Chronic Liver Disease Questionnaire Domains Research Articles

Frailty Predicting Health-Related Quality of Life Trajectories in Individuals with Sarcopenia in Liver Cirrhosis: Finding from BCAAS Study.

The association between frailty and health-related quality of life (HRQoL) among Asian patients with liver cirrhosis and sarcopenia remains largely unexplored. To address this knowledge gap, we conducted a cross-sectional study involving individuals aged 32 to 69 years, all diagnosed with liver cirrhosis. The chronic liver disease questionnaire (CLDQ) was used to assess HR-QoL, the CLDQ score was used as an outcome to measure the factors related to HR-QoL, and the liver frailty index (LFI) was used to assess the frailty status. The association between the frailty status and the CLDQ summary scales was investigated using the correlation coefficient and multiple regression analyses. A total of 138 patients in the frail (n = 62) and non-frail (n = 76) groups with (alcohol: 97; viral: 24; autoimmune: 17; and cryptogenic: 12) were included in the study. Age, CTP score, and model for end-stage liver disease (MELD) sodium were significantly higher in the frail group. In the CLDQ domains, there was a significant difference between the frail and non-frail groups (p value = 0.001). In health-related quality-of-life summary measures, there was a strong negative correlation between frailty and the scores for activities, emotional function, and fatigue (p value = 0.001). When comparing frail to non-frail patients, these characteristics demonstrated significantly increased odds as indicated by their adjusted odds ratios: OR 3.339 (p value = 0.013), OR 3.998 (p value = 0.006), and OR 4.626 (p value = 0.002), respectively.

PROMIS Profile-29 is a valid instrument with distinct advantages over legacy instruments for measuring the quality of life in chronic liver disease.

The Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used to measure health-related quality of life, yet, it has not been well-studied in chronic liver disease (CLD). This study compares PROMIS Profile-29 to Short-Form Health Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ) in patients with CLD. In all, 204 adult outpatients with CLD completed PROMIS-29, CLDQ, SF-36 and usability questionnaires. Mean scores were compared between groups, the correlation between domain scores was assessed, and floor/ceiling effects were calculated. Etiologies of CLD were NAFLD (44%), hepatitis C (16%), and alcohol (16%). Fifty-three percent had cirrhosis and 33% were Child-Pugh B/C with a mean model for end-stage liver disease score of 12.0. In all 3 tools, the poorest scores were in physical function and fatigue. The presence of cirrhosis or complications was associated with worse scores in most PROMIS Profile-29 domains, indicating known group validity. Strong correlations ( r ≥ 0.7) were present between Profile-29 and SF-36 or CLDQ domains measuring similar concepts, indicating strong convergent validity. Profile-29 was completed faster than SF-36 and CLDQ (5.4 ± 3.0, 6.7 ± 3.3, 6.5 ± 5.2min, p = 0.003) and rated equally on usability. All CLDQ and SF-36 domains reached the floor or ceiling, while none were noted for Profile-29. These floor/ceiling effects were magnified when assessed in those with and without cirrhosis, indicating the improved depth of measurement by Profile-29. Profile-29 is a valid, more efficient, well-received tool that provides an improved depth of measurement when compared to SF-36 and CLDQ and, therefore, an ideal tool to measure general health-related quality of life in CLD.

Predictors of Health-Related Quality of Life in Sarcopenic Patients: Result from BCAAS Study

Background: Liver cirrhosis is a major burden that includes marked metabolic dysfunction and sarcopenia which may influence patients’ HRQoL. The main aim of the study was to analyse the mental, physical, and social well-being in sarcopenic population with liver cirrhosis (LC) using Chronic Liver Disease Questionnaire (CLDQ). Methods: The six domains of CLDQ were applied in a cross-sectional study during the 18 months of research in Rajasthan, India. Severity of the liver disease was determined through CTP and MELD. For the physical evaluation of sarcopenia, participants had undergone TAMA, hand grip strength, and gait speed test. For the statistical analysis, mean, SD, median, interquartile range, and multi logistic regression was used for final analysis. The total sample size was 138 patients. Result: The mean age of participants was 47.42±13.47 years, alcohol induced cirrhosis was the major factor contributing LC. CLDQ showed association with CTP, Meld Na, Ascites and Sarcopenia. CTP and MELD Na had an inverse effect with all domains of CLDQ and it showed a direct association with TAMA, hand grip strength and gait speed test. Conclusion: LC sarcopenic patients do worst in the domains of CLDQ that impair the health-related quality of life, as evidenced by CTP and MELD scores.

