Health-related Quality of Life in Patients with Liver Cirrhosis: Its Determination and Correlation with Relevant Factors
Keywords:
Cirrhosis of the liver, Child Turcotte Pugh, Model of end-stage liver disease, Health related quality of lifeAbstract
OBJECTIVE: To determine the health-related quality of life (HRQOL) among patients with Cirrhosis of the liver using a short form of liver disease quality of life (SF-LDQOL) instrument, also to correlate HRQOL scores with relevant factors.
METHODOLOGY: This prospective, cross-sectional study was carried out in the medical department of Civil Hospital Karachi from May 2021 to April 2022. One hundred ninety-seven confirmed cases of Cirrhosis from either gender over 18 years of age without malignancy, HIV infection, or Psychiatric/Neurological diseases were enrolled using convenient sampling. The SF-LDQOL instrument assessed HRQOL, summarizing overall disease-targeted HRQOL (0 to 100), where a higher score shows good HRQOL or otherwise.
RESULTS: Using SPSS version 23, the SF-LDQOL score was 44±7.3. The severity of liver cirrhosis by CTP-A correlated weakly (-0.1294), while CTP B and CTP C strongly correlated with SF-LDQOL scores (-0.9894 and -0.9912), respectively. The p-value for CTP A (0.705) is insignificant; however, for CTP B and C (p < 0.00001 & p < 0.00001) is significant. Demographically, the age and income status correlated strongly to SF-LDQOL scores, displaying considerable p-values (p <0.00001 and p < 0.00001).
CONCLUSION: Most patients had compromised HRQOL as assessed by well-validated and more disease-specific tool SF-LDQOL score. HRQOL correlated positively with the severity of Cirrhosis by applying CTP and Model of end-stage liver disease (MELD) scoring. Sociodemographic parameters of age and income status also correlated well with HRQOL.
KEYWORDS: Cirrhosis of the liver, Child Turcotte Pugh, Model of end-stage liver disease, Health-related quality of life.
References
Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019; 70(1): 151-71. doi: 10.1016/j.jhep.2018.09.014.
Zhai M, Long J, Liu S. The burden of liver cirrhosis and underlying etiologies: results from the global burden of disease study 2017. Aging (Albany NY). 2021; 13(1): 279-300. doi: 10.18632/aging.104127
D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in Cirrhosis: a systematic review of 118 studies. J Hepatol. 2006; 44(1): 217-31. doi: 10.1016/j.jhep.2005.10.013.
Tran TXM, Lee S, Oh CM, Chang YJ, Cho H. Understanding health problems in people with extremely low health-related quality of life in Korea. Sci Rep. 2022; 12(1): 4037. doi: 10.1038/s41598-022-07528-2.
Wu H, Han S, Zhang G, Wu W, Tang N. Health-related quality of life and determinants in North-China urban community residents. Health and Quality of Life Outcomes. 2020; 18: 1-9. doi: 10.1186/s12955-020-01522-w.
Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019; 53: 100903. doi: 10.1016/j.arr.2019.04.005.
Janani K, Jain M, Vargese J. Health-related quality of life in liver cirrhosis patients using SF-36 and CLDQ questionnaires. Clin Exp Hepatol. 2018; 4(4): 232-39. doi: 10.5114/ceh.2018.80124.
Kim HJ, Chu H, Lee S. Factors influencing on health-related quality of life in South Korean with chronic liver disease. Health Qual Life Outcomes. 2018; 16(1): 142. doi: 10.1186/s12955-018-0964-1.
Hui Y, Li N, Yu Z. Health-Related Quality of Life and Its Contributors According to a Preference-Based Generic Instrument in Cirrhosis. Hepatol Commun. 2022; 6(3): 610-620. doi: 10.1002/hep4.1827.
