Advertisement

Digestive Diseases and Sciences

, Volume 48, Issue 8, pp 1622–1626 | Cite as

Influence of Hepatic Encephalopathy on Health-Related Quality of Life in Patients with Cirrhosis

  • Miguel R. Arguedas
  • Thomas G. DeLawrence
  • Brendan M. McGuire
Article

Abstract

Cirrhosis is associated with decrements in health-related quality of life (HRQOL), but the specific effects of encephalopathy, especially subclinical, on quality of life are incompletely understood. Therefore, the aim of our study was to define the effects of encephalopathy on specific domains of HRQOL in a sample of patients with advanced liver disease. The sample consisted of 160 patients with cirrhosis presenting for liver transplantation evaluation. Health-related quality of life was measured with the Short Form-36 questionnaire. Clinical, demographic, and laboratory data were collected. The presence and degree of encephalopathy was ascertained clinically and by the use of the Reitan trail test. HRQOL scores were compared according to liver disease severity and to the presence and degree of encephalopathy. In addition, scores were compared to US population norms. Data were obtained from 148 patients. Compared to the US general population, the physical and mental component summary scores were lower in patients with cirrhosis. Among patients with cirrhosis, there were no significant differences in the physical and mental component summary scores according to age, gender, ethnicity, and etiology (hepatocellular versus/ cholestatic and HCV versus non-HCV). Increasing severity of liver disease (based on the Child-Pugh score), a history of hospitalizations, and a history of ascites were associated with decreased physical component summary scores but not mental component summary scores. Patients with encephalopathy (overt and subclinical) had decreased physical and mental component summary scores compared to patients without encephalopathy. Compared to patients without encephalopathy, those with subclinical encephalopathy had a lower mental component summary score. In conclusion, cirrhosis is associated with a decreased HRQOL, especially at advanced stages. Increased severity of liver disease is associated with decreased physical aspects of quality of life. Overt hepatic encephalopathy negatively affects both physical and mental aspects of quality of life, whereas subclinical encephalopathy affects mainly the mental aspects, independently of liver disease severity.

liver transplantation quality of life questionnaires 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Rodger AJ, Jolley D, Thompson SC, Lanigan A, Crofts N: The impact of diagnosis of hepatitis Cvirus on quality of life. Hepatology30:1299–301, 1999Google Scholar
  2. 2.
    Carithers RL Jr, Sugano D, Bayliss M: Health assessment for chronic HCV infection: results of quality of life. Dig Dis Sci 41(suppl):75–80, 1996Google Scholar
  3. 3.
    Ware JE Jr, Bayliss MS, Mannocchia M, Davis GL: Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group. Hepatology 30:550–555, 1999Google Scholar
  4. 4.
    Davis GL, Balart LA, Schiff ER, Lindsay K, Bodenheimer HC Jr, Perrillo RP, Carey W, Jacobson IM, Payne J, Dienstag JL: Assessing health-related quality of life in chronic hepatitis Cusing the Sickness Impact Profile. Clin Ther 16:334–343, 1994Google Scholar
  5. 5.
    De Bona M, Ponton P, Ermani M, et al: The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation. J Hepatol 33:609–15, 2000Google Scholar
  6. 6.
    Marchesini G, Bianchi G, Amodio P, et al: Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology120:170–8, 2001Google Scholar
  7. 7.
    Younossi ZM, Boparai N, Price LL, et al: Health-related quality of life in chronic liver disease: the impact of type and severity of disease. Am J Gastroenterol 96:2199–205, 2001Google Scholar
  8. 8.
    Ware JE, Kosinski M, Keller SD: SF-36 Physical and Mental Health Summary Scales: A Users' Manual. Boston, The Health Institute,1994Google Scholar
  9. 9.
    The short-form-36 health survey. In Measuring Health, 2nd ed. I McDowell, C Newell (eds). New York, Oxford University Press,1996, pp 446–56Google Scholar
  10. 10.
    Fayers P, Bjordal K: Should quality-of-life needs influence resource allocation? Lancet 357:978, 2001Google Scholar
  11. 11.
    Weinstein MC:From cost-effectiveness ratios to resource allocation: where to draw the line? In Valuing Health Care: Costs, Benefits, and Effectiveness of Pharmaceuticals and Other Medical Technologies. FA Sloan (ed). New York, Cambridge University Press,1995Google Scholar
  12. 12.
    Fryback DG, Lawrence WF, Martin PA, Klein R, Klein BE: Predicting quality of well-being scores from the SF-36: Results from the beaver dam health outcomes study. Med Decis Making 17:1–9,1997Google Scholar
  13. 13.
    Srivastava A, Mehta R, Rothke SP, Rademaker AW, Blie AT: Fitness to drive in patients with cirrhosis and portal-systemic shunting: a pilot study evaluating driving performance. J Hepatol 21:1023–28, 1994Google Scholar
  14. 14.
    Kaplan RM: Utility assessment for estimating quality-adjusted life-years. In Valuing Health Care, 1st ed. F Sloan (ed). New York, Cambridge University Press, 1995, pp 21–60Google Scholar
  15. 15.
    Gold MR, Patrick DL, Torrance GW, Fryback DG, Hadorn DC, Kamlet MS, Daniels N, Weinstein MC: Identifying and valuing health outcomes. In Cost-Effectiveness in Health and Medicine, 1st ed. MR Gold, JE Siegel, LB Russell, MC Weinstein (eds). New York, Oxford University Press, 1996, pp 82–134.Google Scholar
  16. 16.
    Butterworth RF: Complications of cirrhosis III. Hepatic encephalopathy.J Hepatol 32:171–80, 2000Google Scholar
  17. 17.
    Cordoba J, Blei AT: Treatment of hepatic encephalopathy. Am J Gastroenterol 92:1429–39, 1997Google Scholar
  18. 18.
    Schenker S, Bay MK: Portal systemic encephalopathy. Clin Liver Dis 1:157–84, 1997Google Scholar
  19. 19.
    Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D: Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut 45:295–300, 1999Google Scholar
  20. 20.
    Gralnek IM, Hays RD, Kilbourne A, Rosen HR, Keeffe EB, Artinian L, Kim S, Lazarovici D, Jensen DM, Busuttil RW, Martin P: 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 95:3552–65,2000Google Scholar
  21. 21.
    Penson DF, Stoddard ML, Pasta DJ, Lubeck DP, Flanders SC, Litwin MS: The association between socioeconomic status, health insurance coverage, and quality of life in men with prostate cancer. J Clin Epid 54:350–358, 2001Google Scholar
  22. 22.
    Pinson CW, Feurer ID, Payne JL, Wise PE, Shockley S, Speroff T: Health-related quality of life after different types of solid organ transplantation. Ann Surg 232:597–607, 2000Google Scholar
  23. 23.
    Kusek JW, Greene P, Wang SR, Beck G, West D, Jamerson K. Agodoa LY, Faulkner M, Level B: Cross-sectional study of health-related quality of life in African Americans with chronic renal insufficiency: the African American Study of Kidney Disease and Hypertension Trial. Am J Kidney Dis 39:513–524, 2001Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Miguel R. Arguedas
    • 1
  • Thomas G. DeLawrence
    • 1
  • Brendan M. McGuire
    • 1
  1. 1.Department of Medicine, Division of Gastroenterology & HepatologyUniversity of Alabama at BirminghamBirminghamUSA

Personalised recommendations