Assessment of health-related quality of life in Chinese patients with minimal hepatic encephalopathy.

AIM To evaluate the health-related quality of life (HRQOL) based on the Chinese version of SF-36 and Chronic Liver Disease Questionnaire (CLDQ) in subjects with chronic hepatitis B, liver cirrhosis, including patients with minimal hepatic encephalopathy (MHE). METHODS The SF-36 and CLDQ were administered to 160 healthy volunteers, 20 subjects with chronic hepatitis B and 106 patients with cirrhosis (33 cases exhibited MHE). HRQOL scores were compared among the different study groups. The SF-36 includes eight health concepts: physical functioning, role-physical, body pain, general health, vitality, social functioning, role-emotion, and mental health. Six domains of CLDQ were assessed: abdominal symptoms, fatigue, systemic symptoms, activity, emotional function and worry. RESULTS Compared with healthy controls (96.9 +/- 4.5, 86.6 +/- 18.4, 90.1 +/- 12.5, 89.0 +/- 5.7, 87.5 +/- 4.3, 95.8 +/- 7.1, 88.5 +/- 15.9, 88.7 +/- 5.2 in SF-36 and 6.7 +/- 0.5, 6.1 +/- 0.6, 6.3 +/- 0.6, 6.5 +/- 0.5, 6.3 +/- 0.5, 6.8 +/- 0.4 in CLDQ), patients with chronic hepatitis B (86.3 +/- 11.0, 68.8 +/- 21.3, 78.9 +/- 14.4, 60.8 +/- 10.5, 70.8 +/- 8.6, 76.1 +/- 12.6, 50.0 +/- 22.9, 72.2 +/- 10.6 and 5.5 +/- 1.0, 4.5 +/- 1.0, 5.2 +/- 1.1, 5.3 +/- 0.9, 4.8 +/- 0.9, 4.9 +/- 1.0) and cirrhosis (52.8 +/- 17.4, 32.8 +/- 27.9, 61.6 +/- 18.9, 30.2 +/- 18.3, 47.9 +/- 20.1, 54.0 +/- 19.2, 28.9 +/- 26.1, 51.1 +/- 17.8 and 4.7 +/- 1.2, 3.9 +/- 1.2, 4.7 +/- 1.2, 4.7 +/- 1.3, 4.7 +/- 1.0, 4.4 +/- 1.1) had lower HRQOL on all scales of the SF-36 and CLDQ (P < 0.01 for all). Increasing severity of liver cirrhosis (based on the Child-Pugh score/presence or absence of MHE) was associated with a decrease in most components of SF-36 and CLDQ, especially SF-36. CONCLUSION The Chinese version of SF-36 along with CLDQ is a valid and reliable method for testing MHE in patients with liver cirrhosis. Cirrhosis and MHE are associated with decreased HRQOL.

[1]  A. Lockwood,et al.  Hepatic encephalopathy—Definition, nomenclature, diagnosis, and quantification: Final report of the Working Party at the 11th World Congresses of Gastroenterology, Vienna, 1998 , 2002, Hepatology.

[2]  D. Freides,et al.  Subclinical hepatic encephalopathy: detection, prevalence, and relationship to nitrogen metabolism. , 1978, Gastroenterology.

[3]  Quality-of-life assessments and chronic liver disease , 1998 .

[4]  Lin Jia,et al.  Prevalence of subclinical hepatic encephalopathy in cirrhotic patients in China. , 2004, World journal of gastroenterology.

[5]  W. Häuser,et al.  Lebensqualitätsmessung in der Gastroenterologie - Konzepte, Instrumente und Probleme , 2001 .

[6]  Ding‐Shinn Chen,et al.  Somatosensory evoked potentials in subclinical portosystemic encephalopathy: A comparison with psychometric tests , 1998, Hepatology.

[7]  Ritesh Agarwal,et al.  Lactulose improves cognitive functions and health‐related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy , 2007, Hepatology.

[8]  C. Wein,et al.  Minimal hepatic encephalopathy impairs fitness to drive , 2004, Hepatology.

[9]  S. Fukuhara,et al.  Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. , 1998, Journal of clinical epidemiology.

[10]  D. Simonson,et al.  Assessment of quality-of-life outcomes. , 1996, The New England journal of medicine.

[11]  O. Garin,et al.  Validity of the Spanish version of the Chronic Liver Disease Questionnaire (CLDQ) as a standard outcome for quality of life assessment , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[12]  D. Provenzale,et al.  Quality of life measurement in gastroenterology: what is available? , 2001 .

[13]  Gordon Guyatt,et al.  Measuring Health-Related Quality of Life , 1993, Annals of Internal Medicine.

[14]  M. Colombo,et al.  Validity and reliability of the Italian version of the Chronic Liver Disease Questionnaire (CLDQ-I) for the assessment of health-related quality of life. , 2005, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[15]  W. Häuser,et al.  Validation of the German version of the Chronic Liver Disease Questionnaire , 2004, European Journal of Gastroenterology and Hepathology.

[16]  W. Hop,et al.  Subclinical hepatic encephalopathy impairs daily functioning , 1998, Hepatology.

[17]  W. Hop,et al.  Screening of subclinical hepatic encephalopathy. , 2000, Journal of hepatology.

[18]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[19]  W. Hop,et al.  The prognostic significance of subclinical hepatic encephalopathy. , 2000 .

[20]  K. Weissenborn,et al.  Attention Deficits in Minimal Hepatic Encephalopathy , 2001, Metabolic Brain Disease.

[21]  C. Randolph,et al.  Neuropsychological characterization and detection of subclinical hepatic encephalopathy. , 1996, Archives of neurology.

[22]  Manuel Romero-Gómez,et al.  Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy , 2001, American Journal of Gastroenterology.

[23]  M. Bayliss Methods in outcomes research in hepatology: definitions and domains of quality of life. , 1999, Hepatology.

[24]  J E Ware,et al.  Methods for testing data quality, scaling assumptions, and reliability: the IQOLA Project approach. International Quality of Life Assessment. , 1998, Journal of clinical epidemiology.

[25]  Ross D Crosby,et al.  Defining clinically meaningful change in health-related quality of life. , 2003, Journal of clinical epidemiology.

[26]  R. Dhiman,et al.  Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis , 2001, Journal of gastroenterology and hepatology.

[27]  G. Guyatt,et al.  Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease , 1999, Gut.

[28]  N. Gitlin,et al.  The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulant, non-shunted patients with cirrhosis. , 1986, Journal of hepatology.

[29]  N. Gitlin Subclinical portal-systemic encephalopathy. , 1988, The American journal of gastroenterology.

[30]  S W Schalm,et al.  Subclinical Hepatic Encephalopathy , 1996, Seminars in liver disease.