Impact Of Chronic Liver Disease Research Articles

Impact of chronic liver disease on outcomes of hospitalized patients with COVID-19: A multicentre United States experience.

Liver injury has been described with COVID‐19, and early reports suggested 2%‐11% of patients had chronic liver disease (CLD). In this multicentre retrospective study, we evaluated hospitalized adults with laboratory‐confirmed COVID‐19 and the impact of CLD on relevant clinical outcomes. Of 363 patients included, 19% had CLD, including 15.2% with NAFLD. Patients with CLD had longer length of stay. After controlling for age, gender, obesity, cardiac diseases, hypertension, hyperlipidaemia, diabetes and pulmonary disorders, CLD and NAFLD were independently associated with ICU admission ([aOR 1.77, 95% CI 1.03‐3.04] and [aOR 2.30, 95% CI 1.27‐4.17]) and mechanical ventilation ([aOR 2.08, 95% CI 1.20‐3.60] and [aOR 2.15, 95% CI 1.18‐3.91]). Presence of cirrhosis was an independent predictor of mortality (aOR 12.5, 95% CI 2.16‐72.5). Overall, nearly one‐fifth of hospitalized COVID‐19 patients had CLD, which was associated with more critical illness. Future studies are needed to identify interventions to improve clinical outcomes.

Chronic Liver Disease and COVID-19: Alcohol Use Disorder/Alcohol-Associated Liver Disease, Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis, Autoimmune Liver Disease, and Compensated Cirrhosis.

Chronic Liver Disease and COVID-19: Alcohol Use Disorder/Alcohol-Associated Liver Disease, Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis, Autoimmune Liver Disease, and Compensated Cirrhosis.

The impact of chronic liver disease in patients receiving active pharmacological therapy for opioid use disorder: One-year findings from a prospective cohort study

IntroductionDespite the demonstrated benefit of methadone, the incidence opioid-related overdose, and its associated mortality continues to rise at an alarming rate. The impact of high prevalence comorbid features such as chronic liver disease (CLD) on methadone treatment response remain unclear. AimTo determine whether CLD is associated with poor response to methadone treatment. MethodsUsing a well-established multi-center cohort from the Genetics of Opioid Addiction Study (GENOA), we evaluated if presence of CLD among 1234 eligible patients with opioid use disorder receiving methadone treatment impacted health and behavioural responses to treatment. CLD was classified as any liver disorder/dysfunction present for a minimum period of six months. Serial urine toxicology assessments were used to determine treatment response. The effect of CLD was determined using a multi-variable logistic regression model. ResultsCLD was present in 25 % (n = 314) of the population. On average, patients with CLD were found to be older (mean age 44 vs 36 years, p < 0.0001), unemployed (81.8 % vs 61 %, p < 0.0001), and receiving government disability benefits at significantly higher rates (21.9 % vs 11 %, p < 0.0001). Increased levels of physical craving, emotional stress, as well as health risk behaviors were noted in CLD patients. Findings from the multi-variable model demonstrate a 68 % increased risk for dangerous opioid consumption behaviors (Odds Ration [OR]: 1.68, 95 % Confidence Interval [CI] 1.22, 2.31, p = 0.001) among patients with CLD. Methadone dose (OR: 0.76, 95 % CI 0.70, 0.81, p < 0.0001) was shown to be protective with a significant risk reduction of 24 % per 20 mg increase in methadone. Duration in treatment was also found to be protective (OR: 0.99, 95 % CI 0.97, 0.99, p < 0.0001). ConclusionCLD poses a distinct risk for patients with opioid addiction. Closer drug monitoring, and substance use contingency management should be considered to reduce mortality risk in these patients.

The Impact of Chronic Liver Disease on Postoperative Outcomes and Resource Utilization