Amy E. Ustjanauskas, Vanessa L. Malcarne. Health-Related Quality of Life. In: Suzy Bird Gulliver, Lee M. Cohen, eds. The Wiley Encyclopedia of Health Psychology. John Wiley & Sons Ltd, 2021; (cited 2023 April 13): 149-154. doi: 10.1002/978111905 7840.
Orr JG, Homer T, Ternent L. Health related quality of life in people with advanced chronic liver disease. J Hepatol. 2014; 61(5): 1158-1165. doi:10.1016/j.jhep.2014.06.034.
Chang PE, Tan HK, Lee Y, Fook?Chong S, Chia PY, Shaik?Hussain N et al. Clinical validation of the chronic liver disease questionnaire for the Chinese population in Singapore. JGH Open. 2020; 4(2): 191-7. doi: 10.1002/jgh3.12239.
Ha Y, Hwang S, Chon YE, Kim MN, Lee JH, Hwang SG. Validation of the liver disease quality of life instrument 1.0 in patients with Chronic Hepatitis B: A prospective study. J Clin Med. 2019; 8(5): 656. doi:10.3390/jcm8050656.
van der Plas SM, Hansen BE, de Boer JB. The Liver Disease Symptom Index 2.0; validation of a disease-specific questionnaire. Qual Life Res. 2004; 13(8): 1469-81. doi :10.1023/B:QURE.0000040797.17449.c0.
Younossi ZM. Chronic liver disease and health-related quality of life. Gastroenterology. 2001; 120(1): 305-07. doi:10.1053/gast.2001.22073.
Ali B, Salim A, Alam A. HEP-Net opinion on the management of ascites and its complications in the setting of decompensated Cirrhosis in the resource constrained environment of Pakistan. Pak J Med Sci. 2020; 36(5): 1117-1132. doi:10.12669/pjms.36.5.2407.
Kanwal F, Spiegel BM, Hays RD. Prospective validation of the short form liver disease quality of life instrument. Aliment Pharmacol Ther. 2008; 28(9): 1088-101. doi:10.1111/j.1365-2036.2008.03817.x
Gralnek IM, Hays RD, Kilbourne A. Development and evaluation of the Liver Disease Quality of Life instrument in persons with advanced, chronic liver disease--the LDQOL 1.0. Am J Gastroenterol. 2000; 95(12): 3552-65. doi:10.1111/j.1572-0241.2000.03375.x.
Lins-Kusterer L, Valdelamar J, Aguiar CV, Menezes MS, Netto EM, Brites C. Validity and reliability of the 36-Item Short Form Health Survey questionnaire version 2 among people living with HIV in Brazil. Braz J Infect Dis. 2019; 23(5): 313-21. doi: 10.1016/j.bjid.2019.08.001.
World Bank Country and Lending Groups: (2022) Retrieved from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.
Berry P, Theocharidou E, Kotha S. Clinical utility of prognostic scores and models in decompensated liver disease. J Liver Transpl. 2021; 4: 100048.
Tsoris A, Marlar CA. Use of the Child Pugh Score in Liver Disease. [Updated 2023 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542308/.
Rabiee A, Ximenes RO, Nikayin S. Factors associated with health-related quality of life in patients with Cirrhosis: a systematic review. Liver Int. 2021; 41(1): 6-15. doi: 10.1111/liv.14680.
Huang R, Fan JG, Shi JP, Mao YM, Wang BY, Zhao JM et al. Health-related quality of life in Chinese population with non-alcoholic fatty liver disease: a national multicenter survey. Health and Quality of Life Outcomes. 2021; 19(1): 1-8.
Ragusa R, Bertino G, Bruno A, Frazzetto E, Cicciu F, Giorgianni G et al. Evaluation of health status in patients with hepatitis c treated with and without interferon. Health and Quality of Life Outcomes. 2018; 16: 1-9. doi: 10.1186/s 12955-018-0842-x.
Häuser W, Holtmann G, Grandt D. Determinants of health-related quality of life in patients with chronic liver diseases. Clin Gastroenterol Hepatol. 2004; 2(2): 157-63. doi: 10.1016/s1542-3565(03)00315-x.
