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

Authors


  • The members and institutions participating in the Acute Liver Failure Study Group are listed in the Supporting Information.

  • Amol S. Rangnekar has no financial conflicts of interest. Robert J. Fontana has served as a consultant to Bristol-Meyers Squibb, Vertex Pharmaceuticals, Tibotec, Merck, GlaxoSmithKline, and Medtronic in the past year.

  • The authors gratefully acknowledge the support provided by members of the Acute Liver Failure Study Group. This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (DK U-01-58369). Additional funding was provided by the Tips Fund of the Northwestern Medical Foundation and the Jeanne Roberts and Rollin and Mary Ella King Funds of the Southwestern Medical Foundation. Additionally, Amol S. Rangnekar was supported by the National Institute of Diabetes and Digestive and Kidney Diseases through a Training Grant in Gastrointestinal Epidemiology (T32 DK62708-01) and by the Michigan Institute for Clinical and Health Research through a Clinical and Translational Science Award.

  • Amol S. Rangnekar contributed to the study concept, the analysis and interpretation, and the manuscript drafting and finalization. Caitlyn Ellerbe contributed to the manuscript drafting and finalization and the statistical analyses and their interpretation. Valerie Durkalski contributed to the study concept, the manuscript drafting and finalization, and the statistical analyses and their interpretation. Brendan McGuire contributed to the manuscript review and finalization. William M. Lee contributed to the manuscript drafting and finalization and provided overall supervision. Robert J. Fontana contributed to the study concept and design, the data acquisition, the analysis and interpretation, and the manuscript drafting and finalization and provided overall supervision.

Address reprint requests to Robert J. Fontana, M.D., Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, 3912 Taubman Center, Ann Arbor, MI 48109-0362. Telephone: 734-936-4780; FAX: 734-936-7392; E-mail: rfontana@med.umich.edu

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. Liver Transpl 19:991–1000, 2013. © 2013 AASLD.

Ancillary