Author information
1 Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Annandale, Virginia, USA.
2 Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
3 Center for Outcomes Research in Liver Disease, Washington, DC, USA.
4 Texas Liver Institute, University of Texas Health San Antonio, Texas, USA.
5 University of Pennsylvania, Philadelphia, Pennsylvania, USA.
6 The Chinese University of Hong Kong, Hong Kong.
7 Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.
8 Duke Clinical Research Institute, Durham, North Carolina, USA.
9 NYU Medical Center, New York, New York, USA.
10 Gilead Sciences, Foster City, California, USA.
Abstract
INTRODUCTION:
Although there is substantial evidence suggesting poor health-related quality of life (HRQL) in patients with chronic hepatitis C (CHC), similar data in nonalcoholic steatohepatitis (NASH) have not been fully assessed. The aim is to compare HRQL scores in patients with CHC to those with NASH.
METHODS:
Matched patients with advanced fibrosis (bridging fibrosis and compensated cirrhosis) due to CHC and NASH completed Short Form-36 (SF-36) questionnaire, Chronic Liver Disease Questionnaire (CLDQ), and Work Productivity and Activity Instrument questionnaire.
RESULTS:
We included 1,338 patients with NASH with advanced fibrosis (mean age 57.2 years, 47% men, 55% cirrhosis) and 1,338 matched patients with CHC. Patients with CHC and NASH had similar rates of employment and psychiatric disorders (P > 0.05). As expected, patients with NASH had higher body mass index (mean 33.7 vs 27.6) and more type 2 diabetes (74% vs 16%) (all P < 0.01). Patients with NASH had significantly lower HRQL scores related to physical health: Physical Functioning, Bodily Pain, General Health, Vitality, Physical Summary of SF-36, and Fatigue of CLDQ (P < 0.02). By contrast, patients with CHC had a lower Mental Health score of SF-36 and Emotional score of CLDQ and reported greater impairment in daily activities as measured by the Work Productivity and Activity Instrument questionnaire (P < 0.002). In multivariate analysis, after adjustment for demographic parameters, cirrhosis, and history of psychiatric disorders, having NASH was associated with lower physical HRQL scores and higher mental health-related scores (P < 0.05).
DISCUSSION:
Patients with NASH and advanced fibrosis have more impairment of their physical health-related scores than patients with CHC with advanced fibrosis. These data should dispel the misconception that NASH is an asymptomatic disease with little negative impact on patients' well-being.