Health-related quality of life worse in NAFLD patients compared to the general population


Papatheodoridi M, et al. Summary OS044. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).

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LONDON — Patients with non-alcoholic fatty liver had a worse health-related quality of life, regardless of stage of fibrosis, compared to the general population, according to research presented at the International Liver Congress.

“Health-related quality of life has been shown to be impaired in NAFLD patients and possibly associated with the severity of fibrosis, obesity or other metabolic comorbidities,” Margarita Papatheodoridi, MD, PhD, a postdoctoral researcher at University College of London’s Royal Free Hospital Institute for Liver and Digestive Health, said. “It is still uncertain whether quality of life is impaired in NAFLD patients without advanced fibrosis or cirrhosis versus the general population and whether these impairments are due to the presence of fibrosis or other liver co-morbidities.”

Compared to the general population, patients with NAFLD had lower EQ-5D-L scores:

In a prospective, multicenter study, 561 patients with NAFLD from four UK secondary care centers completed the EQ-5D-5L and Chronic Liver Disease Questionnaire (CLDQ) between 2016 and 2019 to assess quality of life. Papatheodoridi and colleagues also collected patient information on demographics and clinical history, liver stiffness, liver biopsy results, and history of cirrhosis.

Researchers used propensity score matching and reports from a general population subcohort study of people without alcohol abuse to compare health-related quality of life (HRQL). The primary endpoint was the assessment of HRQL in patients with NAFLD compared to the general population; secondary endpoints were the association of fibrosis severity and metabolic comorbidities with HRQL disorders.

According to the study results, 514 NAFLD patients had lower EQ-5D-5L index scores compared to 514 healthy controls with the same propensity match (0.762 ± 0.276 vs. 0.844 ± 0.2); this difference was also evident in a subgroup of NAFLD patients without advanced fibrosis compared to the general population (0.781 ± 0.276 vs. 0.845 ± 0.2). Compared to NAFLD patients without cirrhosis, patients with NAFLD and cirrhosis had lower EQ-5D-5L index, EQ visual analog scale (VAS), and CLDQ scores.

Researchers saw no difference between patients with nonalcoholic steatohepatitis regardless of advanced fibrosis, but associated liver stiffness with lower HRQL scores across the patient population and patients without cirrhosis.

Multivariate analysis further showed that the EQ-5D-5L index correlated negatively with type 2 diabetes, depression and osteoarthritis in the entire patient population as well as in patients without cirrhosis and EQ-VAS associated with age, gender, BMI, depression and osteoarthritis.

Lower CLDQ scores correlated with younger age, male gender, type 2 diabetes, ischemic heart disease, depression and osteoarthritis in all patients and lower CLDQ scores correlated with male gender, type 2 diabetes and depression in the subgroup of patients without cirrhosis.

“HRQL is comparable for NASH patients with and without advanced fibrosis and HRQL is independently associated with non-hepatic comorbidities but not with liver stiffness,” concluded Papatheodoridi. “Multidisciplinary management is required for all NAFLD patients, regardless of the severity of their disease.”

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