Health-related Quality of Life in Patients with Liver Cirrhosis: Its Determination and Correlation with Relevant Factors

Authors

  • Iftikhar Haider Naqvi
  • Muhamad Salman
  • Sadia Siddiqui

Keywords:

Cirrhosis of the liver, Child Turcotte Pugh, Model of end-stage liver disease, Health related quality of life

Abstract

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.

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Published

28-12-2023

How to Cite

1.
Naqvi IH, Salman M, Siddiqui S. Health-related Quality of Life in Patients with Liver Cirrhosis: Its Determination and Correlation with Relevant Factors . J Liaq Uni Med Health Sci [Internet]. 2023 Dec. 28 [cited 2024 Nov. 16];22(04):243-9. Available from: http://ojs.lumhs.edu.pk/index.php/jlumhs/article/view/1131