Health-Related Quality of Life among Patients with Hepatitis C Virus Infection: A Cross-Sectional Study in Jianping County of Liaoning Province, China.

Background Patients with chronic liver disease (CLD) have extrahepatic manifestations and impaired health-related quality of life (HRQOL), and hepatitis C virus (HCV) infection is a leading cause of CLD, cirrhosis, and hepatocellular carcinoma (HCC). This study is aimed at assessing HRQOL in patients with HCV infection in the rural areas and identifying factors associated with impairment of HRQOL. Methods A cross-sectional study was conducted in a county of Liaoning Province in northeast China. HRQOL of patients with HCV infection was assessed using the chronic liver disease questionnaire (CLDQ) and EuroQol-5 dimensions (EQ-5D). Data were transformed to score comparisons of six major CLDQ domains, EQ index, and visual analog scale (VAS). Results A total of 397 (93.4%) subjects, including 67 healthy subjects (HSs), 314 patients with chronic hepatitis C (CHC), and 16 patients with liver cirrhosis (LC) completed the study. The overall quartile CLDQ scores for HSs, patients with CHC, and patients with LC were 6.4 (6.0, 6.7), 5.8 (4.6, 6.4), and 4.1 (3.0, 6.0), respectively. The quartile scores of EQ index for the three groups were 1.0 (1.0, 1.0), 1.0 (0.8, 1.0), and 0.9 (0.6, 1.0), respectively. The median scores of EQ VAS for the three groups were 85.0, 60.0, and 60.0, respectively. Female sex, patients with family history of hepatitis, other comorbid chronic diseases, drinking, and disease duration ≥ 10 years were associated with significant improvement in overall CLDQ scores, and family history of hepatitis and other comorbid chronic diseases were considered predictive factors for EQ index and VAS, respectively. Conclusions Compared with HSs, HCV infection had a greater negative impact on HRQOL in patients with CHC and LC. The significant factors associated with HRQOL include female sex, patients with a family history of hepatitis, other comorbid chronic diseases, drinking, and disease duration ≥ 10 years. Patients with HCV infection in the rural areas should be paid careful attention regarding their HRQOL with proper health education and disease management.

54. Assessment of quality of life in patients with cirrhosis

Background and Aims: Cirrhosis may negatively influence the quality of life of patients. Quality of life becomes an important outcome in cirrhotics as an indicator of effective treatment. We aim to evaluate the Health related quality of life (HRQL) in patients with cirrhosis. Methods: Chronic liver disease questionnaire (CLDQ) was used to investigate the quality of life in patients with cirrhosis. The scores for CLDQ ranges from 1 (worst) to 7 (best) in all the six domains. Patients were categorized into Child A (CTP ≤6), Child B (CTP 7–9), Child C (≥10). Osteoporosis (T-score <- 2.5) was determined by dual-energy x-ray absorptiometry (DEXA) at lumbar spine. Scores of each (six) domain were compared with different variables using independent t-test and one way ANOVA. Results: A total of 164 patients (126 males) were included in this study. The mean CLDQ score is significantly higher in child A patients (4.71 ± 1.08; n = 99) as compared to Child C patients (3.75 ± 1.08; n = 10) (P = 0.02). All the six domains of CLDQ showed significantly lower scores in patients with ascites. Scores of abdominal symptoms and activity domain was lower in Child C patients (3.99 ± 1.53; 3.30 ± 1.43) as compared to Child A (5.08 ± 1.42; 4.89 ± 1.43) [P = 0.04; 0.001], respectively. Statistically significant lower scores of abdominal symptoms (P = 0.04); systemic (P = 0.006) and activity (P = 0.04) domain were observed in patients with osteoporosis (n = 61) as compared to non-osteoporotic patients. Conclusions: Health related quality of life (HRQL) is worse in patients with severe liver disease. Patients with ascites and those with osteoporosis had worst quality of life. The authors have none to declare.

Development and Application of the Chinese (Mainland) Version of Chronic Liver Disease Questionnaire to Assess the Health-Related Quality of Life (HRQoL) in Patients with Chronic Hepatitis B.

