Determinants of health-related quality of life in patients with chronic liver diseases

Haüser, Winfried; Holtmann, Gerald; Grandt, Daniel

doi:10.1016/s1542-3565(03)00315-x

Cited by 106 publications

(119 citation statements)

References 21 publications

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“…5 By BDI criteria, at least 30% of patients with cirrhosis have depressive symptoms. [6][7][8] Studies where cirrhotic patients have been assessed for health-related quality of life (HRQOL) as well as depression [the former typically also via questionnaires, such as the Short Form-36 (SF-36)] confirm that depressed cirrhotic patients experience a significantly reduced HRQOL in comparison to nondepressed subjects. 6,9 Furthermore, cirrhotic patients with depression experience worse clinical outcomes than those without.…”

Section: Depression In Patients With Chronic Liver Disease Cirrhosismentioning

confidence: 99%

“…[6][7][8] Studies where cirrhotic patients have been assessed for health-related quality of life (HRQOL) as well as depression [the former typically also via questionnaires, such as the Short Form-36 (SF-36)] confirm that depressed cirrhotic patients experience a significantly reduced HRQOL in comparison to nondepressed subjects. 6,9 Furthermore, cirrhotic patients with depression experience worse clinical outcomes than those without. Depressed patients with decompensated liver disease of different aetiologies assessed for liver transplantation had an increased mortality at 100 days post-assessment compared to nondepressed patients, 9 despite no significant difference between groups in the incidence of specific features of decompensation (including gastrointestinal bleeding and hepatocellular carcinoma).…”

Section: Depression In Patients With Chronic Liver Disease Cirrhosismentioning

confidence: 99%

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Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Mullish

Kabir

Thursz

et al. 2014

Aliment Pharmacol Ther

115

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SummaryBackgroundThe scale of depression in patients with chronic liver disease (CLD) and those who have received orthotopic liver transplantation (OLT) is poorly characterised. Clinicians are uncertain of how best to manage depression within these patients.AimsTo review the literature evaluating both the prevalence and impact of depression in patients with CLD and post‐OLT, and to assess the safety and efficacy of antidepressant use within this context.MethodsA PubMed search using the phrases ‘chronic liver disease’, ‘cirrhosis’, ‘liver transplantation’, ‘depression’, ‘antidepressant’ and the names of specific causes of liver disease and individual antidepressants.ResultsOver 30% of cirrhotic patients have depressive features, and they experience worse clinical outcomes than nondepressed cirrhotic patients. CLD patients with chronic hepatitis C are particularly prone to depression, partly related to the use of interferon therapy. OLT patients with depression have higher mortality rates than nondepressed patients; appropriate antidepressant use reverses this effect. Selective serotonin reuptake inhibitors (SSRIs) and selective noradrenaline reuptake inhibitors (SNRIs) are effective and generally safe in both CLD and OLT patients.ConclusionsDepression is much more prevalent in CLD or OLT patients than is generally recognised, and it adversely affects clinical outcomes. The reasons for this relationship are complex and multifactorial. Antidepressants are effective in both CLD and post‐OLT, although lower doses or a reduced dosing frequency may be required to minimise side effects, e.g. exacerbation of hepatic encephalopathy. Further research is needed to establish optimal management of depression in these patients, including the potential role of nonpharmacological treatments.

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Section: Depression In Patients With Chronic Liver Disease Cirrhosismentioning

confidence: 99%

Section: Depression In Patients With Chronic Liver Disease Cirrhosismentioning

confidence: 99%

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Mullish

Kabir

Thursz

et al. 2014

Aliment Pharmacol Ther

115

View full text Add to dashboard Cite

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“…HRQOL has been shown to be impaired in patients with cirrhosis [127][128][129]. Several factors such as severity of liver disease, symptoms of cirrhosis (muscle cramps and pruritus), and psychological factors have been implicated in HRQOL impairment in patients with chronic liver diseases [127][128][129].…”

Section: Hrqol In Liver Cirrhosismentioning

confidence: 99%

Intestinal permeability in cirrhotic patients with and without ascites

Kalaitzakis

Johansson

Bjarnason³

et al. 2006

Scandinavian Journal of Gastroenterology

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Malnutrition is a common finding in patients with liver cirrhosis. Malnutrition has been shown to be associated with increased morbidity and mortality. Its pathogenesis remains unclear but both poor dietary intake and increased energy expenditure have been reported.Spontaneous bacterial peritonitis is an important clinical problem in cirrhotics. It may occur as a consequence of repeated access of bacteria from the intestinal lumen (translocation) to the mesenteric lymph nodes. One of the mechanisms proposed to explain bacterial translocation in cirrhosis includes increased intestinal permeability.The aims of the present study were to evaluate GI symptoms in cirrhotic patients and their possible relation to nutritional status, to assess whether gastric sensorimotor dysfunction or metabolic disturbances are associated with reduced food intake, and to investigate the role of ascites in intestinal permeability in patients with liver cirrhosis.Gastrointestinal symptoms and health-related quality of life (HRQOL) were assessed with the aid of two questionnaires. Gastric sensorimotor function was measured by means of an electronic barostat. Food intake, as assessed with a food diary, was related to fasting and postprandial glucose, insulin, leptin, and ghrelin concentrations. Intestinal permeability was evaluated by a 51 Cr-EDTA permeability test. Cirrhotics were found to have increased severity of GI symptoms compared with reference values from the general population. A relationship between GI symptoms and compromised HRQOL as well as weight loss was observed.Proximal stomach relaxation to a meal was increased in patients with liver cirrhosis as compared with healthy controls but the relation between gastric accommodation and energy intake was found to be disturbed in these patients. Gastric sensitivity to distension was shown to be related to GI symptom severity and to liver cirrhosis severity scores.Patients with liver cirrhosis exhibited higher postprandial insulin and glucose concentrations compared to controls. Cirrhotics had higher fasting leptin that fell significantly postmeal and they showed an attenuated increase of ghrelin before the next expected meal. Altered glucose and hormonal levels in patients with cirrhosis were associated with poor food intake.Only a few patients with cirrhosis had increased intestinal permeability, as assessed by a 51 Cr-EDTA test, which was not influenced to a major extent by ascites. Conclusions: In patients with liver cirrhosis GI symptom severity is high and it is associated with impaired HRQOL and weight loss. Gastric accommodation is not involved in the poor food intake observed in cirrhotics and gastric sensitivity seems to be a relevant factor for GI symptom generation in these patients. Altered postprandial glucose, leptin, and ghrelin levels are correlated to reduced energy intake in this patient group. Increased intestinal permeability is probably of limited importance in the pathophysiology of bacterial infections in patients with liver cirrhosis and ascites.

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“…38 In another study in more than 200 patients, Hauser et al 39 showed that HRQL was not affected by severity of liver disease (Child-Turcotte-Pugh score) but by psychiatric and active medical comorbidities. Importantly, Kramer et al 34 demonstrated that fatigue itself was not related to the severity of hepatitis, and Hilsabeck et al 40 found that the most significant predictor of fatigue in patients with CHC was poor social functioning.…”

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confidence: 99%