Background Multiple studies have shown high rates of postoperative morbidity and mortality in individuals with chronic liver disease (CLD). However, analyses from comparisons with individuals without CLD are not available. Such analyses might provide opportunities to improve outcomes. Methods Data from The National Surgical Quality Improvement Program (NSQIP) from 2008 to 2011 were analyzed comparing CLD patients undergoing non-liver surgery propensity matched to those without CLD. Patients with CLD were stratified by Model of End Stage Liver Disease (MELD) scores <15 and ≥15. Primary outcome was all cause mortality, and secondary outcomes were composite and individual morbidity, hospital length of stay, readmission, reoperation, and discharge destination. Odds ratios (OR) were calculated, and length of hospital stay was estimated using Poisson regression. Results There were 6,209 patients with CLD (4,013 with low MELD, 2,196 with high MELD) matched to 18,627 patients without. Patients with CLD had 1.8- and 3.3-times higher odds of mortality (95% CI 1.6–2.1 for Low MELD (10.6%), 2.9–3.8 for high MELD (35.2%), and 1.8- and 2.2-times higher odds of any morbidity (1.6–1.9 and 1.9–2.4). Complications specific to CLD were increased based on MELD specifically coma (OR 1.6, 0.9–2.9 for Low MELD, 2.2, 1.5–3.2 for High MELD), renal failure (OR 1.4, 1.1–1.8 and 2.4, 2.0–2.9), and bleeding (OR 1.7, 1.5–1.9 and 2.0, 1.8–2.3). They also had a 20% and 80% longer length of stay, 2.2- and 3.4-times higher odds of being discharged somewhere other than home, 1.7- and 1.6-times higher odds of readmission, and 1.5- and 1.6-times higher odds of reoperation. Conclusion Patients with CLD have significantly higher odds of mortality and morbidity, which is increased with a higher MELD. Interventions that decrease those morbidities are needed and have the potential to decrease mortality and resource utilization.

Predictors of Quality of Life after Liver Transplant

Background and Hypothesis: The impact of chronic liver diseases on patients and their family member is often understated and understudied. Chronic liver diseases can sometimes progress to a need for Liver transplant (LT). While recent studies have described quality of life (QOL) at different stages of liver disease, the impact of the patient’s QOL in LT survivors has not been examined. The importance of studying QOL in patients is due to its effect on the survivorship of LT recipients. We hypothesize that QOL in LT patients is lower than the general population. Our aim was to describe predictors of QOL in a well-described cohort of LT patients.&#x0D; Methods: Patients were enrolled at the Digestive and Liver Disease Liver clinic at Indiana University Hospital. All patients over the age of 18 were approached, if patients consented to the study, they were then enrolled during their liver follow up visit. The PROMIS survey was administered on an iPad and completed during the clinic visit. Survey were then scored and analyzed.&#x0D; Results: The T-scores for post liver transplant patients are lower in physical function, anxiety and depression, but higher in general life satisfaction compared to the general population. LT recipients have similar T-scores in Fatigue, Sleep disturbance, ability to participate in social activities, and pain interference compared to the general population.&#x0D; Conclusion and Potential Impact: Previous diagnosis of PBC, HCC, diagnosis of depression, household income, insurance status, Charlson Comorbid Index and number of non-transplant related medications have the highest association with quality of life. Further enrollment is needed to increase the power of the study. However, this can inform physicians the importance to taking these factors in to consideration in order to improve the QOL in LT recipients.

Impact of diabetes mellitus and chronic liver disease on the incidence of dementia and all-cause mortality among patients with dementia.

This study investigated the effects of the presence of type 2 diabetes mellitus (T2D) and/or chronic liver disease (CLD) on the incidence and prognosis of dementia during a 10-year period in Korea using a nationwide population-based dataset from the Korea National Health Insurance Service.To assess the impact of T2D and CLD on the incidence of dementia, we included subjects aged ≥60 years without dementia, T2D, and CLD from 2003 to 2005. We created another cohort for evaluating the all-cause mortality in subjects with dementia between 2003 and 2005. The participants were categorized into 4 groups: control (neither CLD nor T2D), CLD-only, T2D-only, and T2D-and-CLD groups, and they were followed up until 2013.The incidence of dementia was higher in the T2D-only group than in the control and CLD-only groups (2.78 vs. 2.04 and 2.00 per 1000 person-years). After adjustment for age, gender, and comorbid conditions, both T2D and CLD increased the risk of any type of dementia; however, the impact of CLD alone was much lower [hazard ratio (HR) 1.07, 95% confidence interval (CI): 1.06–1.08] than that of T2D alone (HR 1.27, 95% CI: 1.27–1.28). The risk of dementia did not significantly change in patients with the co-occurrence of T2D and CLD compared to those with T2D alone. The all-cause mortality rate was the lowest in the control group (2.59 per 1000 person-years) and the highest in the T2D-and-CLD group (3.77 per 1000 person-years). Presence of T2D or CLD alone was associated with higher mortality (HR 1.46 and HR 1.21, respectively) compared with in the absence of both the diseases. Furthermore, the presence of both the diseases further significantly increased the mortality rate compared to the presence of each disease alone (HR 1.67, 95% CI: 1.65–1.69).In conclusion, this study found that the incidence of dementia was much higher in patients with T2D. CLD was associated with a modest increase in risk of dementia; however, there was no additive effect with T2D. In the population with dementia, however, the presence of CLD was associated with high mortality in patients with or without T2D.

