Quality of life, major medical complications and hospital service utilization in patients with primary biliary cirrhosis after liver transplantation

Navasa, Miquel; Forns, Xavier; Sánchez, Victoria; Andreu, Hernán; Marcos, Victoria; Boarràs, Joseph M.; Rimola, Antoni; Grande, Luís; García-Valdecasas, J.C.; Granados, Alı́cia; Rodés, Joan

doi:10.1016/s0168-8278(96)80064-x

Cited by 54 publications

(40 citation statements)

References 19 publications

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“…40 It is measured by using general health scales like Nottingham Health Profile (NHP), the Sickness Impact Profile (SIP), SF -36 16,[41][42][43] and disease specific scales like Chronic Liver Disease Questionnaire (CLDQ), NIDDK-QA and the Liver Disease Quality of Life Instrument. [44][45][46][47] MHE adversely affects HRQOL as shown by various studies.…”

Section: Effect Of Minimal Hepatic Encephalopathy On Quality Of Lifementioning

confidence: 99%

“…[44][45][46][47] MHE adversely affects HRQOL as shown by various studies. 11,41,43,[48][49][50] Complex activities which require attention or information processing and psychomotor skills are mainly affected, such as driving a car or planning a trip. Basic functions of day to day self-care like personal hygiene, dressing and shopping are preserved.…”

Section: Effect Of Minimal Hepatic Encephalopathy On Quality Of Lifementioning

confidence: 99%

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Minimal Hepatic Encephalopathy Impairs Quality of Life

Agrawal

Umapathy

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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Minimal hepatic encephalopathy (MHE) is the mildest form of the spectrum of neurocognitive impairment in cirrhosis. It is a frequent occurrence in patients of cirrhosis and is detectable only by specialized neurocognitive testing. MHE is a clinically significant disorder which impairs daily functioning, driving performance, work capability and learning ability. It also predisposes to the development of overt hepatic encephalopathy, increased falls and increased mortality. This results in impaired quality of life for the patient as well as significant social and economic burden for health providers and care givers. Early detection and treatment of MHE with ammonia lowering therapy can reverse MHE and improve quality of life. ( J CLIN EXP HEPATOL 2015;5:S42-S48) H epatic encephalopathy (HE) is a neurocognitive disorder in which brain function is impaired and is associated with both acute and chronic liver dysfunction. 1 It is a major complication that develops in some form and at some stage in a majority of patients with liver cirrhosis. Minimal HE (MHE) is the mildest form of spectrum of HE which is characterized by subtle cognitive and psychomotor deficits in the absence of recognizable clinical symptoms of HE. 2 It occurs in patients with liver dysfunction and/or portosystemic shunts. In MHE, neurocognitive abnormalities primarily affect attention, speed of information processing, executive control, motor ability and coordination in an individual. 3 In 1970, Zeegen et al 4 first described this condition when they discovered that 38% of patients who had undergone portal decompression surgery scored abnormal in Reitan trail making test (number connection test). Eight years later, the term subclinical HE 5 was introduced to describe these patients. Since then, this condition was described under various names like early HE, latent HE, subclinical HE and finally minimal HE. The latest classification combines MHE and grade 1 HE into covert HE while higher grades are classified as overt HE, thus simplifying the clinical schema so that HE can be uniformly diagnosed. 6 Covert HE means that the mental defect is not detectable by the clinician using conventional testing and is not noticeable to the patient. However, it is significant because these patients usually have neuropsychiatric and neurophysiological abnormalities on advanced testing which are not enough to cause disorientation or asterixis. MHE is regarded as a preclinical stage of HE and ammonia and systemic inflammation plays an important role in its pathogenesis similar to HE. Ammonia lowering therapies were used in the treatment of MHE and found to be effective.MHE is clinically significant as it impairs daily functioning, health related quality of life (HRQOL) and driving skills, predicts the development of overt HE and is associated with poor survival. 7-11 Overt HE develops in >50% of MHE patients within three years. 10 These patients pose a significant burden to their care givers depending on the severity of cognitive dysfunction. 2,12 Considering all ...

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Section: Effect Of Minimal Hepatic Encephalopathy On Quality Of Lifementioning

confidence: 99%

Section: Effect Of Minimal Hepatic Encephalopathy On Quality Of Lifementioning

confidence: 99%

Minimal Hepatic Encephalopathy Impairs Quality of Life

Agrawal

Umapathy

Dhiman

2015

Journal of Clinical and Experimental Hepatology

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“…1 Other studies have focused on specific aspects of the concept, e.g., fatigue, depression, [2][3][4] or quality of life after liver transplantation. 5,6 Recognizing that the patient's perception of his or her quality of life is an important part of clinical care, we assessed quality of life in a large cohort of unselected patients with PBC using a generic quality-of-life scale, the French version of the Nottingham Health Profile (NHP) questionnaire. 7,8 The NHP is a generic scale that has the advantage of encompassing the six major subdimensions of quality of life and can identify those aspects affected by the disease.…”

