title: Prediction of improvement in quality of life (QoL-AGHDA) in adults with growth hormone deficiency by normative reference limits: data of the German KIMS cohort.
abstract: OBJECTIVE
  The objective of the present study was to calculate sex- and age-specific normative values for health-related quality of life (HRQoL) in Germany using quantile regression. Furthermore, we investigate the estimates of these normative data to and to predict the improvement of QoL-AGHDA scores in the German KIMS cohort during growth hormone treatment.
  
  
  METHODS
  Normative data of HRQoL was assessed by quality of life assessment of growth hormone deficiency (GHD) in adults (QoL-AGHDA) in a representative sample of the German population (n=4172). Corresponding data for 888 patients with GHD were retrieved from the German KIMS cohort (Pfizer International Metabolic Database).
  
  
  RESULTS
  The overall mean QoL-AGHDA score of the general population was 4.8±5.2. ANOVA indicated that variability in QoL-AGHDA scores did not differ significantly across gender (p=0.20), whereas age was a significant predictor (p<0.001). Given the QoL-AGHDA score distribution of the general population, we calculated reference values based on quantile regression. In KIMS patients we observed significantly higher QoL-AGHDA scores, 7.9±6.5 (p<0.001), before GH treatment. The optimal predictive QoL-AGHDA score was 6 (70th percentile) with a sensitivity of 0.57 and a specificity of 0.70 in ROC analysis. Furthermore, a baseline QoL-AGHDA score above the 70th percentile allowed predicting an improvement of QoL by GH treatment.
  
  
  CONCLUSIONS
  This study established normative reference values for the QoL-AGHDA in a representative sample of the German population. Based on these normative data a QoL-AGHDA cut-off value for prediction of improvement was investigated for the German population, which may facilitate clinical assessment of HRQoL response to GH replacement for patients with GHD.
authors.affiliation: Institute of Community Medicine, University Medicine Greifswald, Germany. joern.moock@uni-greifswald.de
authors.forename: Joern
authors.initials: J
authors.lastname: Moock
authors.forename: Nele
authors.initials: N
authors.lastname: Friedrich
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Christin
authors.initials: C
authors.lastname: Spielhagen
authors.forename: Matthias
authors.initials: M
authors.lastname: Nauck
authors.forename: Maria
authors.initials: M
authors.lastname: Koltowska-Häggström
authors.forename: Michael
authors.initials: M
authors.lastname: Buchfelder
authors.forename: Henri
authors.initials: H
authors.lastname: Wallaschofski
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohlmann
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019992:Databases as Topic; D005260:Female; D005858:Germany; D013006:Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011788:Quality of Life; D012372:ROC Curve; D012015:Reference Standards; D012189:Retrospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires
chemical_list: D013006:Growth Hormone