Patients With Diabetes and Chronic Liver Disease Are at Increased Risk for Overall Mortality: A Population Study From the United States.

IN BRIEF Chronic liver disease (CLD) and type 2 diabetes have both been linked to increased morbidity and mortality. In this study, the impact of CLD and diabetes on all-cause mortality was quantified at the population level using U.S. population data. Both type 2 diabetes and CLD were found to be independently associated with increased mortality (age-adjusted hazard ratio [aHR] 1.98 and 1.37 for diabetes and CLD, respectively), and having both diabetes and CLD substantially increased the risk of mortality (aHR 2.41).

THU-138 - Impact of chronic liver disease on the survival of patients hospitalized with acute hepatitis A infection: nationwide hospital admission data from Thailand

THU-138 - Impact of chronic liver disease on the survival of patients hospitalized with acute hepatitis A infection: nationwide hospital admission data from Thailand

The effect of chronic liver disease on acute outcomes following cervical spine trauma

Background ContextThe adverse impact of chronic liver diseases, including chronic hepatitis and cirrhosis, on outcomes following orthopedic surgery has been increasingly recognized in recent years. The impact of these conditions on acute outcomes following spinal trauma remains unknown. Study DesignThis is a cohort control study that uses patient records in the Massachusetts Statewide Inpatient Dataset (2003–2010). PurposeThe study aimed to evaluate whether chronic liver disease increased the odds of mortality, complications, failure to rescue (FTR), reoperation, and hospital length of stay (LOS) following cervical spine trauma. Patient SampleThe sample is composed of 10,841 patients with cervical spine trauma. Outcome MeasuresPosttreatment morbidity, mortality, reoperation, and LOS were the outcome measures. MethodsDifferences between patients with and without chronic liver disease were evaluated using chi-square or Wilcoxon rank-sum tests. Logistic and negative binomial regression techniques were used to adjust for confounders, including whether a surgical intervention was performed. Receiver operator characteristic curves were used to assess final model discrimination. ResultsThere were 117 patients with chronic liver disease identified in the cohort. The rate of surgical intervention for cervical trauma was not significantly different between patients with and without chronic liver disease (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.52–1.29). Mortality (OR: 2.12, 95% CI: 1.23–3.66), FTR (OR: 2.86, 95% CI: 1.34–6.11), complications (OR: 1.65, 95% CI: 1.12–2.45), and LOS (regression coefficients: 0.31, 95% CI: 0.14–0.48) were all significantly increased for patients with chronic liver disease in final adjusted models that controlled for differences in case-mix and whether a surgical procedure was performed. Final models explained approximately 72% of the variation in mortality and FTR. ConclusionsOur novel findings indicate that patients with chronic liver disease may be at elevated risk of posttreatment morbidity and mortality following cervical spine trauma. Medical comanagement in the acute period following injury and optimization before surgery may diminish the potential for adverse events.

The impact of chronic liver disease on the risk assessment of ACS NSQIP morbidity and mortality after hepatic resection

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk-adjustment model for patients who require hepatic resection does not include metrics of underlying chronic liver disease. The applicability of the current risk adjustment model is under debate. This study aims to assess the impact of chronic liver disease on the ACS NSQIP estimates of postoperative morbidity and mortality. This retrospective cohort study included all cases of hepatic resection at our quaternary referral institution between 2006 and 2013. Metrics of chronic liver disease were abstracted and linked with the ACS NSQIP risk-adjustment model estimated probabilities of morbidity and mortality for each case. Sequential general linear models were used to estimate differences in ACS NSQIP probabilities of morbidity and mortality associated with measures of underlying chronic liver disease. A total of 522 hepatic resections were performed during the study period. The patient cohort included 91 patients with fibrosis (17%) and 38 patients with cirrhosis (7%). The mean ACS NSQIP estimated probability of morbidity was 0.24 ± 0.11 and probability of mortality was 0.02 ± 0.02. Fibrosis was associated with increased probability of morbidity (0.26 ± 0.11; P = .019); cirrhosis was also associated with increased probability of morbidity (0.27 ± 0.10; P = .059). Parenchymal liver disease was not associated with increased probability of mortality (all P ≥ .62). Increased probabilities of mortality were associated with diagnosis and extent of resection (both P < .001). In patients selected for hepatectomy, metrics of chronic liver disease were associated with differences in ACS NSQIP estimated probability of morbidity. Incorporation of metrics of chronic liver disease into the ACS NSQIP targeted hepatectomy modules should improve estimates of risk after hepatic resection.

