P182 Quality of life in patients with autoimmune hepatitis: a review of patient-reported outcome measures

Abstract

Introduction Patient-Reported Outcome Measures (PROMs) have been used to assess quality of life (QoL) in Autoimmune Hepatitis (AIH). We aimed to identify which components of QoL have been assessed and which, if any, are impaired in AIH. Methods Systematic search of Medline, EMBASE and PsycINFO (inception to January 2020). We included studies measuring QoL in adults (>16 years) with AIH. Studies without AIH-specific data or on transplanted patients were excluded. A pooled analysis was performed of studies using the Short Form (SF)-36 PROM, which has 8 subscales (0–100): Physical Functioning (PF), Role (physical) Functioning (RF), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role Emotion (RE), Mental Health (MH). We calculated physical and mental component summary scores (PCS and MCS) using a formula to aggregate individual subscales. Results Of 1153 studies assessed, 14 met inclusion criteria. 10 PROMs were identified: 2 liver disease-specific: Chronic Liver Disease Questionnaire (CLDQ) and Liver Disease Symptom Index (LDSI-2.0); 2 generic: SF-36 (or the derived SF-12) and EuroQol (EQ)-5D-5L; 4 mental health specific: Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire (PHQ)-9, General Anxiety Disorder (GAD)-7 and State Trait Anxiety Index (STAI); and 2 fatigue-specific: Fatigue Impact Scale (FIS) (or its modification, MFIS) and Multidimensional Fatigue Index (MFI)-20. Mean SF-36 subscale scores were available in 6 studies (633 patients). Pooled analysis indicated greater patient-control differences in the physical subscales GH and RF (figure 1). PCS scores were reduced more than MCS scores in four studies. In a case-control study, 11% (n=103) patients with AIH had PHQ-9 scores indicating clinically relevant depression (PHQ-9>10), significantly more than controls (p 15) was more common in AIH vs. controls in this study (p=0.006) and STAI scores were higher (STAI1 p Four studies compared disease activity and QoL, one of which found an association. Seven studies looked at association of cirrhosis with QoL, three found impaired physical (not mental) health, with no association in four. In two studies reporting comorbidities, these correlated with worse SF-36 physical subscales (RP, BP, GH). There were associations (one study each) between corticosteroid use and lower EQ-5D-5L Utility Index, with depression (PHQ-9), and with worry scores (CLDQ). Conclusions Patients with AIH have impaired QoL compared to the general population, in both physical and emotional components. Studies to date are heterogenous and it is difficult to compare results. Further research is needed to fully explore the impact of AIH on QoL.