Abstract
Quality of life is a construct that reflects the positive and negative aspects of one’s life, and is expanded upon by health-related quality of life (HRQL), which specifically address the impact of health on patients’ well-being. Cirrhosis is the culmination of various pathways that leads into development of advanced hepatic fibrosis with its complications. This paper addresses the impact of cirrhosis on individuals HRQL. In addition, we will define what disease specific and general HRQL instruments aim to measure. We discuss the liver disease specific scales [Chronic Liver Disease Questionnaire (CLDQ), Liver Disease Quality of Life 1.0 (LDQOL)] and the most commonly used generic health profile [Short Form 36 Profile (SF-36)]. Furthermore, we examine recent literature which describes how to measure and what is known about quality of life of patients with cirrhosis. This information gives insight to health care providers concerning the impact of disease on patients if treatments are not only to improve health but also function and unexpected treatment outcomes.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Davis GL, Later MJ, El-Serag H, Poynard T, Jennings LW. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology. 2010;138:513–21.
Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129:113–21.
Davis GL, Albright JE, Cook SF, Rosenberg DM. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl. 2003;9(4):331–8.
• McGarry LJ, Pawar VS, Parekh HH, et al. Economic model of a birth cohort screening program for hepatitis C virus. Hepatology. 2012;55:1344–55. Important paper about screening for HCV.
• Rein DB, Smith BD, Wittenborn JS, Lesesne SB, Wagner LD, Roblin DW, Patel N, Ward JW, Weinbaum CM. The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings. Ann Intern Med. 2012;156(4):263–70. Epub 2011 Nov 4. Important paper about screening for HCV.
Anonymous. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. MMWR Recomm Rep. 2012 Aug 17;61(RR-4):1–32.
Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491–7. Epub 2012 Jan 17.
• Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, Srishord M. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524–30. Important paper about prevalence of CLD in the USA
Rakoski MO, McCammon RJ, Piette JD, Iwashyna TJ, Marrero JA, Lok AS, Langa KM, Volk ML. Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study. Hepatology. 2012;55(1):184–91. doi:10.1002/hep.24616.
Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH. The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization. J Clin Pathol. 1978;31(5):395–414.
Greenhalgh J, Long AF, Flynn R. The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory? Soc Sci Med. 2005;60(4):833–43. Review.
Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, Loguercio C, Apolone G, Niero M, Abbiati R. Factors associated with poor health-related quality of life patients with cirrhosis. Gastroenterol. 2001;120:170–8.
Owen JE, Boxley L, Klapow JC. Measurement of quality of life outcomes. In: Berger AM, Shuster JL, Von Roenn JH, editors. Principles & Practice of Palliative Care & Supportive Oncology. Philadelphia: Lippincott-Raven Publishers; 1998. p. 878–9.
Dan AA, Younossi ZM. Long-term improvement in health-related quality of life after orthotopic liver transplantation. Liver Transpl. 2008;14(10):1404–5.
• Starr SP, Raines D. Cirrhosis: diagnosis, management, and prevention. Am Fam Physician. 2011;84(12):1353–9. Review. This article gives great insight into the complications of cirrhosis and how diagnosis and prevention can reduce incidences of cirrhosis.
Kochanek KD, Xu J, Murphy SL, Minino AM, Ching Kung H. Deaths: final data for 2009. In: National Vital Statistics Reports. 2011. http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf. Accessed 19 April 2012.
Dan AA, Martin LM, Crone C, Ong JP, Farmer DW, Wise T, Robbins SC, Younossi ZM. Depression, anemia and health-related quality of life in chronic hepatitis C. J Hepatol. 2006; 44(3):491–8.
Younossi Z, Kallman J, Kincaid J. The effects of HCV infection and management on health-related quality of life. Hepatology. 2007;45:806–16.
Bajaj JS, Wade JB, Gibson DP, Heuman DM, Thacker LR, Sterling RK, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol. 2011. doi:10.1038/ajg.2011.157.
Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician. 2006;74(5):756–62. Review.
Grattagliano I, Ubaldi E, Bonfrate L, Portincasa P. Management of liver cirrhosis between primary care and specialists. World J Gastroenterol. 2011;17(18):2273–82.
Alizadeh AH, Ranjbar M, Yadollahzadeh M. Patient concerns regarding chronic hepatitis B and C infection. East Mediterr Health J. 2008;14(5):1142–7.
Minuk GY, Gutkin A, Wong SG, Kaita KD. Patient concerns regarding chronic hepatitis C infections. J Viral Hepat. 2005;12(1):51–7.