Su1765 The Impact of Chronic Liver Disease on the Risk Assessment of ACS NSQIP Mortality and Morbidity After Hepatic Resection

Su1765 The Impact of Chronic Liver Disease on the Risk Assessment of ACS NSQIP Mortality and Morbidity After Hepatic Resection

Chronic liver disease and 90-day mortality in 21,359 patients following peptic ulcer bleeding--a Nationwide Cohort Study.

Bleeding is a serious and frequent complication of peptic ulcer disease. Hepatic dysfunction can cause coagulopathy and increases the risk of peptic ulcer bleeding. However, whether chronic liver disease increases mortality after peptic ulcer bleeding remains unclear. To examine the prognostic impact of chronic liver disease on mortality after peptic ulcer bleeding. We used population-based medical registries to conduct a cohort study of all Danish residents hospitalised with incident peptic ulcer bleeding from 2004 through 2011. We identified patients diagnosed with liver cirrhosis or non-cirrhotic chronic liver disease before their admission for peptic ulcer bleeding. We then computed 90-day mortality after peptic ulcer bleeding based on the Kaplan-Meier method (1 - survival function) and used a Cox regression model to estimate mortality rate ratios (MRRs), controlling for potential confounders. We identified 21,359 patients hospitalised with peptic ulcer bleeding. Among these, 653 (3.1%) had a previous diagnosis of liver cirrhosis and 474 (2.2%) had a history of non-cirrhotic chronic liver disease. Patients with liver cirrhosis and non-cirrhotic chronic liver disease had a cumulative 90-day mortality of 25.3% and 20.7%, respectively, compared to 18.3% among patients without chronic liver disease. Liver cirrhosis was associated with an adjusted 90-day MRR of 2.38 (95% CI: 2.02-2.80), compared to 1.49 (95% CI: 1.22-1.83) among patients with non-cirrhotic chronic liver disease. Patients with chronic liver disease, particularly liver cirrhosis, are at increased risk of death within 90 days after hospitalisation for peptic ulcer bleeding compared to patients without chronic liver disease.

Impact of Post Hepatitis C Chronic Liver Disease and Hepatocellular Carcinoma on Health Related Quality of Life

Background: Post hepatitis C virus chronic liver disease (CLD) is prevalent among the Egyptian population with a bad impact upon their quality of life (QOL). Hepatocellular carcinoma (HCC) is one of the long term and fatal complications of CLD and it also has its negative impact on patient’s quality of life. Aim: To assess impact of CLD and HCC on the quality of life of group of hospitalized elderly patients. Methodology: Ninety elderly patients were divided into three groups: 30 elderly with post hepatitis C virus CLD, 30 elderly with HCC and 30 others free of liver disease as control group (Cn), all were recruited from the in-patient ward and the outpatient clinic of the Geriatric Department, Ain-Shams University Hospital. After giving consent, comprehensive geriatric assessment was done with assessment of their quality of life by using the Short Form-36 health survey (SF-36). Investigations including liver enzymes, serum albumin, serum bilirubin and abdominal ultrasound were done. Results: All QOL domains were the highest among control group, followed by HCC group and the least among CLD group. The differences were statistically significant in most subscales and total score [Mean of Cn = 81.9 ± 12.4, Mean of CLD = 47.5 ± 21.9, Mean of HCC = 62.3 ± 16.1; P Cn/CLD ≤ 0.001, P Cn/HCC ≤ 0.001, P CLD/HCC = 0.004]. Albumin was the only biochemical marker correlated positively with total SF score and two subscales (PF and EF) [r = 0.408; P = 0.025]. Conclusion & Recommendation: Our study showed a decrease in the QOL of Egyptian post hepatitis C virus CLD and HCC patients compared with Egyptian population norms. The results showed that CLD were more affected than HCC patients. This had a particularly serious negative impact on their life. The findings indicate a need for updated counseling and educational materials designed to provide adequate information and consistent healthcare service to this patient setting.

