Background:End-stage liver disease is a common cause of morbidity and mortality
worldwide, yet little is known about its symptomatology and impact on
health-related quality of life.Aim:To describe symptom prevalence and health-related quality of life of patients
with end-stage liver disease to improve care.Design:Systematic review.Data sources:We searched eight electronic databases from January 1980 to June 2018 for
studies investigating symptom prevalence or health-related quality of life
of adult patients with end-stage liver disease. No language restrictions
were applied. Meta-analyses were performed where appropriate.Results:We included 80 studies: 35 assessing symptom prevalence, 41 assessing
health-related quality of life, and 4 both. The instruments assessing
symptoms varied across studies. The most frequently reported symptoms were
as follows: pain (prevalence range 30%–79%), breathlessness (20%–88%),
muscle cramps (56%–68%), sleep disturbance (insomnia 26%–77%, daytime
sleepiness 29.5%–71%), and psychological symptoms (depression 4.5%–64%,
anxiety 14%–45%). Erectile dysfunction was prevalent (53%–93%) in men. The
health-related quality of life of patients with end-stage liver disease was
significantly impaired when compared to healthy controls or patients with
chronic liver disease. Compared with compensated cirrhosis, decompensation
led to significant worsening of both components of the 36-Item Short Form
Survey although to a larger degree for the Physical Component Summary score
(decrease from average 6.4 (95% confidence interval: 4.0–8.8); p < 0.001)
than for the Mental Component Summary score (4.5 (95% confidence interval:
2.4–6.6); p < 0.001).Conclusion:The symptom prevalence of patients with end-stage liver disease resembled
that of patients with other advanced conditions. Given the diversity of
symptoms and significantly impaired health-related quality of life,
multidisciplinary approach and timely intervention are crucial.