Quality of life as an indicator of the effects of concomitant hypertensive disease on the state of health of patients with non-alcoholic fatty liver disease

Objective — to determine the effects of concomitant hypertension on the quality of life (QOL) of patients with non‑alcoholic fatty liver disease (NAFLD) using the Medical Outcomes Study Short Form (SF‑36) and The Chronic Liver Disease Questionnaire (CLDQ). Materials and methods. Examinations involved 115 patients with NAFLD at the stage of non‑alcoholic steatohepatitis. The patients were divided into two groups: the main group included 63 patients with NAFLD and hypertension (32 men and 31 women, the mean age 48.4 years) and comparison group consisted of 52 patients with NAFLD (25 men and 27 women, the mean age 48.3 years). The control group consisted of 20 practically healthy people (12 women and 8 men, the mean age 47.1 years). The NAFLD duration did not significantly differ between the groups of comorbid course (6.6 years (95 % confidence interval (CI) — 5.8; 7.3)) and isolated NAFLD (7.8 years (95 % CI 6.7; 8.8)) (p = 0.086). Hypertension duration was 8.4 years (95 % CI 7.3; 9.5). Assessments included body mass index calculation (BMI) and measurements of systolic (SBP) and diastolic (DBP) arterial pressure. The Medical Outcomes Study Short Form (SF‑36) and Chronic Liver Disease Questionnaire (CLDQ) were used to assess the QOL of NAFLD patients. Results. In comparison with the control group and regardless of the presence of concomitant pathology, the significant decrease in QOL scores of almost all SF‑36 scales was established in NAFLD patients. In NAFLD patients with hypertension, decrease in the QOL indicators was observed for all components of health, except for the results on the scale of physical functioning («PF»). Indicators of the total physical («PCS») and mental («MCS») health components were also significantly lower in the group with NAFLD and hypertension and amounted to 25.00 % (95 % CI 21.20; 29.60) and 44.00 % (95 % CI 42.23; 50.47) out of the maximum possible 100 %. There was a significant decrease in indicators for all domains of the CLDQ questionnaire in patients with NAFLD and hypertension compared to the isolated NAFLD and the control group. Significant inverse correlations were determined between the QOL indicators according to both questionnaires and the diseases duration, SBP, DBP levels and BMI. Conclusions. NAFLD is associated with significant deviant changes in patients’ quality of life indicators according to the SF‑36 and CLDQ questionnaires. The presence of concomitant hypertension, the duration of fatty changes in the liver, the experience of hypertension, the levels of SBP, DBP and BMI significantly worsen the QOL of patients with NAFLD. The quantitative variability of QOL components in patients with NAFLD and hypertension can negatively affect the course of the disease and reduce the effectiveness of therapeutic and rehabilitation measures.

Validation and Performance of Chronic Liver Disease Questionnaire (CLDQ-RO) in the Romanian Population

Background and Aims: Health-related quality of life is an essential part of managing chronically ill patients, including patients with chronic liver disease. Various methods are used to try to assess the quality of life ranging from generic to disease-specific questionnaires. Some of the results may reveal a novel connection to the disease‘s evolution, which is observed directly by the patient. This study aimed to validate and assess the chronic liver disease questionnaire (CLDQ-RO) performance in the Romanian population. Methods: A two-phase study was designed. The first phase consisted of linguistic validation of CLDQ-RO (translation and piloting), while in the second phase, the questionnaire was applied to patients with various chronic liver diseases. Statistical validation (reliability, structural, and construct validity) was performed using SPSS v20.0, and statistical significance was considered p<0.05. Results: The CLDQ-RO was applied to 231 patients with chronic liver disease (14.3% with chronic hepatitis, 35.5% with compensated cirrhosis, and 50.2% with decompensated cirrhosis). The questionnaire showed excellent overall reliability (Cronbach‘s alpha=0.93) and good structural and construct validity, with most of the items in CLDQ-RO fitting in the domains of the original version of the questionnaire. There was a significant decrease in the overall score of the CLDQ-RO with the progression of disease (p<0.001), indicating a substantial impact of the decompensation event on health-related quality of life. Regarding the type of decompensation, ascites accurately predicted a lower quality of life (p=0.004). Conclusions: The CLDQ-RO is a valid and disease-specific method for assessing patients‘ health-related quality of life with liver disease. Among the decompensation events, it seems that ascites seriously impacts the quality of life.

