title: The Impact of Liver Cell Injury on Health-Related Quality of Life in Patients with Chronic Liver Disease.
abstract: BACKGROUND
  Patients with chronic liver disease often suffer from unspecific symptoms and report severe impairment in the quality of life. The underlying mechanisms are multifactorial and include disease-specific but also liver related causes. The current analysis evaluated the association of hepatocellular apoptosis in non-viral chronic liver disease and health-related quality of life (HRQL). Furthermore we examined factors, which influence patient's physical and mental well-being.
  
  
  METHODS
  A total of 150 patients with non-infectious chronic liver disease were included between January 2014 and June 2015. The German version of the Chronic Liver Disease Questionnaire (CLDQ-D), a liver disease specific instrument to assess HRQL, was employed. Hepatocellular apoptosis was determined by measuring Cytokeratin 18 (CK18, M30 Apoptosense ELISA).
  
  
  RESULTS
  Female gender (5.24 vs. 5.54, p = 0.04), diabetes mellitus type II (4.75 vs. 5.46, p<0.001) and daily drug intake (5.24 vs. 6.01, p = 0.003) were associated with a significant impairment in HRQL. HRQL was not significantly different between the examined liver diseases. Levels of CK18 were the highest in patients with NASH compared to all other disease entities (p<0.001). Interestingly, CK18 exhibited significant correlations with obesity (p<0.001) and hyperlipidemia (p<0.001). In patients with cirrhosis levels of CK18 correlated with the MELD score (r = 0.18, p = 0.03) and were significantly higher compared to patients without existing cirrhosis (265.5 U/l vs. 186.9U/l, p = 0.047). Additionally, CK18 showed a significant correlation with the presence and the degree of hepatic fibrosis (p = 0.003) and inflammation (p<0.001) in liver histology. Finally, there was a small negative association between CLDQ and CK18 (r = -0.16, p = 0.048).
  
  
  CONCLUSIONS
  Different parameters are influencing HRQL and CK18 levels in chronic non-viral liver disease and the amount of hepatocellular apoptosis correlates with the impairment in HRQL in chronic non-viral liver diseases. These findings support the role of liver-protective therapies for the improvement of the quality of life in chronic liver disease.
authors.affiliation: I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Alt
authors.affiliation: I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Grimm
authors.affiliation: I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Liesa
authors.initials: L
authors.lastname: Schlegel
authors.affiliation: I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Grambihler
authors.affiliation: I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Jens M
authors.initials: JM
authors.lastname: Kittner
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Wiltink
authors.affiliation: I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.affiliation: I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Marcus A
authors.initials: MA
authors.lastname: Wörns
authors.affiliation: I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Jörn M
authors.initials: JM
authors.lastname: Schattenberg
mesh_terms: D000328:Adult; D000368:Aged; D017209:Apoptosis; D002908:Chronic Disease; D005260:Female; D006801:Humans; D053538:Keratin-18 / Q000096:biosynthesis*; D008099:Liver / Q000378:metabolism* / Q000473:pathology; D008103:Liver Cirrhosis / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life
chemical_list: D053538:Keratin-18