Health-Related Quality of Life: A Rapid Predictor of Hospitalization in Patients With Cirrhosis

Abstract

OBJECTIVES: Patients with cirrhosis experience a worsened quality of life; this may be quantified by the use of health-related QoL (HRQoL) constructs, such as the chronic liver disease questionnaire (CLDQ) and EuroQoL Group—visual analog scale (EQ-VAS). In this multicenter prospective study, we aimed to evaluate HRQoL as a predictor of unplanned hospital admission/early mortality, identify HRQoL domains most affected in cirrhosis, and identify predictors of low HRQoL in patients with cirrhosis. METHODS: Multivariable logistic regression was used to determine independent association of HRQoL with primary outcome and identify predictors of low HRQoL. HRQoL was also compared with population norms. RESULTS: In this cohort of 402 patients with cirrhosis, mean model for end-stage liver disease was 12.5 (4.9). More than 50% of the cohort had low HRQoL, considerably lower than population norms. HRQoL (measured by either CLDQ or EQ-VAS) was independently associated with the primary outcome of short-term unplanned hospitalization/mortality. Every 1-point increase in the CLDQ and every 10-point increase in the EQ-VAS reduced the risk of reaching this outcome by 30% and 13%, respectively. Patients with cirrhosis had lower HRQoL scores than population norms across all domains of the CLDQ. Younger age, female sex, current smoker, lower serum albumin, frailty, and ascites were independently associated with low CLDQ. DISCUSSION: Patients with cirrhosis experience poor HRQoL. HRQoL is independently associated with increased mortality/unplanned hospitalizations in patients with cirrhosis and could be an easy-to-use prognostic screen that patients could complete in the waiting room before their appointment.

A Comparison of Different Frailty Scores and Impact of Frailty on Outcome in Patients With Cirrhosis

“…CLDQ has been used as a predictor of HRQOL in patients with cirrhosis (35). Consistent with published work from Kok et al (36), in the current series, CLDQ was also found to be an independent predictor of all-cause unplanned hospitalization and deaths. Although uncommonly evaluated, this finding highlights the importance of measuring patient-reported outcomes.…”

Serum Zinc Level Is Associated with Frailty in Chronic Liver Diseases

“…Frailty is defined as the presence of three or more of the following phenotypes: body weight (BW) loss, self-reported exhaustion, skeletal muscle functional decline, slow walking speed (WS), and decreased PA [4,5]. Recently, the concept of frailty has been enlarged to chronic liver diseases (CLDs) as clinical symptoms of impaired global physical function [6][7][8][9][10][11][12][13][14][15]. Tanaka et al reported that frailty, age of 76 years or more, and open surgery were independent adverse predictors associated with loss of independence after surgery in independently living subjects aged 65 years or more undergoing liver surgery [6].…”

Short‐term intraperitoneal catheters: An ambulatory care intervention for refractory ascites secondary to cirrhosis during COVID‐19

“…Patients with decompensated liver disease experience a high symptom burden comparable to that of other end‐stage chronic disease and worse than that experienced by those with compensated liver disease 13 . Distressing symptoms drive poor HRQoL, which is associated with increased mortality and hospitalization 2 . Improvements in HRQoL are likely multifactorial and remain a major clinical objective for this cohort who otherwise have limited treatment options.…”

“…The COVID‐19 pandemic has created challenges in how healthcare systems provide care for patients with cirrhosis complicated by refractory ascites. The consequences of refractory ascites can include spontaneous bacterial peritonitis, 1 high healthcare resource utilization, and reduced health‐related quality of life 2 . As the most common complication of decompensated cirrhosis, 3,4 ascites necessitates frequent face‐to‐face interactions with the healthcare system through elective large‐volume paracentesis (LVP), emergency department presentations, and acute hospitalization.…”

“…The consequences of refractory ascites can include spontaneous bacterial peritonitis, 1 high healthcare resource utilization, and reduced health‐related quality of life. 2 As the most common complication of decompensated cirrhosis, 3 , 4 ascites necessitates frequent face‐to‐face interactions with the healthcare system through elective large‐volume paracentesis (LVP), emergency department presentations, and acute hospitalization. The development of ascites is a predictor of mortality, both as a component of the Child–Pugh score and as an independent variable.…”