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confidence: 99%

Quality of life in patients with primary biliary cirrhosis

et al. 2004

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The impact of primary biliary cirrhosis (PBC) on health-related quality of life (HRQOL) is poorly documented. We assessed quality of life in a group of 276 unselected patients with PBC using the Nottingham Health Profile (NHP). This is a generic scale that assesses six major areas commonly associated with HRQOL. Data were compared with those of a sex-and age-matched control group. The associations between NHP scores and the severity of PBC were tested. Patients (86% women) had a median age of 62 years (range 33-87). Most patients were treated with UDCA. PBC patients showed a strong statistically significant difference in energy compared to controls (respectively, 40.6 vs. 22.9, P < .0001) and had worse scores for emotional reactions (22.2 vs. 16.1, P < .005). No other differences were observed. No associations of the dimension subscores were found with biochemical liver tests, histological stages, or duration of the disease. Among the signs or symptoms, fatigue was the finding most often associated with the dimension subscores. In conclusion, patients with PBC feel that their overall quality of life is worse than that of the control population. This difference is mainly due to the decrease in the subscores of energy and emotional reactions, both associated with fatigue. These effects must be taken into account by clinicians when treating these patients, as they constitute the clinical outcomes that have the most impact on patients' lifestyle and adherence to treatment. (HEPATOLOGY 2004;40:489 -494.)

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“…3 While a number of studies have described the QOL outcomes of heterogeneous series of LT recipients, [4][5][6][7][8] QOL findings specific to patients with cholestatic liver disorders are very limited. 9 Patients with PBC or PSC form a distinct subgroup of LT patients in terms of their demographics, symptomatology, and complications of hepatic decompensation leading to transplantation. By studying a homogeneous group of patients, we hypothesized that the influence of clinical variables on QOL outcome might be better defined than by studying a more heterogenous population of liver patients.…”

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confidence: 99%

Quality of life before and after liver transplantation for cholestatic liver disease

et al. 1999

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Liver transplantation (LT) is an established therapy for patients with end-stage primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In this report, we describe the health status and quality of life (QOL) in patients with these cholestatic liver diseases before and after LT. A QOL questionnaire was completed by 157 adult patients with PBC or PSC before and 1 year after liver transplantation at the Mayo Clinic or Baylor University Medical Center. This questionnaire measured four aspects of QOL, including symptoms; physical, social, and emotional functioning; health perceptions; and overall QOL. Changes in these QOL parameters before and after LT were described, and regression analysis was used to assess the relationships between clinical and QOL factors. There were no differences in QOL parameters between patients with PBC and PSC. QOL following transplantation was substantially better than before transplantation. This was observed in all four aspects of QOL. The degree of improvement as measured by effect size (difference in mean scores divided by the pretransplantation standard deviation) was 0.53 for symptoms (P F .01), 1.16 for function (P F .01), 2.37 for health satisfaction (P F .01), and 1.16 for overall QOL (P F Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are cholestatic liver diseases of unknown etiology with distinctive clinical and epidemiological features. These diseases are characterized by a slow and usually progressive course that, over time, leads to cirrhosis, portal hypertension, and, eventually, liver failure. Patients with liver failure from end-stage PBC or PSC are potential candidates for orthotopic liver transplantation (LT). Between 1988 and 1994, these patients accounted for approximately 17% of LT recipients. 1 Following LT, these patients have an improved prognosis, with 2-year survival rates reported to be over 90%. 2 It is not known how rapidly or completely LT reverses the devastating symptoms of severe PBC or PSC, or how well these patients adapt to the drug regimens necessary to maintain their grafts. Information about these benefits and consequences of LT taken from the patient' s perspective can improve clinicians' understanding of the recovery process and enable clinicians to better prepare these patients and their families for LT. Furthermore, this information may identify important issues for long-term survivors and contribute to the evaluation of new therapies to enhance LT outcomes. Information of this type, about the effects of an illness and its consequent therapy on a patient' s health and well-being as perceived by the patient, is termed quality of life (QOL), or more specifically, health-related QOL. 3 While a number of studies have described the QOL outcomes of heterogeneous series of LT recipients, 4-8 QOL findings specific to patients with cholestatic liver disorders are very limited. 9 Patients with PBC or PSC form a distinct subgroup of LT patients in terms of their demographics, symptomatology, and complications of...

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Quality of life, major medical complications and hospital service utilization in patients with primary biliary cirrhosis after liver transplantation

Cited by 54 publications

References 19 publications

Minimal Hepatic Encephalopathy Impairs Quality of Life

Minimal Hepatic Encephalopathy Impairs Quality of Life

Quality of life in patients with primary biliary cirrhosis

Quality of life before and after liver transplantation for cholestatic liver disease

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