Published online Feb 18, 2017. doi: 10.4254/wjh.v9.i5.263
Peer-review started: August 14, 2016
First decision: September 2, 2016
Revised: October 28, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 18, 2017
To verify how malnutrition is related to health-related quality of life (HRQL) impairment in patients with cirrhosis.
Data was retrospectively abstracted from medical records and obtained by direct interview. We included patients with cirrhosis from any etiology, evaluated at the Liver Clinic from Gastroenterology Department in a tertiary healthcare center, from June 2014 to June 2016. Child-Pugh score, data about complications, and demographic, clinical and anthropometric characteristics of patients were obtained. Nutritional status was evaluated by the Subjective Global Assessment (SGA). HRQL was evaluated through the Chronic Liver Disease Questionnaire. Patients were requested to assess their global HRQL with the following code: 0 = impairment of HRQL, when it was compared with other healthy subjects; 1 = good HRQL, if it was similar to the quality of life of other healthy subjects. To compare the primary outcome between malnourished and well-nourished groups, the χ2 test, Fisher’s exact test or Student’s t-test were used, based on the variable type. Associations between predictor variables and deterioration of HRQL were determined by calculating the hazard ratio and 95% confidence interval using Cox proportional hazards regression.
A total of 127 patients with cirrhosis were included, and the mean age was 54.1 ± 12.3 years-old. According to Child-Pugh scoring, 25 (19.7%) were classified as A (compensated), 76 (59.8%) as B, and 26 (20.5%) as C (B/C = decompensated). According to SGA, 58 (45.7%) patients were classified as well-nourished. Sixty-nine patients identified HRQL as good, and 76 patients (59.8%) perceived impairment of their HRQL. Multivariate analysis to determine associations between predictor variables and self-perception of an impairment of HRQL found strong association with malnutrition (P < 0.0001). The most important impaired characteristics in malnourished patients were: Presence of body pain, dyspnea on exertion with daily activities, decreased appetite, generalized weakness, trouble lifting or carrying heavy objects, and decreased level of energy (P < 0.0001).
Malnutrition is a key factor related to impairment of HRQL in patients with cirrhosis.
Core tip: Several factors, particularly the severity of disease, development of ascites, need for paracentesis and history of hospitalization for any cause, are factors that worsen the health-related quality of life (HRQL) of patients with cirrhosis. Noteworthy malnutrition is a very important factor which impacts negatively on HRQL of patients suffering cirrhosis; clinicians must recognize it promptly and search for strategies to avoid this preventable comorbidity.