Relationship Between Pretransplantation Liver Status and Health-Related Quality of Life After Grafting: A Single-Center Prospective Study

Quality of Life and Its Determinants in Liver Transplantation Candidates: A Missed Link in Liver Care Program during the Waiting Time for Liver Transplantation

Background

The health-related quality of life (HRQOL) in the before liver transplantation (LT) stage has not been studied as much as that after the LT stage. We aimed to assess HRQOL and its determinants before the LT stage.

Methods

As a cross-sectional study, HRQOL of all adult patients (n=632) referred to the LT center of Shiraz, Iran in 2018-2019 were assessed. Demographic, socioeconomic, medical, and paraclinical data were requested. Physical (PCS) and mental (MCS) aspects of HRQOL were assessed using the SF36 questionnaire. Univariable, multivariable (linear regression), and confirmatory factor analysis were performed utilizing SPSS 20 and Mplus 6.1 software. P<0.05 was considered to be significant.

Results

The mean age of the patients was 47.6±12.3 years, while 414 (65.6%) were men, and the mean, score of the model for end-stage liver disease (MELD) was 18.36±5.58. The mean score of QOL, PCS, and MCS was 50.01±21.73, 46.23±23.23, and 53.78±23.91 (out of 100), respectively. Vitality had the most association with HRQOL, while role limitations had the lowest. The multivariable analysis revealed that unemployment (P<0.001), anemia (P=0.005), weight loss (P=0.005), diabetes mellitus (DM) (P=0.009), low MELD score (P=0.027), and drug use (P=0.03) were the significant determinants of HRQOL, respectively.

Conclusion

The present study showed that HRQOL in the LT candidates was at the intermediate level, while their PCS and MCS are at the low and moderate levels, respectively. Furthermore, physical performance, job status, anemia, weight loss, MELD score, DM, and drug use should be considered as the significant determinants of HRQOL in the LT candidates.

Selected Healthy Behaviors and Quality of Life in People Who Practice Combat Sports and Martial Arts

Background: The quality of life of a society is conditioned by many factors, and depends, among other things, on preferred behavior patterns. Combat sports (CS) and martial arts (MA) have a special educational potential in the area of shaping positive behavior patterns and transmitting moral values which could help reduce aggression in society. The aim of the work was to determine the relationship between health behaviors and the quality of life of people who practice combat sports and martial arts (CS and MA) recreationally, in addition to practicing other sports, and as competitors at the master level. Methods: The research embraced 543 people who practice combat sports and martial arts. Three groups were selected: recreational (n = 362), people who reconciled practicing various sports (n = 115), and competitors who practiced combat sports or martial arts at the master level (n = 66). The average age of the respondents was 24.49 ± 7.82. The standardized WHOQOL-BREF questionnaire and another questionnaire for a lifestyle survey were applied. The Kruskal-Wallis test was used to compare several independent samples. In the case of determining statistical significance of differences the Mann-Whitney test was employed, and for the qualitative data analyses the trait frequency and the independence chi-square test were used. The effect size was calculated for each test (ER2, rg, Cramér’s V). The value of p ≤ 0.05 was assumed to be statistically significant. Results: The highest quality of life (in the physical, psychological and environmental domains) was characteristic of the competitors, who practiced only combat sports and martial arts. They also displayed the most health-oriented behaviors. The surprising results were: lower quality of life in the assessment of nondrinkers and nonsmokers, and higher among people who were overweight. Conclusions: We have found positive correlations between practicing CS and MA, health behaviours and higher scores in quality of life self-evaluation, particularly where practitioners are exclusively focused on CS and MA and practice these at a competitive level. Our findings thus support the growing evidence that competitive level CS and MA are an effective means of improving people’s quality of life. Future research needs to clarify whether CS and MA can also be recommended to recreational and non-competitive practitioners as a means to improve their subjective quality of life.

Autoimmune hepatitis exerts a profound, negative effect on health-related quality of life: A prospective, single-centre study

BACKGROUND AND AIMS

Autoimmune hepatitis is a progressive chronic liver disease. Health-related quality of life in autoimmune hepatitis has not attracted much attention so far. We prospectively assessed various aspects of health-related quality of life in a well characterized group of patients with autoimmune hepatitis.

METHODS

In total, 140 patients with autoimmune hepatitis (mean age 40 ± 17 years) and 170 controls (mean age 36 ± 14 years) were included. Health-related quality of life was evaluated with following questionnaires: The Short Form (36) Health Survey, Modified Fatigue Impact Score, State-Trait Anxiety Inventory and Patient Health Questionnaire-9 assessing depression.

RESULTS

Patients with autoimmune hepatitis showed a significant impairment of health-related quality of life in all, but one, domains of The Short Form (36) Health Survey. Autoimmune hepatitis was associated with pronounced physical fatigue (P < 0.001), anxiety (P < 0.001) and depression (P < 0.001). As compared to males, female patients demonstrated greater impairment of physical aspects of The Short Form (36) Health Survey and Modified Fatigue Impact Score. Twenty-seven patients (19%) had moderate (Patient Health Questionnaire-9 >10) and 14 (10%) moderately severe depression (Patient Health Questionnaire-9 >15). Depression showed a very strong correlation with chronic fatigue (R = 0.68; P < 0.001); physical and mental components of The Short Form (36) Health Survey (R = 0.52/0.68 respectively; P < 0.001) and anxiety (R = 0.47; P < 0.001). There was a trend towards better life's quality in patients treated with budesonide in some aspects of their health-related quality of life. Duration of the disease, age at diagnosis, liver fibrosis and the presence of cirrhosis were not associated with health-related quality of life.

CONCLUSIONS

Health-related quality of life is significantly impaired in patients with autoimmune hepatitis. Depression seems to be a dominant symptom affecting their well-being, not associated with clinical and biochemical features of the disease.

Chronic Liver Disease Questionnaire as a Tool to Evaluate the Quality of Life in Liver Transplant Candidates

INTRODUCTION:

The advanced stage of liver disease causes impairments in the quality of life due to the physiological symptoms, besides the social and emotional stress. The aim of this study was to evaluate the quality of life of candidates for liver transplantation in specialized center in the interior of the state of São Paulo, Brazil.

METHODS:

An observational study was carried out, with a quantitative approach. The sample was of convenience with the participation of 50 candidates for liver transplantation. Demographic characterization data, clinical data, and the Chronic Liver Disease Questionnaire were used to evaluate the quality of life.

RESULTS:

The majority of the participants were male (68%), married (76%), with an average age of 55.7 years and average income of 2 to 3 minimum wages (42%). The main cause of liver disease was alcoholism (34%), mean time on the waiting list was 247.8 days, and mean model for end-stage liver disease was 20.5 points. The mean quality of life score was 2.9 points (standard deviation = 1.0) and the analysis of the 6 domains showed greater impairment of fatigue (2.2), activity (2.7), and concern (2.9) and better evaluation of systemic symptoms (3.4) and emotion (3.3).

CONCLUSION:

Quality of life is impaired in most of the participants, indicating the need for greater attention and evaluation in the physical, mental, and social scope of this clientele.