Clinical outcomes and resource utilisation in Medicare patients with chronic liver disease: a historical cohort study

ObjectiveThe aim of this study is to assess recent trends in health resource utilisation and patient outcomes of Medicare beneficiaries with chronic liver disease (CLD).SettingLiver-related mortality is the 10th leading...

Impact of chronic liver disease in intensive care unit acquired pneumonia: a prospective study

To assess the impact of chronic liver disease (CLD) on ICU-acquired pneumonia. This was a prospective, observational study of the characteristics, microbiology, and outcomes of 343 consecutive patients with ICU-acquired pneumonia clustered according to the presence of CLD. Sixty-seven (20%) patients had CLD (67% had liver cirrhosis, LC), MELD score 26 ± 9, 20% Child-Pugh class C). They presented higher severity scores than patients without CLD both on admission to the ICU (APACHE II, LC 19 ± 6 vs. other CLD 18 ± 6 vs. no CLD 16 ± 6; p < 0.001; SOFA, 10 ± 3 vs. 8 ± 4 vs. 7 ± 3; p < 0.001) and at onset of pneumonia (APACHE II, 19 ± 6 vs. 17 ± 6 vs. 16 ± 5; p = 0.001; SOFA, 11 ± 4 vs. 9 ± 4 vs. 7 ± 3; p < 0.001). Levels of CRP were lower in patients with LC than in the other two groups (day 1, 6.5 [2.5-11.5] vs. 13 [6-23] vs. 15.5 [8-24], p < 0.001, day 3, 6 [3-12] vs. 16 [9-21] vs. 11 [5-20], p = 0.001); all the other biomarkers were higher in LC and other CLD patients. LC patients had higher 28- and 90-day mortality (63 vs. 28%, p < 0.001; 72 vs. 38%, p < 0.001, respectively) than non-CLD patients. Presence of LC was independently associated with decreased 28- and 90-day survival (95% confidence interval [CI], 1.982-17.250; p = 0.001; 95% confidence interval [CI], 2.915-20.699, p = 0.001, respectively). In critically ill patients with ICU-acquired pneumonia, CLD is associated with a more severe clinical presentation and poor clinical outcomes. Moreover, LC is independently associated with 28- and 90-day mortality. The results of this study are important for future trials focused on mortality.

Lactate metabolism in chronic liver disease

Background. In the healthy liver there is a splanchnic net-uptake of lactate caused by gluconeogenesis. It has previously been shown that patients with acute liver failure in contrast have a splanchnic release of lactate caused by a combination of accelerated glycolysis in the splanchnic region and a reduction in hepatic gluconeogenesis. Aims. The aims of the present study were to investigate lactate metabolism and kinetics in patients with chronic liver disease compared with a control group with normal liver function. Methods. A total of 142 patients with chronic liver disease and 14 healthy controls underwent a liver vein catheterization. Blood samples from the femoral artery and the hepatic and renal veins were simultaneously collected before and after stimulation with galactose. Results. The fasting lactate levels, both in the hepatic vein and in the femoral artery, were higher in the patients than in the controls (P < 0.001) and there were a hepatic net-uptake of lactate in both groups. Fasting lactate concentrations correlated directly with the portal pressure, mean arterial blood pressure, and SaO2 and negatively with ICG clearance. Conclusions. Lactate levels are elevated in cirrhotic patients compared to controls relating to portal pressure and aspects of liver dysfunction and the lactate levels seem to increase with the severity of cirrhosis. This may not be caused by decreased gluconeogenesis but merely be due to accelerated glycolysis in the splanchnic region. Future studies should focus on the impact of chronic liver disease on lactate kinetics.

