Cholestatic liver diseases and health-related quality of life.
OBJECTIVE
Symptoms associated with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) negatively affect health-related quality of life (HRQL). The aim of this study was to measure HRQL in patients with chronic cholestatic liver diseases and to determine factors associated with more severe impairment.


METHODS
We conducted a cross-sectional study in which we documented patients' demographic and clinical characteristics, and measured their HRQL using the Short Form-36 and Chronic Liver Disease Questionnaire. We assessed the association of HRQL impairment with disease severity (Child's-Pugh class and Mayo PBC Risk Score) and compared patients' HRQL with those of a healthy population, and patients with congestive heart failure, chronic obstructive pulmonary disease, and diabetes.


RESULTS
One hundred and four patients with PBC and PSC participated, of whom 73% were women, with an average age of 55+/-12 yr. Of these patients, 61% had cirrhosis (37% Child's A, 23% Child's B, and 2% Child's C). Patients with cholestatic liver disease showed more HRQL impairment than the healthy population and were similar to patients with other chronic conditions. Additionally, patients who experienced severe itching showed profound HRQL impairment. In patients with PBC, Physical Component Summary (PCS) scores of the SF-36 and Chronic Liver Disease Questionnaire (CLDQ) scores fell from noncirrhotic to Child's A to Child's B/C and with worsening Mayo PBC Risk Scores. No other clinicodemographic data were associated with patients' well-being.


CONCLUSIONS
Patients with cholestatic liver disease (PBC and PSC) showed substantial impairment of HRQL, which is further affected by worsening disease severity. Disease-specific measures were better able to discriminate patients with varying severities.
Younossi
Z M
ZM
Department of Gastroenterology, and Liver Transplant Center, The Cleveland Clinic Foundation, Ohio 44195, USA.
Kiwi
M L
ML
Boparai
N
N
Price
L L
LL
Guyatt
G
G
D000704:Analysis of Variance; D001663:Bilirubin / Q000097:blood; D015209:Cholangitis, Sclerosing / Q000145:classification / Q000503:physiopathology*; D002779:Cholestasis / Q000145:classification / Q000503:physiopathology*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000503:physiopathology; D008105:Liver Cirrhosis, Biliary / Q000145:classification / Q000503:physiopathology*; D008173:Lung Diseases, Obstructive / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000503:physiopathology; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index
D001663:Bilirubin