Quality of life in patients with chronic liver disease.

Objective: Treatment of patients with liver disease has improved over the last decades, causing the diseases to become chronic. The focus of treatment is on long-term medical care. The impact of having a chronic liver disease on daily functioning can be big and a lot of patients report fatigue as a symptom of their disease. Quality of life of patients visiting Medisch Spectrum Twente in Enschede, a large regional hospital in the Netherlands, has not been evaluated. The aim of this study is to evaluate quality of life and fatigue and identify factors that influence quality of life and fatigue. This so we can increase our understanding of the impact chronic liver disease may have on patients, in order to try to improve medical care of our patients. Methods: Questionnaires were sent to 513 patients with a chronic liver disease, selected from hospital’s database. The questionnaire included socio-demographics, health characteristics and 2 questions about quality of sleep. Also the Medical Outcomes Survey Short Form-12, evaluating quality of life, and the Multidimensional fatigue inventory, evaluating fatigue, were included. Patients health characteristics were retrospectively collected from patients medical records. Patients were then divided into groups of diagnosis and stages of cirrhosis. Results: 320 out of 507 patients returned the questionnaire. Responders differ significantly from non-responders in age, gender, diagnosis and stage of cirrhosis. Of responders 34% have cirrhosis (44% compensated and 26% decompensated cirrhosis). Analysis of quality of life and fatigue showed no differences in mental quality of life and fatigue between liver diseases, but did show differences in physical quality of life. Patients with viral hepatitis and autoimmune/ cholestatic disease have better physical quality of life than patients with non-alcoholic steatohepatitis. Variables negatively influencing quality of life and fatigue by univariate analysis were presence of cirrhosis, ascites, splenomegaly, esophageal varices, trouble sleeping, trouble falling asleep, low education level, unemployment and birth country (people born in the Netherlands have better mental quality of life, less mental fatigue and worse physical quality of life). For mental quality of life these are also encephalopathy and higher MELD score and for physical quality of life age. Independent risk factors of low physical quality of life are unemployment, low education level, having ascites, being born in the Netherlands, trouble sleeping and increasing age. For mental quality of life these factors are having ascites, trouble sleeping, unemployment and being born outside the Netherlands. Conclusion: This study investigating quality of life and fatigue in patients with chronic liver disease visiting the outpatient department of MST Enschede had a response rate of 63%. Quality of life was reduced and fatigue increased compared to previous reports about normal Dutch controls, except physical quality of life of patients with viral hepatitis. Contribution of severity of disease on reducing quality of life is shown by health characteristics (including ascites) univariately and multivariately associated to worse quality of life. General factors influencing quality of life and fatigue are employment status, education level, birth country and quality of sleep. Given the differences between responders and non-responders it is unclear if our results are applicable to all patients with chronic liver disease visiting MST Enschede. Further research is required to identify additional factors influencing quality of life and fatigue and to investigate if interventions aimed at improving quality of sleep and extra guidance of unemployed patients or patients with a low education level actually improve quality of life.