Managing systemic symptoms in chronic liver disease

Improved medical management and the changing disease demographic mean that the majority of patients with chronic liver disease are living with the disease rather than dying from it. Historically, the perception has been that the impact of chronic liver disease is related entirely to the consequences of endstage liver disease; however, more recently a number of systemic symptoms have been recognised that can occur at any point in the natural history of chronic liver disease and which can be associated with functional impairment and reduced quality of life. The most characteristic of these systemic symptoms is fatigue, which frequently associates with sleep disturbance and autonomic dysfunction, particularly manifest as abnormality of blood pressure regulation. Cognitive symptoms can occur even in non-cirrhotic patients. Falls can present in patients with autonomic dysfunction, complicated by the presence of peripheral muscle strength problems. Importantly for clinicians managing chronic liver disease, the severity of these systemic symptoms is typically not related to liver disease severity, and therefore despite optimal liver disease management, patients can often continue to experience debilitating symptoms. The similarity in systemic symptoms between different chronic liver diseases (and indeed chronic inflammatory conditions affecting other organs) suggests the possibility of shared pathogenetic processes and raises the possibility of common management strategies, although further research is urgently needed to confirm this. In primary biliary cirrhosis, where our understanding of systemic symptoms is arguably most developed, structured management strategies have been shown to improve the quality of life of patients. It is highly likely that similar approaches will have comparable benefits for other chronic liver disease groups. Here, we review the current understanding of systemic symptoms in chronic liver disease and offer recommendations regarding the successful management of these symptoms. Critical for successful treatment is use of a structured and systematic approach to management in which all contributing factors are addressed in an organised fashion. We believe that such a systematic approach, when applied to research as well as to clinical management, will allow us to reduce the overall burden of chronic liver disease, improve quality of life and enhance functional ability.

Psychological Determinants of Health-Related Quality of Life in Patients With Chronic Liver Disease

The negative impact of chronic liver disease on health-related quality of life (HRQoL) of patients with chronic liver disease (CLD) has long been established, and treatable physiological or psychological factors may potentially influence HRQoL.The authors assessed the interrelationships of multiple psychological factors and HRQoL in patients with CLD.Both direct and indirect relationships among HRQoL, depression, anxiety, coping, and self-efficacy in 164 patients with CLD were assessed.Depression, largely determined by low self-efficacy and, possibly, by use of maladaptive coping strategies, influenced HRQoL in three groups of liver patients.HRQoL in CLD patients may be positively affected by enhancing coping and self-efficacy skills, thus improving levels of depression.

Psychological Determinants of Health-Related Quality of Life in Patients With Chronic Liver Disease

The negative impact of chronic liver disease on health-related quality of life (HRQoL) of patients with chronic liver disease (CLD) has long been established, and treatable physiological or psychological factors may potentially influence HRQoL. The authors assessed the interrelationships of multiple psychological factors and HRQoL in patients with CLD. Both direct and indirect relationships among HRQoL, depression, anxiety, coping, and self-efficacy in 164 patients with CLD were assessed. Depression, largely determined by low self-efficacy and, possibly, by use of maladaptive coping strategies, influenced HRQoL in three groups of liver patients. HRQoL in CLD patients may be positively affected by enhancing coping and self-efficacy skills, thus improving levels of depression.

Impact of chronic liver disease and cirrhosis on health utilities using SF-6D and the health utility index

Assessment of health-related quality of life (HRQL) and health utilities have become important aspects of clinical research. Patient-derived utility adjustments are frequently used in economic analysis. Although HRQL has been frequently studied among patients with liver disease, extensive data on the health utilities of patients with liver disease are not available. Recently, SF-6D has been developed to obtain utility scores from the widely used Short Form 36 questionnaire. To assess health utilities of patients with chronic liver disease using 2 utility assessments [SF-6D and Health Utility Index 2 (HUI-2)], a total of 140 patients were identified from our Liver Disease Quality of Life Database with HRQL data available, as well as clinical and demographic data. Of the 140 patients, 42% were female, had a mean age of 49.4 years (standard deviation = +/-11.2) 36% had hepatitis B virus (HBV), 29% had hepatitis C (HCV), 24% had cholestatic liver disease, and 11% had another liver disease (for example, nonalcoholic steatohepatitis). Bivariate analyses indicated that HBV patients had the highest health status as measured by all of SF-6D and HUI-2 subscales and the overall SF-6D and HUI-2 utility measures, whereas patients with HCV and cholestatic liver disease had similar scores, and those with other liver diseases had the poorest quality of life. When controlling for the effects of gender, age, and cirrhosis, impact of chronic liver disease diagnosis on utility scores persisted only for the SF-6D, with HCV patients having significantly poorer health than HBV patients. In conclusion, SF-6D provides not only a generic assessment of HRQL but also a utility score that can be used for economic analysis of patients with chronic liver disease.