Are physician-derived disease severity indices associated with health-related quality of life in patients with end-stage liver disease?
OBJECTIVE
Model for end-stage liver disease (MELD) score is now often used as an overall indicator of health status for patients with end-stage liver disease. However, there are no data evaluating the associations between MELD scores and patient reports of health-related quality of life (HRQOL).


METHODS
Two hundred-three patients with end-stage liver disease completed a disease-targeted HRQOL instrument (the LDQOL 1.0). Patients also rated the severity of their liver disease and reported number of disability days attributed to their liver disease in the preceding month. MELD and Child Turcott Pugh (CTP) scores were calculated for all patients. Associations of MELD and CTP scores with patient-derived outcomes were estimated.


RESULTS
The mean MELD and CTP scores were 12 and 7, respectively, indicating mild severity of liver disease. HRQOL of patients was generally poor, with the mean SF-36 physical and mental component summary scores of 35 and 40. Seventy percent of patients rated their liver disease symptoms as moderate to severe. Similarly, 70% reported being disabled from their liver disease. MELD was associated with physical functioning scale and the physical component summary (PCS) score in patients with end-stage liver disease. In contrast, CTP score was significantly associated with physical functioning, role limitations due to physical health problems, PCS score, effects of liver disease, sexual functioning, and sexual problems. Both MELD and CTP scores correlated with self-rated severity of liver disease symptoms but not with self-reported disability days.


CONCLUSIONS
Despite objectively mild liver disease, the subjective HRQOL of this cohort was severely impaired. CTP score was more closely associated with patient-reported estimates of HRQOL than the MELD score. CTP or disease-specific HRQOL instruments may compliment MELD by providing insights into outcomes of importance to patients with low risk of mortality.
Kanwal
Fasiha
F
VA Greater Los Angeles Health Care System, David Geffen School of Medicine at UCLA, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA.
Hays
Ron D
RD
Kilbourne
Amy M
AM
Dulai
Gareth S
GS
Gralnek
Ian M
IM
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006306:Health Surveys; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016019:Survival Analysis