ObjectiveTo develop the Chinese (Mainland) version of Chronic Liver Disease Questionnaire (CLDQ) and use it to assess the health-related quality of life (HRQoL) of chronic hepatitis B (CHB) patients in China and identify the determinants of HRQoL.MethodsThe Chinese (Mainland) CLDQ was developed by expert consultation, focus group interviews with patients, and pilot study. The final version of questionnaire was adopted to assess the HRQoL of chronic hepatitis B outpatients enrolled from two largest infectious hospitals in Beijing. Cronbach’ s alpha was used to measure the internal consistency reliability. The construct validity was measured by factor analysis. T-test, one-way analysis of variance (ANOVA), and multi-variable linear regression were used to analyze the data.ResultsCronbach’s alpha of the overall CLDQ is 0.935, ranging from 0.628 to o.881 among six subscales. Six factors were identified via factor analysis, including a new factor sleeping(SL). A total of 519 patients with CHB were included in the investigation with the final version of questionnaire, 405 of them were only with CHB, 53 with compensated cirrhosis, and 61 with decompensated cirrhosis. The CHB group scored the highest in the overall score of CLDQ (p<0.05). The score of worry (WO) domain was significantly lower in the compensated group than the CHB group (p<0.05). Decompensated cirrhosis patients scored lower than the CHB group in all CLDQ domains and the overall score (p<0.05). Stages of illness, gender, regular visits to specialized hospitals, and work status in last year were determinants of HRQoL.ConclusionThe psychometric properties of the Chinese(Mainland) CLDQ is acceptable. The HRQoL of CHB patients deteriorated with disease progression. Advanced stages of CHB, female, long time absence from work after illness, and no job or retirement were determinants of poor HRQoL. Regular visits to specialized hospitals was a positive determinant of HRQoL.

Analyzing the Dimensions of the Quality of Life in Hepatitis B Patientsusing Confirmatory Factor Analysis

Background and Objectives:The scope of the quality of life assessment is not widespread in any time like today. Economists, social scientists and politicians look at this topic from the particular approach. The life quality in hepatitis B patients regarding the degree of its progress is considered a major concern in these patients. Thus, the aim of the study was analyzing the dimensions of the life quality of a group of people suffering from hepatitis B in Mazandaran province in 2012.Methods:This study was done by descriptive, cross-sectional method on 210 (118 women and 92 men) hepatitis B patients that six month have passed from their diagnosis and formation of follow-up form in health centers, using access sampling method atsix regions of Mazandaran province. The instruments of the study were the questionnaire of World Health Organization questionnaire (WHOQOL-BREF) and the chronic liver disease questionnaire (CLDQ). For analyzing the data from descriptive statistics and Kolmogrov-Smirnov test, one sample t-test, two stage Confirmatoryfactor analysis, Spss and Lisrel software has been used.Results:Findings showed that the social relationship dimension with factor loading of 0.81 has the most amount of coefficient of effectiveness; physical health with factor loading of 0.72, mental health with factor loading of 0.63 and environmental health with factor loading of 0.55 have the least amount of coefficient of effectiveness in creating the generallife quality of hepatitis B patients. In the quality of life in hepatitis patients, the emotional function with factor loading of 0.76 has the most coefficient of effectiveness, activity dimension with factor loading of 0.67, fatigue withfactor loading of 0.47, abdominal syptoms with factor loading of 0.42 and worry with factor loading of 0.32 have the least coeficient of effectivness in making CLDQ domains of hepatit B patients.Conclusions:The general quality of life in patients had been below average and social relationship and emotional function must be properly investigated and managed in hepatitis B patients in order to improve life quality. WHOQOL-BREF and CLQD proved to be a useful instrument to assess general life quality in patients and can be helpful to find practical strategies to improving life quality in these patients.

Dynamics and liver disease specific aspects of quality of life among patients with chronic liver disease in Yunnan, China.

