Quality of life is significantly impaired in long-term survivors of acute liver failure and particularly in acetaminophen-overdose patients

Abstract

Functional outcomes for long-term survivors of acute liver failure (ALF) are not well characterized. The aim of this prospective study was to determine health-related quality of life in long-term adult ALF survivors. Acute Liver Failure Study Group registry participants completed the Centers for Disease Control and Prevention Health-Related Quality of Life 14 and Short Form 36 (SF-36) questionnaires at 1- and/or 2-year follow-up study visits. Responses were compared among ALF subgroups and to those for available general US population controls. Among the 282 adult ALF patients, 125 had undergone liver transplantation (LT), whereas 157, including 95 acetaminophen overdose (APAP) patients and 62 non-APAP patients, were spontaneous survivors (SSs). APAP SS patients reported significantly lower general health scores and more days of impaired mental and physical health, activity limitations due to poor health, pain, depression, and anxiety in comparison with the other groups (P ≤ 0.001). There were no significant differences in coma grade or in the use of mechanical ventilation or intracranial pressure monitoring among the patient groups during their ALF hospitalization, but APAP SSs had significantly higher rates of psychiatric disease and substance abuse (P < 0.001). In comparison with the general US population, a greater proportion of the combined SS patients reported fair or poor health and ≥14 days of impaired physical/mental health and activity limitations due to poor health. In addition, a greater proportion of LT recipients reported ≥14 days of impaired physical/mental health. Similar results were observed with the SF-36 across the 3 ALF subgroups and in comparison with population controls. In conclusion, long-term adult survivors of ALF reported significantly lower quality of life scores than US population controls. Furthermore, APAP SS patients reported the lowest quality of life scores, possibly because of higher rates of premorbid psychiatric and substance abuse disorders.

Conflict of interest statement

Disclosures: Dr. Rangnekar has no financial conflicts of interest. Dr. Fontana has served as a consultant to Bristol-Meyers Squibb, Vertex Pharmaceuticals, Tibotec, Merck, GlaxoSmithkline and Medtronic in the past year.

© 2013 American Association for the Study of Liver Diseases.

Figures

Figure 1

Figure 2

CDC HRQOL Healthy Days Core Module questions in 156 spontaneous survivors (SS) and 123 liver transplant (LT) recipients stratified by gender. Overall, female SS had significantly poorer HRQOL indices compared to the general population while the scores in male SS were only significantly different in Days of activity limitations. The male and female LT recipient scores were similar to the general US population. (SS; N=41 males and N=115 females) (LT; N=43 males and N=80 females). * p ≤0.001 when compared to the U.S. general population.

Figure 3

CDC HRQOL Healthy Days Core Module questions in 156 spontaneous survivors (SS) and 123 liver transplant (LT) recipients stratified by age. The HRQOL scores were significantly lower in the SS patients in most age groupings while the LT recipients were generally similar to age matched population controls. (SS; Age 18–24 N=29, 25–34 N=37, 35–44 N=36, 45–54 N=27, 55–64 N=19) (LT; Age 18–24 N=14, 25–34 N=26, 35–44 N=31, 45–54 N=30, 55–64 N=18) * p ≤0.001 when compared to the U.S. general population.

Figure 4

a. SF-36 scores in 95 APAP SS, 62 non-APAP SS, and 124 liver transplant recipients. SF-36 Domains: (PF) Physical functioning scale, (RP) Physical health problems scale, (BP) SF-36 Pain Scale, (GH) SF-36 General Health Perceptions Scale, (VT) Energy/fatigue scale, (SF) Social functioning scale, (RE) Emotional Health problems scale, (MH) Emotional well-being scale; ¶ represents overall statistical significance at alpha ≤0.001 comparing SS Non-APAP, SS APAP, LT. b. SF-36 Component Scores: (PCS) Physical, (MCS) Mental; * represents statistical significance at alpha ≤0.001 when compared to the U.S. general population, ¶ represents overall statistical significance at alpha ≤0.001 comparing SS Non-APAP, SS APAP, LT.

Figure 4

a. SF-36 scores in 95 APAP SS, 62 non-APAP SS, and 124 liver transplant recipients. SF-36 Domains: (PF) Physical functioning scale, (RP) Physical health problems scale, (BP) SF-36 Pain Scale, (GH) SF-36 General Health Perceptions Scale, (VT) Energy/fatigue scale, (SF) Social functioning scale, (RE) Emotional Health problems scale, (MH) Emotional well-being scale; ¶ represents overall statistical significance at alpha ≤0.001 comparing SS Non-APAP, SS APAP, LT. b. SF-36 Component Scores: (PCS) Physical, (MCS) Mental; * represents statistical significance at alpha ≤0.001 when compared to the U.S. general population, ¶ represents overall statistical significance at alpha ≤0.001 comparing SS Non-APAP, SS APAP, LT.