Health-related quality of life linked with mortality, hospitalizations in cirrhosis

Health-related quality of life scores may be useful prognostic screening tools for patients with cirrhosis, according to research published in The American Journal of Gastroenterology.

Puneeta Tandon, MD, FRCP(C), MSc (Epi), of the liver unit at the University of Alberta, and colleagues wrote that health-related quality of life (HRQoL) tools are regularly used for other chronic diseases and have been associated with increased mortality and hospitalization.

“Regardless of etiology, patients with cirrhosis have significant impairment in HRQoL, more so in patients with decompensated disease,” they wrote. “Despite the more frequent use of HRQoL tools, there remains a lack of clarity around predictors of HRQoL and whether these tools are independent of conventional measures such as model for end-stage liver disease or Child-Pugh in predicting clinically relevant outcomes such as hospitalizations and mortality.”

Using a cohort of 402 patients with cirrhosis, researchers sought to evaluate HRQoL — determined by the chronic liver disease questionnaire (CLDQ) and EuroQL Group-visual analog scalre (EQ-VAS) — as a predictor of unplanned hospital admission or early mortality, identify HRQoL domains most affected in cirrhosis and identify predictors of low HRQoL in patients with cirrhosis.

Among the patients in the study the mean model of end-stage liver disease was 12.5, and more than 50% had low HRQoL, which the researchers said was considerably lower compared with population norms.

Whether measured by CLDQ or EQ-VAS, HRQoL was independently associated with the primary outcome of short-term, unplanned hospitalization/mortality. With every one-point increase in CLDQ, the risk for reaching this outcome went down by 30%. The risk went down 13% for every 10-point increase in EQ-VAS.

Tandon and colleagues also found that younger age, female sex, smoking status, lower serum albumin, frailty and ascites were all independently associated with low CLDQ scores.

“Patients with cirrhosis experience poor HRQoL,” they wrote. “Whether assessed by disease-specic or generic constructs, HRQoL is independently associated with increased mortality and unplanned hospitalizations in patients with cirrhosis and could be an easy-to-use screen that patients could complete in the waiting room before their appointment.” – by Alex Young

Disclosure: The authors report no relevant financial disclosures.