Patients with chronic liver diseases (CLD) may have compromised health related quality of life (HRQoL). Hepatitis B virus (HBV) infection has long been the leading cause of CLD including liver cancer and cirrhosis. Knowledge on different symptom profiles of CLD should help in development of comprehensive treatment and patient care plans. To access the facets of HRQoL in chronic liver diseases throughout their spectrum of severity. A cross-sectional study was conducted in the First Affiliated Hospital of Kunming Medical University in Yunnan Province of China. Both out- and inpatients undergoing treatment protocols for different HBV related liver disease states were consecutively collected from December 2012 to June 2013. ANOVA was used to compare the mean scores of EQ-5D and chronic liver disease questionnaire (CLDQ) among 5 disease groups. The relationship between demographic variables predicting global CLDQ scores and the domains of CLDQ was analysed. A total of 1040 patients including 520 without complications, 91 with compensated cirrhosis, 198 with decompensated cirrhosis, 131 with HCC and 100 with liver failure were recruited. All domains of CLDQ, the means of EQ-5D value and EQ VAS exhibited significant decline with worsening of disease severity from uncomplicated HBV to liver failure. The multivariate regression demonstrated the reduction of mean scores of CLDQ domain at advanced stage. Patients with liver failure and HCC had more HRQoL impairment than other disease states. No effect of patient gender was found. Patient age was associated with 'fatigue' and 'worry' domains (p=0.006; p=0.004) but not with other domains and global scores of CLDQ and ED-5D. The HRQoL in chronic hepatitis B patients is greatly affected by disease states. Care for HBV-related diseases should consider not only the outcomes of treatment strategies but also improvement in patient wellbeing.

Differences in health-related quality of life scores after orthotopic liver transplantation with respect to selected socioeconomic factors

One of the current ultimate goals of orthotopic liver transplantation (OLT) is the improvement of patients' health-related quality of life (HRQOL). The purpose of this study was to look at the effects of socioeconomic and demographic differences on the short-term and long-term HRQOL outcomes of OLT recipients. Three hundred three adult OLT recipients who were seen at the University of California Los Angeles were administered the Medical Outcomes Study Short Form 36 (SF-36), the Chronic Liver Disease Questionnaire (CLDQ), and a demographic survey. A parsimonious model of 12 socioeconomic and demographic predictors was identified. Their simultaneous influence on each SF-36 and CLDQ HRQOL domain score was evaluated with multivariate linear regression and backward selection. Hepatitis C virus impaired HRQOL; this was shown in the SF-36 Vitality and Bodily Pain domains and in most CLDQ domains. Females experienced more HRQOL impairment only within the CLDQ Abdominal Symptoms domain. OLT recipients who were married had better SF-36 Role-Emotion domain scores. OLT recipients with more than 12 years of education had better SF-36 Physical Functioning scores. Employed OLT recipients had less HRQOL impairment; this was evidenced by better scores in multiple domains of the SF-36 and the CLDQ. OLT patients with health maintenance organization or preferred provider organization insurance had higher HRQOL scores within almost all SF-36 and CLDQ domains. Patients with a mix of public and private insurance had significantly higher HRQOL scores in comparison with those with only public insurance. Identifying patients at higher risk for worse HRQOL scores, less satisfaction with OLT results, and greater problems with fatigue or mental health stressors will assist transplant centers in using their medical teams to develop early interventions and multidisciplinary approaches to improve HRQOL outcomes after OLT.

Minimal hepatic encephalopathy does not impair health-related quality of life in patients with cirrhosis: a prospective study

Minimal hepatic encephalopathy (HE) is a serious complication of cirrhosis; however, the impact of minimal HE on health-related quality of life (HRQoL) remains controversial. The Psychometric Hepatic Encephalopathy Score (PHES) remains a 'gold standard' for the assessment of minimal HE, but its results clearly differ between studied populations. We studied the effect of minimal HE on patient HRQoL. Eighty-seven consecutive cirrhotic patients were included. All patients underwent clinical and psychometric evaluation at the same day. Ten subjects with overt HE confirmed with West Haven criteria were excluded from the study, thus 77 patients were finally analysed. Patients with minimal HE were identified on the grounds of altered PHES. HRQoL was assessed by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ). Normative reference data for PHES were established from a cohort of 305 healthy Polish subjects. Twenty-nine (37.7%) patients were diagnosed with minimal HE. When patients with and without minimal HE were compared, HRQoL was not significantly different in none of the SF-36 and CLDQ domains. Minimal HE does not affect HRQoL.

