Abstract
BackgroundPatients with chronic liver disease often suffer from unspecific symptoms and report severe impairment in the quality of life. The underlying mechanisms are multifactorial and include disease-specific but also liver related causes. The current analysis evaluated the association of hepatocellular apoptosis in non-viral chronic liver disease and health-related quality of life (HRQL). Furthermore we examined factors, which influence patient's physical and mental well-being.MethodsA total of 150 patients with non-infectious chronic liver disease were included between January 2014 and June 2015. The German version of the Chronic Liver Disease Questionnaire (CLDQ-D), a liver disease specific instrument to assess HRQL, was employed. Hepatocellular apoptosis was determined by measuring Cytokeratin 18 (CK18, M30 Apoptosense ELISA).ResultsFemale gender (5.24 vs. 5.54, p = 0.04), diabetes mellitus type II (4.75 vs. 5.46, p<0.001) and daily drug intake (5.24 vs. 6.01, p = 0.003) were associated with a significant impairment in HRQL. HRQL was not significantly different between the examined liver diseases. Levels of CK18 were the highest in patients with NASH compared to all other disease entities (p<0.001). Interestingly, CK18 exhibited significant correlations with obesity (p<0.001) and hyperlipidemia (p<0.001). In patients with cirrhosis levels of CK18 correlated with the MELD score (r = 0.18, p = 0.03) and were significantly higher compared to patients without existing cirrhosis (265.5 U/l vs. 186.9U/l, p = 0.047). Additionally, CK18 showed a significant correlation with the presence and the degree of hepatic fibrosis (p = 0.003) and inflammation (p<0.001) in liver histology. Finally, there was a small negative association between CLDQ and CK18 (r = -0.16, p = 0.048).ConclusionDifferent parameters are influencing HRQL and CK18 levels in chronic non-viral liver disease and the amount of hepatocellular apoptosis correlates with the impairment in HRQL in chronic non-viral liver diseases. These findings support the role of liver-protective therapies for the improvement of the quality of life in chronic liver disease.
Highlights
Chronic liver diseases (CLD) are a major cause of morbidity and mortality worldwide
The current analysis evaluated the association of hepatocellular apoptosis in non-viral chronic liver disease and health-related quality of life (HRQL)
Hepatocellular apoptosis was determined by measuring Cytokeratin 18 (CK18, M30 Apoptosense enzyme-linked immunosorbent assay (ELISA))
Summary
Chronic liver diseases (CLD) are a major cause of morbidity and mortality worldwide. The underlying causes include chronic viral and alcoholic hepatitis, cholestatic, autoimmune and metabolic diseases, all of which can progress to cirrhosis and hepatocellular carcinoma [1]. In advanced chronic liver disease cirrhosis and its complications such as ascites, spontaneous bacterial peritonitis, hepatic encephalopathy and recurrent variceal bleeding are associated with severe impairments in health-related quality of life [1, 7]. This invasive procedure is associated with possible complications and due to sampling errors the biopsy may not completely represent the stage of liver disease [10] To overcome these diagnostic uncertainties, non-invasive markers of hepatocellular injury and inflammation have been developed. The aim of the study was to evaluate the impact of hepatocellular injury as determined by CK18 levels on the reported health-related quality of life in different non-infectious chronic liver diseases. The current analysis evaluated the association of hepatocellular apoptosis in non-viral chronic liver disease and health-related quality of life (HRQL). We examined factors, which influence patient's physical and mental well-being
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