their well-being and needs in real time.

'As my liver condition deteriorated, my ability to walk around diminished dramatically,' revealed Martin Owen, a commercial airline pilot who managed to return to work after a transplant. 'I used to spend my life asleep in a chair at home because I had absolutely no energy at all. I had to rely on my wife to take time off her employment to take me into hospital,' he said in a film about the D-LIVER project.

LIVE LONGER, LIVE BETTER

A typical patient, Martin still has to visit the hospital every six weeks, first for a blood sample, then a few days later for the consultation to discuss the results. 'Active involvement in my own care would be a boon to me," he says.

One of the aims of D-LIVER is to hand back control to the patient. By developing the home monitoring and support system, connected to a central liver patient management system at the hospital, the project focuses on improving quality of life for patients at an advanced stage of the disease. Such patients might be waiting for a transplant; they may have undergone liver resection, where the remaining organ is undergoing regeneration; or they may have unstable advanced disease, prone to episodes of deterioration.

Using the system developed by d-LIVER, the patient inserts a 3cm x 3cm plastic chip into a measurement instrument and then simply has to prick a finger and squeeze a drop of blood which, when presented to the cartridge opening, will be immediately drawn into the system. The test results are carried out automatically and the results of the various parameters (sodium, potassium, creatinine, bilirubin, albumin and blood clotting time) become available within a few minutes.

D-LIVER has also created a wearable device to allow continuous monitoring of physiological parameters such as heart rate, temperature, activity, posture and changes in blood pressure. And it has a cognitive test on a tablet computer to measure concentration and brain function, since high liver toxicity often leads to a state of mental confusion (encephalopathy).

These tests can be performed as often as required, daily or weekly, and the results are available not just to the patient at home, but also the clinician monitoring the patient from the hospital.

D-LIVER TECHNOLOGY COULD BE APPLIED FOR OTHER DISEASES

As D-LIVER coordinator Prof Calum McNeil, of Newcastle University, explained: 'The platform is generic. Once we get over the technological hurdles, it could be applied to all sorts of other disease conditions: e.g. management of cardiovascular, renal, neurological and inflammatory diseases.'

Colleagues of Prof McNeil at Newcastle University, studying the economics of such a system, estimate it will save thousands of euros a year in hospital admission costs per patient, particularly those with hepatic encephalopathy.

Now the technology developed during the first two years of the project is to be tested on patients. Between now and the end of D-LIVER in September 2015, participants are preparing for a multi-center clinical trial of the system they plan to conduct in 2016, involving up to 150 patients in Newcastle, Berlin and Milan.

D-LIVER, which ends in September 2015, involves 14 partners from 7 countries and is receiving just under 11 million euros in funding from FP7-ICT for Health.