Health‐related quality of life in patients with non‐alcoholic fatty liver disease

The relative impact of non-alcoholic fatty liver disease (NAFLD) on health-related quality of life (HRQL) compared to other chronic liver diseases has not been fully explored. To compare the domain scores of the 29-item Chronic Liver Disease Questionnaire (CLDQ) for patients with NAFLD to those with chronic hepatitis B and chronic hepatitis C. A HRQL questionnaire, CLDQ, was routinely administered to patients attending a liver clinic. Additional clinical and laboratory data were obtained on patients with NAFLD, chronic hepatitis B, and chronic hepatitis C from our quality of life database. Scores for each of the six CLDQ domains were compared using one-way anova and multiple regression. Complete data were available for 237 patients. NAFLD patients scored lowest on multiple CLDQ domains. Based on the bivariate data, NAFLD patients have the poorest HRQL, followed by chronic hepatitis C and chronic hepatitis B patients. Multivariate analysis showed that some specific domain score correlations remained significant for NAFLD diagnosis, cirrhosis, gender, and body mass index. NAFLD patients had significantly lower quality of life scores compared with patients with hepatitis B or hepatitis C on multiple CLDQ domains, suggesting that HRQL was severely impaired in patients with NAFLD.

Disease-specific health-related quality of life and its determinants in liver cirrhosis patients in Lithuania

To evaluate disease-specific quality of life (QOL) in liver cirrhosis patients and to compare it with those of a healthy population. Also an important objective was to assess whether QOL in liver cirrhosis patients differs by age and gender, by type and severity of disease. The case group of 131 liver cirrhosis patients was selected. The control group of 262 was enrolled from a healthy population according to the scheme of case-control study. Clinical, demographic, laboratory data were collected. QOL was measured with a specific chronic liver disease questionnaire (CLDQ), which was translated and validated in Lithuanian. QOL scores were compared between groups by age, gender, type and severity of disease. Cronbach's alpha statistics calculation was used for evaluation of internal consistency reliability. Student's t test or ANOVA were used for evaluation hypothesis about probability equation. QOL was significantly lower in liver cirrhosis patients than in healthy population (59.5 +/- 18.3 vs 85.3 +/- 12.3, P < 0.001). The significant QOL differences between case and control groups were observed in domains of worry and abdominal symptoms, the smaller differences-in emotional functions and systematic symptom domains. Significantly worse QOL was in observed patients with increased clinical severity of the disease measured by Child-Pugh class. Age, gender and etiology of disease had an insignificant effect on QOL in cirrhotic patients. QOL was significantly impaired in all CLDQ domains in liver cirrhosis patients. Increase in severity of disease was the major factor associated with poorer QOL.

Chronic liver disease questionnaire: translation and validation in Thais.

Quality of life (QOL) is a concept that incorporates many aspects of life beyond "health". The chronic liver disease questionnaire (CLDQ) was developed to evaluate the impact of chronic liver diseases (CLD) on QOL. The objectives of this study were to translate and validate a liver specific questionnaire, the CLDQ. The CLDQ was formally translated from the original version to Thai language with permission. The translation process included forward translation, back translation, cross-cultural adaptation and a pretest. Reliability and validity of the translated version was examined in CLD patients. Enrolled subjects included CLD and normal subjects with age- and sex-matched. Collected data were demography, physical findings and biochemical tests. All subjects were asked to complete the translated versions of CLDQ and SF-36, which was previously validated. Cronbach's alpha and test-retest were performed for reliability analysis. One-way Anova or non-parametric method was used to determine discriminant validity. Spearman's rank correlation was used to assess convergent validity. P -value <0.05 was considered statistically significant. A total of 200 subjects were recruited into the study, with 150 CLD and 50 normal subjects. Mean ages (SD) were 47.3(11.7) and 49.1(8.5) years, respectively. The number of chronic hepatitis: cirrhosis was 76:74, and the ratio of cirrhotic patients classified as Child A:B:C was 37(50%): 26(35%): 11(15%). Cronbach's alpha of the overall CLDQ scores was 0.96 and of all domains were higher than 0.93. Item-total correlation was >0.45. Test-retest reliability done at 1 to 4 wk apart was 0.88 for the average CLDQ score and from 0.68 to 0.90 for domain scores. The CLDQ was found to have discriminant validity. The highest scores of CLDQ domains were in the normal group, scores were lower in the compensated group and lowest in the decompensated group. The significant correlation between domains of the CLDQ and SF-36 was found. The average CLDQ score was strongly correlated with the general health domain of SF-36. (P=0.69: P=0.01). The translated CLDQ is valid and applicable in Thais with CLD. CLDQ reveals that QOL in these patients is lower than that in normal population. QOL is more impaired in advanced stage of CLD.