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Abstract
Purpose
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.
Abbreviations
EQ-5D, EuroQol Group 5 Dimension; HRQoL, health-related quality of life; ACLF, acute-on-chronic liver failure; RCS, restricted cubic spline; DALY, disability-adjusted life year; MASLD, metabolic dysfunction-associated steatotic liver disease; PT-INR, prothrombin time-international normalized ratio; BMI, body mass index; ALP, alkaline phosphatase; CTP, Child-Turcotte-Pugh; MELD, Model for End-stage Liver Disease; HR, hazard ratio; CI, confidence interval.
Data Sharing Statement
The datasets generated and/or analyzed during this study are available from the corresponding author (Chao Sun) upon reasonable request.
Acknowledgments
We thank all nurses who participated in this study and Dr Kui Jiang for technical support. Yangyang Hui, Han Wang and Gaoyue Guo contributed equally to this work and share first authorship.
Disclosure
The authors declare that there is no conflict of interest.