Quality of Life in Liver Cirrhosis

  • E. Kalaitzakis
Reference work entry


Liver cirrhosis is a chronic condition imposing a considerable burden on patients, families, health care, and society. Assessment of health-related quality of life (QOL) is particularly important for these patients in view of the paucity of therapies substantially improving their survival except for liver transplantation. To date several investigators employing numerous generic and disease-specific QOL measurement instruments have reported poor QOL in these patients irrespective of the etiology of liver disease. Apart from the severity and complications of liver cirrhosis several disease-specific symptoms (such as pruritus, muscle cramps, sleep disturbance, sexual dysfunction, fatigue, and gastrointestinal symptoms) have been shown to be of importance in determining QOL in this patient group. Liver transplantation has been repeatedly shown to improve QOL. However, some of the few studies evaluating the impact of other medical interventions on QOL in cirrhotics have demonstrated that various treatment modalities may improve survival or decrease complication risk but they do not invariably improve patients’ QOL which stresses the need for rigorous selection of patients suitable for a specific type of treatment. Last, the value cirrhotic patients place on the state of their health differs from that assigned by physicians. Thus, in cost-utility analysis, which is based on quality-adjusted life years, utilities should be based on patient reports.


Liver Cirrhosis Chronic Liver Disease Hepatic Encephalopathy Primary Biliary Cirrhosis Transjugular Intrahepatic Portosystemic Shunt 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


