Health-Related Quality of Life Predicts Mortality in Patients With Advanced Chronic Liver Disease
Health-Related Quality of Life Predicts Mortality in Patients With Advanced Chronic Liver Disease
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DOI：
10.1016/j.cgh.2009.03.013
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发表时间：
2009-07-01
影响因子：
12.6
通讯作者：
Spiegel, Brennan M. R.
中科院分区：
文献类型：
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作者：
Kanwal, Fasiha;Gralnek, Ian M.;Spiegel, Brennan M. R.
背景与目的：肝硬化对健康相关的生活质量（HRQOL）有负面影响，这一点已得到公认。然而，如何在日常临床实践中使用这些信息还不太清楚。如果HRQOL预测肝硬化患者的生存率，那么测量HRQOL将具有重要的临床意义。我们试图测量肝硬化患者的HRQOL和生存率之间的关系，并调查HRQOL和生存率之间的关系是否独立于终末期肝病模型（MELD）。方法：我们采用简明肝病生活质量量表对156例等待肝移植的肝硬化患者进行了HRQOL测定。我们前瞻性随访患者，并使用考克斯比例风险模型来衡量基线HRQOL对生存率的独立影响，并对MELD和其他协变量进行了调整。结果：在平均9个月的随访中，26例（17%）患者死亡，30例（20%）接受肝移植。在未校正的分析中，较高的基线HRQOL预测较低的死亡率（风险比，0.96; 95%置信区间，0.94-0.99）。具体而言，HRQOL每增加1分，死亡率下降4%。在调整MELD评分、患者人口统计学或心理社会特征后，这些结果没有变化; MELD评分占HRQOL评分变化的1%（P= 0.18）。生存率最强的预测日常生活活动，健康困扰，睡眠障碍，和感知疾病的耻辱。结论：肝硬化患者HRQOL越高，死亡率越低。这种关系与MELD无关; MELD不能反映肝脏特异性HRQOL。除了在临床试验中作为次要结局外，HRQOL还可用于预测晚期肝病患者的生存率。
BACKGROUND & AIMS: It is well-established that cirrhosis negatively impacts health-related quality of life (HRQOL). However, it is less clear how to use this information in everyday clinical practice. If HRQOL predicted survival in cirrhosis, then measuring HRQOL would have important clinical implications. We sought to measure the association between HRQOL and survival in patients with cirrhosis and investigated whether the relationship between HRQOL and Survival is independent of Model for End-Stage Liver Disease (MELD). METHODS: We measured HRQOL in 156 patients with cirrhosis awaiting liver transplantation by using the Short Form Liver Disease Quality of Life instrument. We followed patients prospectively and used Cox proportional hazard models to measure the independent effect of baseline HRQOL on survival, adjusting for MELD and other covariates. RESULTS: During a mean 9-month follow-up, 26 (17%) patients died, and 30 (20%) received liver transplants. In unadjusted analysis, higher baseline HRQOL predicted lower mortality (hazard ratio, 0.96; 95% confidence interval, 0.94-0.99). Specifically, for each 1-point increase in HRQOL, there was a 4% decrease in mortality. These results did not change after adjusting for MELD scores, patient demographics, or psychosocial characteristics; the MELD score accounted for 1% of the variation in HRQOL scores (P=.18). Survival was most strongly predicted by activities of daily living, health distress, sleep disturbance, and perceived disease stigma. CONCLUSIONS: Higher HRQOL predicts lower mortality in patients with cirrhosis. This relationship is independent of MELD; MELD does not capture liver-specific HRQOL. Beyond its use as a secondary outcome in clinical trials, HRQOL could be used to predict survival of patients with advanced liver disease.