ASSESMENT OF FATIGUE IN PATIENTS WITH CHRONIC LIVER DISEASES

To determine the most sensitive questionnaire for the detection of fatigue in patients with chronic liver diseases, 61 patients with chronic liver diseases were inpatient treatment at the City Infectious Diseases Clinical were interviewed. And 72 relatively healthy responses were interviewed using Chronic Liver Disease Questionnaire, the Short Form-36, the Fatigue Assessment Scale. The study was conducted between November 2019 and March 2020. The severity of fatigue and declining quality of life was correlated with the presence of chronic liver diseases, excess body weight, and female sex. The Short Form-36 questionnaire showed greater sensitivity for assessing fatigue in people with chronic liver diseases compared to the Chronic Liver Disease Questionnaire. The Fatigue Assessment Scale didn't reveal reliable differences between the groups being compared.

Funcionalidade, força muscular respiratória e qualidade de vida em pacientes pré-transplante de fígado / Functionality, respiratory muscle strength and quality of life in patients before liver transplantation

Introdução: As doenças hepáticas causam alterações metabólicas, diminuição de massa e função muscular que prejudicam a funcionalidade e a qualidade de vida (QV). Objetivo: Comparar capacidade funcional, força muscular respiratória e QV de candidatos a transplante de fígado segundo etiologia da doença. Método: Estudo transversal com cirróticos em protocolo para transplante. Foram analisados a capacidade funcional pelo teste de caminhada de seis minutos (TC6), a QV pelo questionário Chronic Liver Disease Questionnaire (CLDQ) e a força muscular respiratória pela manovacuometria para obtenção da pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx). Os pacientes foram divididos em cinco grupos: cirrose por vírus B (VHB), vírus C (VHC), esteato-hepatite não alcoólica (NASH), álcool (ALD) e outros tipos de cirroses (OTC). Resultados: A comparação da distância do TC6 demonstrou que os pacientes do grupo NASH obtiveram distância predita significativamente maior (p=0,02) que o grupo OTC. Não houve diferença significativa (p>0,05) para força muscular respiratória entre os grupos. Na QV o grupo ALD apresentou escore significativamente menor (p=0,03) que o grupo VHB no domínio sintomas sistêmicos. Conclusão: Candidatos a transplante de fígado de etiologia NASH demonstraram pior capacidade funcional que os pacientes de outras etiologias de cirrose e os com cirrose por álcool demonstraram pior QV relacionada aos sintomas sistêmicos na comparação com os pacientes com cirrose por vírus B. Estes achados demonstram que esses pacientes podem apresentar pior prognóstico pós-transplante devido os comprometimentos prévios apresentados.Palavras Chave: Qualidade de vida, Músculos respiratórios, Transplante de fígado, Cirrose hepática, Teste de esforçoABSTRACTIntroduction: Liver diseases cause metabolic changes, decreased muscle mass and function that impair functionality and quality of life (QOL). Objective: To compare functional capacity, respiratory muscle strength and QoL of liver transplant candidates according to the disease etiology. Methods: Cross-sectional study with cirrhotics in a transplant protocol. The following were analyzed: functional capacity by the six-minute walk test (6MWT), QOL by the Chronic Liver Disease Questionnaire (CLDQ) and respiratory muscle strength by manovacuometry to obtain the maximum inspiratory pressure (PImax) and maximum expiratory pressure (MEP). The patients were divided into five groups: cirrhosis by virus B (HBV), virus C (HCV), non-alcoholic steatohepatitis (NASH), alcohol (ALD) and other types of cirrhosis (OTC). Results: The comparison of the 6MWT distance showed that patients in the NASH group had a significantly greater predicted distance (p=0.02) than the OTC group. There was no significant difference (p>0.05) for respiratory muscle strength between groups. In QOL, the ALD group had a significantly lower score (p=0.03) than the HBV group in the systemic symptoms domain. Conclusion: Liver transplant candidates of NASH etiology showed worse functional capacity than patients of other cirrhosis etiologies and patients with alcohol cirrhosis demonstrated worse QOL related to systemic symptoms in comparison with patients with cirrhosis by virus B. These findings demonstrate that these patients may have a worse post-transplant prognosis due to previous impairments.Keywords: Quality of life, Respiratory muscles, Liver transplantation, Liver cirrhosis, Exercise test