Pradhan RR, Kafle Bhandari B, Pathak R. The Assessment of Health-Related Quality of Life in Patients With Chronic Liver Disease: A Single-Center Study. Cureus. 2020; 12(9): e10727. doi: 10.7759/cureus.10727.
Nagel M, Labenz C, Wörns MA. Impact of acute-on-chronic liver failure and decompensated liver cirrhosis on psychosocial burden and quality of life of patients and their close relatives. Health Qual Life Outcomes. 2020; 18(1): 10. doi: 10.1186/s12955-019-1268-9.
Zuberi BF, Memon AR, Afsar S, Qadeer R, Kumar R. Correlation of quality of life in patients of Cirrhosis of liver with etiology and disease severity using disease-specific quality of life questionnaire. J Ayub Med Coll Abbottabad. 2007; 19(2): 7-11.
Afendy A, Kallman JB, Stepanova M. Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther. 2009; 30(5): 469-76. doi: 10.1111/j.1365-2036.2009.04061.x.
Bao ZJ, Qiu DK, Ma X. Assessment of health-related quality of life in Chinese patients with minimal hepatic encephalopathy. World J Gastroenterol. 2007; 13(21): 3003-8. doi: 10.3748/wjg.v13.i21.3003.
Younossi ZM, Boparai N, Price LL, Kiwi ML, McCormick M, Guyatt G. Health-related quality of life in chronic liver disease: the impact of type and severity of disease. Am J Gastroenterol. 2001; 96(7): 2199-205. doi: 10.1111/j.1572 -0241.2001.03956.x.
Kamath PS, Kim WR. Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007; 45(3): 797-805. doi: 10.1002/hep.21563.
Nikam V, Ramaswamy V, Chaudhary A, Singhvi S. Effect of Orthotopic Liver Transplantation on the Health-Related Quality of Life in Indian Patients with End-Stage Liver Disease: A Prospective Study. J Surg Res. 2022; 5: 435-440.
Kanwal F, Hays RD, Kilbourne AM, Dulai GS, Gralnek IM. Are physician-derived disease severity indices associated with health-related quality of life in patients with end-stage liver disease? Am J Gastroenterol. 2004; 99(9): 1726-32. doi: 10.1111/j.1572-0241.2004.30300.x
Saab S, Ibrahim AB, Shpaner A. MELD fails to measure quality of life in liver transplant candidates. Liver Transpl. 2005; 11(2): 218-23. doi: 10.1002/lt.20345.
Malik M, Mushtaq H, Hussain A. Health-related quality of life and depression among patients of liver cirrhosis in Pakistan. Int J Curr Pharm Sci [Internet]. 2021; 13(2): 19-25. Available from: https://innovareacademics.in/journals/index.php/ijcpr/article/view/41546.
Parkash O, Iqbal R, Jafri F, Azam I, Jafri W. Frequency of poor quality of life and predictors of health related quality of life in Cirrhosis at a tertiary care hospital Pakistan. BMC Res Notes. 2012; 5: 446. doi: 10.1186/1756 -0500-5-446.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Journal of Liaquat University of Medical & Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Submission of a manuscript to the journal implies that all authors have read and agreed to the content of the undertaking form or the Terms and Conditions.
When an article is accepted for publication, the author(s) retain the copyright and are required to grant the publisher the right of first publication and other non-exclusive publishing rights to JLUMHS.
Articles published in the Journal of Liaquat University of Medical & health sciences are open access articles under a Creative Commons Attribution-Noncommercial - Share Alike 4.0 License. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal. This is in accordance with the BOAI definition of open access. In addition to that users are allowed to remix, tweak and build upon the work non-commercially as long as appropriate credit is given and the new creations are licensed under the identical terms. Or, in certain cases it can be stated that all articles and content there in are published under creative commons license unless stated otherwise.