Determinants of health-related quality of life in patients with chronic liver diseases

doi:10.1016/S1542-3565(03)00315-X

Clinical Gastroenterology and Hepatology

Volume 2, Issue 2, February 2004, Pages 157-163

https://doi.org/10.1016/S1542-3565(03)00315-X Get rights and content

Abstract

$Background & Aims$ : The study aims to assess influence of the liver disease, active medical and psychiatric comorbidities, and sociodemographic variables in the determination of health-related quality of life (HRQOL) measured by a generic and a liver-specific instrument in unselected patients with chronic liver disease. $Methods$ : Two hundred four of 255 consecutive patients (80%) with all stages of various liver diseases attending a tertiary-care center completed the following self-report questionnaires: sociodemographic questionnaire of the Competence Network Bowel Disease, morbidity list of the German Pain Questionnaire, the German version of the Hospital Anxiety and Depression Scale (HADS-D), and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) as generic instruments; and the German version of the Chronic Liver Disease Questionnaire (CLDQ) as a disease-specific HRQOL-instrument. $Results$ : Stepwise multiple regression showed that cause of liver disease, severity of disease (cirrhosis vs. no cirrhosis, Child-Pugh score), sex, age, and social class had no effect on HRQOL. Anxiety resp. depression scores ≥ 11 in the German version of the HADS, indicating a probable psychiatric disorder, contributed independently to the impaired HRQOL in the total score of the CLDQ and the Physical and Mental Summary Scores of the SF-36 (P < 0.0001). Number of active medical comorbidities contributed independently to the reduced HRQOL in the total score of the CLDQ and the Physical Summary Score of the SF-36 (P < 0.0001). Furthermore, the SF-36 Mental Summary Score was influenced negatively by active cardiovascular comorbidity (P < 0.003). $Conclusions$ : Psychiatric comorbidity and active medical comorbidity, and not severity of the liver disease according to Child-Pugh score, determine reduced HRQOL in patients with chronic liver diseases.

Section snippets

Patients

Consecutive adult patients with a diagnosis of a chronic liver disease, confirmed by laboratory tests, imaging studies, and, in most cases, liver histological examination, attending a referral center for patients with liver diseases were invited to take part in the study. Enrollment started August 2001 and ended August 2002. Non-German-speaking patients, patients after liver transplantation, those with dementia or psychosis, and patients with refractory encephalopathy (≥ grade II), preventing

Results

Twenty-four patients were excluded because of their inability to understand German or cognitive deficiencies caused by alcoholic cerebral damage or lethal complications of the liver disease. Of the 255 consecutive patients approached, 203 patients (80%) agreed to participate in the study and completed questionnaires. There were no differences in terms of sex, age, and cause of liver disease in patients who agreed and did not agree to take part in the study. Of those who agreed, not all provided

Discussion

This is the first study with simultaneous assessment of the determination of HRQOL in patients with mixed chronic liver diseases by variables of the liver disease, sociodemographic variables, and active medical and psychiatric comorbidity. Our study shows that patients with chronic liver disease perceive significantly impaired HRQOL compared with the German general population. The reduced overall HRQOL in patients with chronic liver diseases can be predicted best by psychiatric and active

References (30)

Z.M. Younossi
Chronic liver disease and health-related quality of life
Gastroenterology
(2001)
G. Marchesini et al.
Factors associated with poor health-related quality of life of patients with cirrhosis
Gastroenterology
(2001)
Z.M. Younossi et al.
Cholestatic liver diseases and health-related quality of life
Am J Gastroenterol
(2000)
Z.M. Younossi et al.
Assessment of utilities and health-related quality of life in patients with chronic liver disease
Am J Gastroenterol
(2001)
C. Herrmann
International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results
J Psychosom Res
(1997)
P.M. Huet et al.
Impact of fatigue on the quality of life of patients with primary biliary cirrhosis
Am J Gastroenterol
(2000)
J. Goldblatt et al.
The true impact of fatigue in primary biliary cirrhosisa population study
Gastroenterology
(2002)
R.J. Fontana et al.
Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C
Am J Gastroenterol
(2001)
E. Guthrie et al.
Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn’s disease
Am J Gastroenterol
(2002)
M.S. Bayliss
Methods in outcomes research in hepatologydefinitions and domains of quality of life
Hepatology
(1999)

W. Häuser et al.

Quality of life measurement in gastroenterology—concepts, instruments and problems

Z Gastroenterol

(2001)

J.E. Ware et al.

Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group

Hepatology

(1999)

J.E. Ware

SF-36 Health Survey

Manual and interpretation guide

(1993)

Z.M. Younossi et al.

Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease

Gut

(1999)

B.N. Gaynes et al.

Depression and health-related quality of life

J Nerv Ment Dis

(2002)

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Citation Excerpt :
The presence of depressive disorders was associated with a remarkable deterioration of HRQL scores and all cognitive domains.59,61 Kramer and colleagues62 and Hauser and colleagues63 provided evidence that HRQL was not influenced by liver disease severity, with the exception of decompensated cirrhosis; conversely, HRQL could be affected by the presence of a comorbidity (eg, internal and psychiatric), age, and severity of fatigue. Finally, onset of psychological disorders and a negative impact on patient quality of life were noted to merely result from a diagnosis of HCV infection as well.64
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Chronic liver (CLD) is a major public health concern. We assessed its effects on quality of life and work productivity, as well as its economic burden in the United States.
We performed a cross-sectional study of data from the Medical Expenditure Panel Survey (MEPS; 2004–2013). We extracted participants’ sociodemographic parameters and medical histories. Subjects with CLD were identified based on Clinical Classification Software codes. MEPS participants were compared between those with and without CLD, and then between employed and unemployed patients with CLD. Outcomes were quality-of-life scores, employment, and health care use.
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Original articleDeterminants of health-related quality of life in patients with chronic liver diseases

Abstract

Section snippets

Patients

Results

Discussion

Gastroenterology

Gastroenterology

Am J Gastroenterol

Am J Gastroenterol

J Psychosom Res

Am J Gastroenterol

Gastroenterology

Am J Gastroenterol

Am J Gastroenterol

Methods in outcomes research in hepatologydefinitions and domains of quality of life

Hepatology

Quality of life measurement in gastroenterology—concepts, instruments and problems

Z Gastroenterol

Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group

Hepatology

SF-36 Health Survey

Manual and interpretation guide

Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease

Gut

Depression and health-related quality of life

J Nerv Ment Dis

Original article
Determinants of health-related quality of life in patients with chronic liver diseases