title: Health-related quality of life predicts mortality in patients with advanced chronic liver disease.
abstract: OBJECTIVE
  It is well-established that cirrhosis negatively impacts health-related quality of life (HRQOL). However, it is less clear how to use this information in everyday clinical practice. If HRQOL predicted survival in cirrhosis, then measuring HRQOL would have important clinical implications. We sought to measure the association between HRQOL and survival in patients with cirrhosis and investigated whether the relationship between HRQOL and survival is independent of Model for End-Stage Liver Disease (MELD).
  
  
  METHODS
  We measured HRQOL in 156 patients with cirrhosis awaiting liver transplantation by using the Short Form Liver Disease Quality of Life instrument. We followed patients prospectively and used Cox proportional hazard models to measure the independent effect of baseline HRQOL on survival, adjusting for MELD and other covariates.
  
  
  RESULTS
  During a mean 9-month follow-up, 26 (17%) patients died, and 30 (20%) received liver transplants. In unadjusted analysis, higher baseline HRQOL predicted lower mortality (hazard ratio, 0.96; 95% confidence interval, 0.94-0.99). Specifically, for each 1-point increase in HRQOL, there was a 4% decrease in mortality. These results did not change after adjusting for MELD scores, patient demographics, or psychosocial characteristics; the MELD score accounted for 1% of the variation in HRQOL scores (P = .18). Survival was most strongly predicted by activities of daily living, health distress, sleep disturbance, and perceived disease stigma.
  
  
  CONCLUSIONS
  Higher HRQOL predicts lower mortality in patients with cirrhosis. This relationship is independent of MELD; MELD does not capture liver-specific HRQOL. Beyond its use as a secondary outcome in clinical trials, HRQOL could be used to predict survival of patients with advanced liver disease.
authors.affiliation: John Cochran VA Medical Center, St. Louis, Missouri, USA.
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
authors.forename: Ron D
authors.initials: RD
authors.lastname: Hays
authors.forename: Angelique
authors.initials: A
authors.lastname: Zeringue
authors.forename: Francisco
authors.initials: F
authors.lastname: Durazo
authors.forename: Steven B
authors.initials: SB
authors.lastname: Han
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Roger
authors.initials: R
authors.lastname: Bolus
authors.forename: Brennan M R
authors.initials: BM
authors.lastname: Spiegel
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*