Association Between Quality of Life Defined by EuroQol Group 5 Dimension and Composite Inferior Outcome Among Inpatients with Cirrhosis

Yangyang Hui,1,&ast; Han Wang,2,&ast; Gaoyue Guo,1,&ast; Wanting Yang,1 Xuqian Zhang,3 Jie Yang,1 Fang Yang,4 Xiaoyu Wang,1 Xiaofei Fan,1 Binxin Cui,5 Xin Chen,1 Huanli Jiao,2 Chao Sun1,5 1Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China; 2Department of Health Management, Tianjin Hospital, Tianjin, People’s Republic of China; 3Department of Gastroenterology and Hepatology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, People’s Republic of China; 4Department of Digestive System, Baodi Clinical College of Tianjin Medical University, Tianjin, People’s Republic of China; 5Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin Airport Economic Area, Tianjin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Huanli Jiao; Chao Sun, Tel +8613642060733 ; +8613820846027, Fax +86-022-27813550, Email jiaohuanli@163.com; chaosun@tmu.edu.cnPurpose: The utility of the EuroQol Group 5 Dimension (EQ-5D) measuring health-related quality of life (HRQoL) has been verified; however, knowledge gaps remain concerning predictive performance in cirrhosis. We aimed to identify the optimal threshold for risk stratification and the pronounced domain in the EQ-5D linked to inferior outcomes.Patients and Methods: The X-tile project was used to obtain a threshold, considering the composite outcome of 1-year all-cause mortality or readmission. A restricted cubic spline (RCS) was performed to test the non-linear relationship between the EQ-5D utility value and the primary outcome. Six multivariate Cox regression models incorporating EQ-5D utility value and each of the five domains were constructed.Setting/Participants: Totally, 420 patients with cirrhosis were recruited.Results: The median utility value of the study population was 0.77 and 59.8% reported impairment in minimal one EQ-5D domain. RCS indicated a linear relationship between the utility value and composite inferior outcome. X-tile pinpointed a utility value of 0.59 stratifying populations into high- and low-risk groups based on the outcome. Inpatients with cirrhosis and deteriorated HRQoL (utility value ≤ 0.59) were at higher risk of death or readmission (adjusted HR: 2.18, P < 0.001). Furthermore, mobility and usual activities were the most pronounced domains associated with composite inferior outcome.Conclusion: A utility value ≤ 0.59 can identify cirrhotic inpatients exhibiting compromised HRQoL and mortality/readmission risk. It is tempting to reverse the decreased HRQoL by applying longitudinal measurements and keeping surveillance on utility value, while interventions appear to mainly focus on improving mobility and usual activities.Keywords: EQ-5D, liver cirrhosis, mortality, readmission, disability-adjusted life year