Otgonsuren M, Venkatesan C, Mishra A, Erari M, Younossi ZM. Mortality and Resource Utilization Associated with the Inpatient Diagnosis of Liver Disease in the United States. Hepatology. 2012 (Abstract).56 (N0.4, Supplement):1096A.
Neff GW, Duncan CW, Schiff ER. The current economic burden of cirrhosis. Gastroenterol Hepatol. 2011;7(10):661–71.
Miniño AM, Xu J, Kochanek KD, Tejada-Vera B. Death in the United States, 2007. NCHS Data Brief. 2009;26:1–8.
Kogure T, Ueno Y, Kawagishi N, Kanno N, Yamagiwa Y, Fukushima K, Satomi S, Shimosegawa T. The model for end-stage liver disease score is useful for predicting economic outcomes in adult cases of living donor liver transplantation. J Gastroenterol. 2006;41(10):1005–10. Epub 2006 Nov 9.
Aberg F, Höckerstedt K, Roine RP, Sintonen H, Isoniemi H. Influence of liver-disease etiology on long-term quality of life and employment after liver transplantation. Clin Transplant. 2012. doi:10.1111/j.1399-0012.2012.01597.x [Epub ahead of print].
Fryback GD. Measuring health-related quality of life. Workshop on advancing social science theory: the importance of common metricks. Washington, D.C.: The National Academies, Division of Behavioral and Social Sciences and Education; 2010.
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. 1999;45(2):295–300.
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. 2000;95(12):3552–65.
Kallman J, O'Neil MM, Larive B, Boparai N, Calabrese L, Younossi ZM. Fatigue and health-related quality of life (HRQL) in chronic hepatitis C virus infection. Dig Dis Sci. 2007;52(10):2531–9. Epub 2007 Apr 4.
• Dan AA, Kallman JB, Wheeler A, Younoszai Z, Collantes R, Bondini S, Gerber L, Younossi ZM. Health-related quality of life in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2007;26(6):815–20. This article discusses how severely impaired HRQL was in a population of patients with chronic liver disease (NAFLD).
Kollia Z, Patelarou E, Vivilaki V, Kollia E, Kefou F, Elefsiniotis I, Dourakis SP, Brokalaki H. Translation and validation of the Greek chronic liver disease questionnaire. World J Gastroenterol. 2010;16(46):5838–44.
Ray I, Dutta D, Basu P, De BK. Quality of life assessment of patients with chronic liver disease in eastern India using a Bengali translation chronic liver disease questionnaire. Indian J Gastroenterol. 2010;29(5):187–95. Epub 2010 Aug 26.
Lam ET, Lam CL, Lai CL, Yuen MF, Fong DY. Psychometrics of the chronic liver disease questionnaire for Southern Chinese patients with chronic hepatitis B virus infection. World J Gastroenterol. 2009;15(26):3288–97.
Ferrer M, Córdoba J, Garin O, Olivé G, Flavià M, Vargas V, Esteban R, Alonso J. Validity of the Spanish version of the Chronic Liver Disease Questionnaire (CLDQ) as a standard outcome for quality of life assessment. Liver Transpl. 2006;12(1):95–104.
Sobhonslidsuk A, Silpakit C, Kongsakon R, Satitpornkul P, Sripetch C. Chronic liver disease questionnaire: translation and validation in Thais. World J Gastroenterol. 2004;10(13):1954–7.
Younossi ZM, Boparai N, McCormick M, Price LL, Guyatt G. Assessment of utilities and health-related quality of life in patients with chronic liver disease. Am J Gastroenterol. 2001;96(2):579–83.
Kim JH, Kwon SY, Lee YS, Lee JH, Lee YS, Lee CH. Virologic response to therapy increases health-related quality of life for patients with chronic hepatitis B. Clin Gastroenterol Hepatol. 2012;10(3):291–6. Epub 2011 Oct 20.
Jafferbhoy H, Gashau W, Dillon J. Cost effectiveness and quality of life considerations in the treatment of hepatitis C infection. Clinicoecon Outcomes Res. 2010;2:87–96. Epub 2010 Jul 14.
Mahmoudi H, Jafari P, Alizadeh-Naini M, Gholami S, Malek-Hosseini SA, Ghaffaripour S. Validity and reliability of Persian version of chronic liver disease questionnaire (CLDQ). Qual Life Res. 2011 Nov 13. [Epub ahead of print].
Saab S, Ibrahim A, Shpaner A, Younossi ZM, Lee C, Durazo F, et al. MELD fails to measure quality of life in liver transplant candidates. Liver Transpl. 2005;11:218–23.
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.
• Sanyal A, Younossi ZM_, Bass N, Mullen KD, Poordad F, Brown R, et al. Randomised clinical trial: rifaximin improves health-related quality of life in cirrhotic patients with hepatic nencephalopathy – a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2011;34:853–61. A large RCT describing HRQL in patients with HE using both CLDQ and SF-36.
