Impact of depressive symptoms and hepatic encephalopathy on health-related quality of life in cirrhotic hepatitis C patients.

Abstract

Depression, common in chronic medical conditions, and hepatic encephalopathy (HE), a reversible neuropsychiatric syndrome due to liver dysfunction, are associated with impaired health-related quality of life (HRQOL) in cirrhosis and hepatitis C (HCV). This study investigated the impact of depression and HE on HRQOL in cirrhotic patients with HCV. A convenience sample of 43 ambulatory patients, with varying degrees of cirrhosis secondary to HCV, was prospectively enrolled in this study. Participants were assessed for any current depressive, fatigue, and daytime sleepiness symptoms and underwent a psychometric evaluation to determine the presence of HE symptoms. Participants reported current HRQOL on general health and liver disease-specific questionnaires. Diagnosis and current health status were confirmed via medical records. The associations between disease severity, depressive symptoms, HE, fatigue, and daytime sleepiness were measured. Predictors of HRQOL in this sample were determined. Depressive symptoms (70%) and HE (77%) were highly prevalent in this sample, with 58% actively experiencing both conditions at the time of study participation. A significant positive association was found between depressive symptoms and HE severity (P=.05). Depressive symptoms were significantly associated with fatigue (P<.001), daytime sleepiness (P<.001), general HRQOL (P<.001), and disease-specific HRQOL (P<.001). HE was significantly associated with fatigue (P=.02), general HRQOL (P<.001), and disease-specific HRQOL (P<.001). Depressive symptoms and HE were significant predictors of reduced HRQOL (P<.001), with depressive symptoms alone accounting for 58.8% of the variance. Depressive symptoms and HE accounted for 68.0% of the variance. Findings suggest a possible pathophysiological link between depression and HE in cirrhosis, and potentially a wider-reaching benefit of treating minimal and overt HE than previously appreciated.