Predictors of health-related quality of life in patients with chronic liver disease

Background: Patient-reported outcomes such as HRQL have become increasingly important for patients with chronic liver disease (CLD). Aim: To explore the relative impact of different types of liver disease on HRQL as well as predictors of HRQL domains in CLD. Design: Our HRQL databases with Short-Form 36 data (SF-36) as well as clinico-demographic data were used. Scores for each of SF-36 scales (PF - physical functioning, RP - role functioning, BP - bodily pain, GH - general health, VT – vitality, SF - social functioning, RE - role emotional and MH - mental health, MCS- mental component score, PCS- physical component score) were compared between different types of CLD as well as other variables. SF-36 scales were compared using Wilcoxon tests. Spearman’s rank coefficient was used as a measure of age-HRQL correlations. For all tests and correlation estimations, p-values not exceeding 0.05 after Benjamini-Hochberg correction were considered to be statistically significant. Results: Complete data was available for 1103 CLD patients. Demographic and clinical data included: age 53.7±11.8 years, 39% female, 792 (65%) with cirrhosis [357 (45%) Child’s A, 274 (35%) Child’s B and 161 (20%) Child’s C)]. Analysis revealed that age correlated significantly (p<0.05) with worsening HRQL on every scale of the SF-36. Female patients had more HRQL impairments in PF, RP, BP, GH, VT and MH scales of SF-36 (Δ scale score: 6.6-10.7, p<0.05). Furthermore, cirrhotic patients had more impairment of HRQL in every scale of SF-36 (Δ scale score: 6.6-43.0, p<0.05). NAFLD patients had more impairment of HRQL. Conclusions: Analysis of this large cohort with CLD suggests a number of important clinico-demographic factors are associated with HRQL impairment. This data contributes to the full understanding of the total impact of CLD on patients and society.