Health-related quality of life in autoimmune hepatitis

Table 1 Overview of the studies assessing aspects of health-related quality of life in autoimmune hepatitis

Ref.	Country	Population (n)	Biochemical remission (%)	Cirrhosis (%)	Questionnaire	Factors/results
van der Plas et al[13], 2007	The Netherlands	AIH (142), other liver diseases (776)	-	-	SF-36, MFI-20, LDSI	HRQoL impairment; Association with: Fatigue
Afendy et al[8], 2009	United States, Italy	AIH (13), other chronic liver diseases (1090)	-	84.61	SF-36	HRQoL impairment; Negative correlation: Age (every scale), female gender (primary predictor of mental health), cirrhosis (every scale, primary predictor of physical health)
Schramm et al[12], 2014	Germany	AIH (103)	77	27	SF-12, PHQ-9, GAD-7	HRQoL impairment (total mental score/mental well-being); Association with: depression and anxiety (positive correlation with female gender, corticosteroid use, and concerns about progression of the liver disease)
Takahashi et al[11], 2018	Japan	AIH (265), chronic hepatitis C (88)	-	10.6	CLDQ, SF-36	HRQoL impairment; Negative correlation: Age, cirrhosis, comorbid diseases, corticosteroid use (worry domain), disease duration, AST; Positive correlation: platelet count
Wong et al[14], 2018	United Kingdom	AIH (990)	56	33	EQ-5D-5L, FIS, CFQ, HADS	HRQoL impairment; Positive correlation: Biochemical remission; Negative correlation: overlap syndromes, corticosteroid use, and calcineurin inhibitor use
Janik et al[15], 2019	Poland	AIH (140)	-	55	SF-36, MFIS, PHQ-9, STAI	HRQoL impairment (every scale, except role emotional2); Negative correlation: Female gender, depression, trend toward better HRQoL (physical health) with budesonide vs prednisone; Association with: Anxiety, depression, and fatigue
Dirks et al[9], 2019	Germany	AIH (27), AIH/PBC (8), other liver diseases (97)	-	0	SF-36, FIS, HADS	HRQoL impairment; Association with: Anxiety, depression, and fatigue
Castellanos-Fernández et al[7], 2021	Cuba	AIH (22), overlap syndrome of AIH and PBC (7), PBC (14), other liver diseases (500)	-	43.93	FACIT-F, WPAI:SHP, CLDQ	HRQoL impairment; Positive correlation: Male gender, exercising > 90 min/wk; Negative correlation: Fatigue, abdominal pain, anxiety, depression, and extrahepatic comorbidity (diabetes mellitus type 2, sleep apnea)
Cortesi et al[10], 2020	Italy	AIH (51), other chronic liver diseases (2911)	-	0	EQ-5D-3L	HRQoL impairment in AIH

¹Eight patients with Child-Pugh class A and three patients with Child-Pugh class C.

²Scale measures the impact of emotional problems on work and daily activities.

³Cirrhosis in patients with autoimmune liver diseases (n = 43). AIH: Autoimmune hepatitis; HRQoL: Health-related quality of life; PBC: Primary biliary cholangitis; AST: Aspartate aminotransferase; CFQ: Cognitive failure questionnaire; CLDQ: Chronic liver disease questionnaire; ECR: Experiences in close relationship scale; EQ-5D-5L/3L: European quality of life 5-dimension 5-level/3-level; FACIT-F: Functional assessment of chronic illness therapy-fatigue; FIS: Fatigue impact scale; GAD-7: Generalized anxiety disorder screener; HADS: Hospital anxiety depression scale; LDSI: Liver disease symptom index 2.0; MFI-20: Multidimensional fatigue index-20; PHQ-9: Patient health questionnaire; SF-12: Short-form 12; SF-36: Short-form 36; STAI: State-trait anxiety inventory; WPAI:SHP: Work productivity and activity-specific health problem.

Table 2 Overview of the questionnaires assessing aspects of health-related quality of life in autoimmune hepatitis

Questionnaire	Main function	Domains	Items, total score
CFQ[41]	Cognition	Memory, attention, concentration, forgetfulness, word-finding abilities, and confusion	25 items scored 0-4, total score 0-100
CLDQ[42]	Generic HRQoL	Abdominal symptoms, fatigue, systemic symptoms, activity, emotions, and worry	29 items scored 1-7, total score 29-203
ECR[43]	Relationship styles	ECR-anxiety, and ECR-avoidance	12 items scored 1-7, each scale total score 7-42
EQ-5D-5L/EQ-5D-3L/EQ-VAS[44]	Generic HRQoL, EQ-VAS: participants’ self-rated health on a visual analog scale	Mobility, self-care, usual activities, pain/discomfort, and anxiety/depression	EQ-5D: 5 items scored 1-5, total score 5-25; EQ-VAS: total score 0-100
FACIT-F[45]	Fatigue	Physical well-being, social well-being, emotional well-being, functional well-being, and a fatigue-specific domain	40 items scored 0-4, total score 0-160
FIS[46]	Fatigue	Cognitive functioning, physical functioning, and psychosocial functioning	40 items scored 0-4, total score 0-160
GAD-7[47]	Anxiety	-	7 items scored 0-3, total score 0-21
HADS[48]	Anxiety, depression	Anxiety, and depression	14 items scored 0-3, total score 0-42
LDSI[49]	Liver disease symptoms	Itch, joint pain, abdominal pain, daytime sleepiness, worry about family situation, decreased appetite, depression, fear of complications, and jaundice (+ symptom hinderance)	18 items scored 1-5, total score 18-90
MFI-20[50]	Fatigue	General fatigue, physical fatigue, reduction in activity, reduction in motivation, and mental fatigue	20 items scored 1-5, each domain total score 4-20
MFIS[46,51]	Fatigue	Physical, cognitive, and psychosocial functioning	21 items scored 0-4, total score 0-84
PHQ-9[52]	Depression	Anhedonia, feeling down, sleep, feeling tired, appetite, feeling bad about self, concentration, activity, and suicidality	9 items scored 0-3, total score 0-27
SF-12[53]	Generic HRQoL	Physical functioning, role limitations due to physical problems, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health	12 items scored 1-5, total score 0-100
SF-36[54]	Generic HRQoL	General health, physical and social functioning, bodily pain, role-physical, mental health, role-emotional, and vitality	36 items, total score 0-100
STAI[55]	Anxiety	State anxiety, and trait anxiety	40 items scored 1-4, total score 0-80
WPAI:SHP[56]	Impairment in daily activities and in work	Work productivity impairment, and activity impairment	6 items scored 0-10, total score -

Included in the table are the questionnaires that were employed in the reviewed studies. CFQ: Cognitive Failure Questionnaire; CLDQ: Chronic Liver Disease Questionnaire; ECR^: Experiences in Close Relationship Scale; EQ-5D-5L/EQ-5D-3L/EQ-VAS: European Quality of life 5-Dimension 5-Level/3-Level/EQ-visual analog scale; FACIT-F^: Functional Assessment of Chronic Illness Therapy-Fatigue; FIS: Fatigue Impact Scale; GAD-7: Generalized Anxiety Disorder Screener; HADS: Hospital Anxiety Depression Scale; LDSI: Liver Disease Symptom Index 2.0); MFI-20: Multidimensional Fatigue Index-20; MFIS: Modified Fatigue Impact Scale); PHQ-9: Patient Health Questionnaire; SF-12: Short-form 12; SF-36: Short-form 36; STAI: State-Trait Anxiety Inventory; WPAI:SHP: Work Productivity and Activity-Specific Health Problem).