Ong JP, Oehler G, Krüger-Jansen C, Lambert-Baumann J, Younossi ZM. Oral L-ornithine-L-aspartate improves health-related quality of life in cirrhotic patients with hepatic encephalopathy: an open-label, prospective, multicentre observational study. Clin Drug Investig. 2011;31(4):213–20.
Younossi ZM, Boparai N, McCormick M. A disease-specific health-related quality of life instrument for chronic hepatitis C: CLDQ-HCV. Hepatology. 2000. (Abstract).
Dan AA, Crone C, Wise TN, Martin LM, Ramsey L, Magee S, Sjogren R, Ong JP, Younossi ZM. Anger experiences among hepatitis C patients: relationship to depressive symptoms and health-related quality of life. Psychosomatics. 2007;48(3):223–9.
Loria A, Escheik CE, Gerber NL, Price JK, Younossi ZM. The Chronic Liver Disease Questionnaire-Hepatitis C (CLDQ-HCV): a sensitive and valid health related quality of life instrument. Hepatology. 2012. (Abstract).
Two R, Verjee-Lorenz A, Clayson D, Dalal M, Grotzinger K, Younossi ZM. Response to the letter from Ms. Tamzin Furtado. Value Health. 2010;13(4):508–14.
Gotardo DR, Strauss E, Teixeira MC, Machado MC. Liver transplantation and quality of life: relevance of a specific liver disease questionnaire. Liver Int. 2008;28(1):99–106. Epub 2007 Nov 1.
Ortega T, Deulofeu R, Salamero P, Casanovas T, Rimola A, Pont T, Caldes A, Twose J, Ortega F, Red Tematica de Investigacion en Trasplante. Impact of health related quality of life in catalonia liver transplant patients. Transplant Proc. 2009;41(6):2187–8.
Casanovas Taltavull T, Jané Cabré L, Herdman M, Casado Collado A, Pubill BP, Fabregat Prous J. Validation of the Spanish version of the liver disease quality of life instrument among candidates for liver transplant. Transplant Proc. 2007;39(7):2274–7.
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.
WHO. Constitution of the world health organization. The constitution was adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100). http://www.who.int/governance/eb/who_constitution_en.pdf. Accessed 19 April 2012.
Escheik CE, Gerber NL, Rover L, Arsalla Z, Otgonsuren M, Younossi ZM. Validation of CLDQ-HCV as a health related quality of life (HRQL) instrument for patients with chronic hepatitis C (CH-C). ACG 2012 (Abstract).107 (Supplement):1252
Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36).I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.
Afendy A, Kallman JB, Stepanova M, Younoszai Z, Aquino RD, Bianchi G, Marchesini G, Younossi ZM. Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther. 2009;30(5):469–76. Epub 2009 Jun 9.
Solà E, Watson H, Graupera I, Turón F, Barreto R, Rodríguez E, Pavesi M, Arroyo V, Guevara M, Ginès P. Factors related to quality of life in patients with cirrhosis and ascites. Relevance of serum sodium concentration and leg edema. J Hepatol. 2012;57(6):1199–206
Moscucci F, Nardelli S, Pentassuglio I, Pasquale C, Ridola L, Merli M, Riggio O. Previous overt hepatic encephalopathy rather than minimal hepatic encephalopathy impairs health-related quality of life in cirrhotic patients. Liver Int. 2011;31(10):1505–10. doi:10.1111/j.1478-3231.2011.02598.x. Epub 2011 Aug 15.
Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, Loguercio C, Apolone G, Niero M, Abbiati R, et al. Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology. 2001;120(1):170–8.
Younossi ZM. Chronic liver disease and health-related quality of life. Gastroenterology. 2001;120(1):305–7.
Kallman-Price J, Younossi Z. Quality of life in hepatic encephalopathy. In: Mullen KD and Prakash RK, editors. Hepatic encephalopathy, clinical gastroenterology. doi 10.1007/978-1-61779-836-8_18, © Springer Science; 2012.
Saab S, Ng V, Landaverde C, Lee S, Comulada WS, Arevalo J, Durazo F, Han S, Younossi ZM, Busuttil RW. Development of a disease-specific questionnaire to measure health-related quality of life in liver transplant recipients. Liver Transpl. 2011;17:567–79.
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Loria, A., Escheik, C., Gerber, N.L. et al. Quality of Life in Cirrhosis. Curr Gastroenterol Rep 15, 301 (2013). https://doi.org/10.1007/s11894-012-0301-5
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DOI: https://doi.org/10.1007/s11894-012-0301-5