Factors associated with health‐related quality of life in patients with cirrhosis: a systematic review

Abstract

Background: Patients with cirrhosis have a poor health-related quality of life (HRQoL). Recognizing factors that affect HRQoL is key in delivering patient-centred care. Aim: To identify factors most commonly associated with a poor HRQoL in adults with cirrhosis in a systematic review of the literature. Methods: Four databases (MEDLINE, EMBASE, CENTRAL and PsycINFO) were searched from inception to March 2020, using terms related to patient-reported outcomes plus cirrhosis. Studies that analysed an association between at least one factor and HRQoL in adult patients with cirrhosis were included. Abstract and full-text screening was performed by two reviewers. Data were collected on factors evaluated in each study and the significance of their association with HRQoL. Results: A total of 10647 citations were reviewed, of which 109 met eligibility criteria. 76% of the studies used a generic instrument while only 45% used liver-specific instruments. Among identified factors, demographic factors and cirrhosis aetiology were not generally associated with poor HRQoL except for poor social support. Depression, poor sleep and muscle cramps affected HRQoL in all the studies that evaluated them. Among comorbidities, frailty, falls, malnutrition and cognitive impairment were also associated with poor HRQoL in the majority of studies. Among cirrhosis-specific decompensating events, only hepatic encephalopathy (HE) was consistently associated with impairment in HRQoL (75% of studies). Conclusion: Many factors impact poor HRQoL in patients with cirrhosis such as depression, muscle cramps, poor sleep, falls, frailty and malnutrition. Among cirrhosis decompensating events, HE was the complication most commonly associated with a poor HRQoL. K E Y W O R D S cirrhosis, patient-reported outcomes, quality of life 1 | INTRODUC TI ON Cirrhosis is a major cause of global health burden, accounting for 1 million deaths, or 2% of all deaths worldwide and 1.2% of global Disability Adjusted Life Years (DALY). 1,2 Although liver transplantation offers a significant survival advantage and improvement in quality of life in patients with decompensated cirrhosis, 3,4 it is only attainable for a minority of patients. A large proportion of

The Patient’s Perspective in Cirrhosis: Unmet Supportive Care Needs Differ by Disease Severity, Etiology, and Age

“…(14) Depression and anxiety are key contributors to a decreased HRQOL in patients with chronic disease, and may affect many aspects of care including engagement with social risk behaviors (e.g., alcohol, drugs) and adherence to medications and medical appointments. (12,28) Embedding mental health and social workers in the multidisciplinary care of patients with cirrhosis may help to address these difficult unmet needs, although substantial hurdles related to cost and access to allied health professionals will need to be addressed.…”

“…Patients with cirrhosis, particularly decompensated cirrhosis, often follow complex medication regimens and dietary restrictions, (9) and experience undesirable life impacts such as a reduction in their capacity to undertake activities of daily living, and high levels of anxiety and stress. (10)(11)(12) In particular, patients with cirrhosis worry about development of liver cancer, disease symptoms and treatment, as well as the impact of the disease on social interactions and their ability to function effectively at home and/or work. (13,14) A key aspect of management for all patients with cirrhosis is supportive care and alleviation of symptoms.…”

Relationship Between Sleep–Wake Disturbance and Risk of Malnutrition in Hospitalized Patients With Cirrhosis

“…Notably, PSQI increased in parallel with HE, and patients with cirrhosis with higher PSQI scores suffered from worse HRQoL ( 22 ). More recently, a systemic review of 109 studies intended to comprehensively summarize the factors relevant to poor HRQoL in patients with cirrhosis ( 23 ). Their findings showed that malnutrition, as a modifiable issue, is among the top factors, which are associated with impairment in HRQoL in most studies.…”

Treatment of Muscle Cramps in Patients With Cirrhosis of Liver: A Systematic Review

“…3 Albeit mostly benign, severely intense and frequent muscle cramps can be debilitating for the affected patients as these can cause frequent sleep deprivation and usually impart a significant adverse impact on the quality of life. 4,5 These affect mainly the lower limb muscles such as muscles of calves and feet, though fingers and hands can also be affected.…”