Austin quality of life scale


Beck depression inventory


brief symptom inventory


compensated cirrhosis


chronic liver disease questionnaire


chronic liver disease quality of life questionnaire


decompensated cirrhosis


gastrointestinal symptom rating scale


hospital anxiety and depression index


liver disease quality of life instrument


liver disease symptom index


liver transplantation


model for end-stage liver disease


multidimensional fatigue index – 20


non-cirrhotic control patients


Nottingham health profile


psychological general well-being index


quality of life


36-item short form health survey


sickness impact profile


 transjugular intrahepatic portosystemic shunt


  1. Arguedas MR, DeLawrence TG, McGuire BM. (2003). Dig Dis Sci. 48: 1622–1626.PubMedCrossRefGoogle Scholar
  2. Bajaj JS, Hafeezullah M, Hoffmann RG, Saeian K. (2007). Am J Gastroenterol. 102: 1903–1909.PubMedCrossRefGoogle Scholar
  3. Bajaj JS, Hafeezullah M, Hoffmann RG, Varma RR, Franco J, Binion DG, Hammeke TA, Saeian K. (2008). Hepatology. 47: 596–604.PubMedCrossRefGoogle Scholar
  4. Belle SH, Porayko MK, Hoofnagle JH, Lake JR, Zetterman RK. (1997). Liver Transpl Surg. 3: 93–104.PubMedCrossRefGoogle Scholar
  5. Bianchi G, Loguercio C, Sgarbi D, Abbiati R, Brunetti N, De Simone T, Zoli M, Marchesini G. (2003). Dig Liver Dis. 35: 46–54.PubMedCrossRefGoogle Scholar
  6. Bianchi G, Marchesini G, Nicolino F, Graziani R, Sgarbi D, Loguercio C, Abbiati R, Zoli M. (2005). Dig Liver Dis. 37: 593–600.PubMedCrossRefGoogle Scholar
  7. Björnsson E, Simren M, Olsson R, Chapman RW. (2005). Eur J Gastroenterol Hepatol. 17: 351–357.PubMedCrossRefGoogle Scholar
  8. Bonkovsky HL, Snow KK, Malet PF, Back-Madruga C, Fontana RJ, Sterling RK, Kulig CC, Di Bisceglie AM, Morgan TR, Dienstag JL, Ghany MG, Gretch DR. (2007). J Hepatol. 46: 420–431.PubMedCrossRefGoogle Scholar
  9. Borgaonkar MR, Irvine EJ. (2000). Gut. 47: 444–454.PubMedCrossRefGoogle Scholar
  10. Campbell MS, Brensinger CM, Sanyal AJ, Gennings C, Wong F, Kowdley KV, McCashland T, Reddy KR. (2005). Hepatology. 42: 635–640.PubMedCrossRefGoogle Scholar
  11. Casanovas Taltavull T, Vallejo Blanxart G, Herdman M, Verge Monedero JM, Tremosa Llurba G, Rodriguez Farina E, Ramos Rubio E, Baliellas Comellas C, Figueras Felip J, Menchon Magrina JM, Casais Alvarez LA. (2003). Gastroenterol Hepatol. 26: 234–244.PubMedCrossRefGoogle Scholar
  12. Cordoba J, Cabrera J, Lataif L, Penev P, Zee P, Blei AT. (1998). Hepatology. 27: 339–345.PubMedCrossRefGoogle Scholar
  13. Cordoba J, Flavia M, Jacas C, Sauleda S, Esteban JI, Vargas V, Esteban R, Guardia J. (2003). J Hepatol. 39: 231–238.PubMedCrossRefGoogle Scholar
  14. Cornely CM, Schade RR, Van Thiel DH, Gavaler JS. (1984). Hepatology. 4: 1227–1230.PubMedCrossRefGoogle Scholar
  15. De Bona M, Ponton P, Ermani M, Iemmolo RM, Feltrin A, Boccagni P, Gerunda G, Naccarato R, Rupolo G, Burra P. (2000). J Hepatol. 33: 609–615.PubMedCrossRefGoogle Scholar
  16. Ferrer M, Cordoba J, Garin O, Olive G, Flavia M, Vargas V, Esteban R, Alonso J. (2006). Liver Transpl. 12: 95–104.PubMedCrossRefGoogle Scholar
  17. Goldblatt J, Taylor PJ, Lipman T, Prince MI, Baragiotta A, Bassendine MF, James OF, Jones DE. (2002). Gastroenterology. 122: 1235–1241.PubMedCrossRefGoogle Scholar
  18. Gralnek IM, Hays RD, Kilbourne A, Rosen HR, Keeffe EB, Artinian L, Kim S, Lazarovici D, Jensen DM, Busuttil RW, Martin P. (2000). Am J Gastroenterol. 95: 3552–3565.PubMedGoogle Scholar
  19. Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, Schalm SW. (1998). Hepatology. 28: 45–49.PubMedCrossRefGoogle Scholar
  20. Gross CR, Malinchoc M, Kim WR, Evans RW, Wiesner RH, Petz JL, Crippin JS, Klintmalm GB, Levy MF, Ricci P, Therneau TM, Dickson ER. (1999). Hepatology. 29: 356–364.PubMedCrossRefGoogle Scholar
  21. Gulberg V, Liss I, Bilzer M, Waggershauser T, Reiser M, Gerbes AL. (2002). Digestion. 66: 127–130.PubMedCrossRefGoogle Scholar
  22. Hauser W, Holtmann G, Grandt D. (2004a). Clin Gastroenterol Hepatol. 2: 157–163.PubMedCrossRefGoogle Scholar
  23. Hauser W, Schnur M, Steder-Neukamm U, Muthny FA, Grandt D. (2004b). Eur J Gastroenterol Hepatol. 16: 599–606.PubMedCrossRefGoogle Scholar
  24. Huet PM, Deslauriers J, Tran A, Faucher C, Charbonneau J. (2000). Am J Gastroenterol. 95: 760–767.PubMedCrossRefGoogle Scholar
  25. Kalaitzakis E, Björnsson E. (2007). Gastroenterology. 132: A475.CrossRefGoogle Scholar
  26. Kalaitzakis E, Simren M, Olsson R, Henfridsson P, Hugosson I, Bengtsson M, Bjornsson E. (2006). Scand J Gastroenterol. 41: 1464–1472.PubMedCrossRefGoogle Scholar
  27. Kanwal F, Hays RD, Kilbourne AM, Dulai GS, Gralnek IM. (2004). Am J Gastroenterol. 99: 1726–1732.PubMedCrossRefGoogle Scholar
  28. Karam V, Castaing D, Danet C, Delvart V, Gasquet I, Adam R, Azoulay D, Samuel D, Bismuth H. (2003). Liver Transpl. 9: 703–711.PubMedCrossRefGoogle Scholar
  29. Lee EH, Cheong JY, Cho SW, Hahm KB, Kim HY, Park JJ, Lee DH, Kim SK, Choi SR, Lee ST, Moon SM. (2008). J Gastroenterol Hepatol. 23: 231–238.PubMedCrossRefGoogle Scholar
  30. Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, Loguercio C, Apolone G, Niero M, Abbiati R. (2001). Gastroenterology. 120: 170–178.PubMedCrossRefGoogle Scholar
  31. Moore KA, Mc LJR, Burrows GD. (2000). Liver Transpl. 6: 633–642.PubMedCrossRefGoogle Scholar
  32. Norman K, Kirchner H, Lochs H, Pirlich M. (2006). World J Gastroenterol. 12: 3380–3385.PubMedGoogle Scholar
  33. Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R. (2007). Hepatology. 45: 549–559.PubMedCrossRefGoogle Scholar
  34. Rucci P, Taliani G, Cirrincione L, Alberti A, Bartolozzi D, Caporaso N, Colombo M, Coppola R, Chiaramonte M, Craxi A, De Sio I, Floreani AR, Gaeta GB, Persico M, Secchi G, Versace I, Mele A. (2005). Dig Liver Dis. 37: 850–860.PubMedCrossRefGoogle Scholar
  35. Saab S, Ibrahim AB, Shpaner A, Younossi ZM, Lee C, Durazo F, Han S, Esrason K, Wu V, Hiatt J, Farmer DG, Ghobrial RM, Holt C, Yersiz H, Goldstein LI, Tong MJ, Busuttil RW. (2005). Liver Transpl. 11: 218–223.PubMedCrossRefGoogle Scholar
  36. Schomerus H, Hamster W. (2001). Metab Brain Dis. 16: 37–41.PubMedCrossRefGoogle Scholar
  37. Sherlock S, Dooley J. (2002). Sherlock S, Dooley J (ed.) “Diseases of the liver and biliary system”. Blackwell Publishing, Milan, pp. 365–380.Google Scholar
  38. Singh N, Gayowski T, Wagener MM, Marino IR. (1997). Dig Dis Sci. 42: 1421–1427.PubMedCrossRefGoogle Scholar
  39. Sullivan M, Karlsson J, Taft C, Ware JE. (2002). “SF-36 Health Survey: Swedish Manual and Interpretation Guide, 2nd ed.” Sahlgrenska University Hospital, Gothenburg.Google Scholar
  40. Tarter RE, Switala J, Arria A, Plail J, Van Thiel D. (1991). Arch Intern Med. 151: 1521–1526.PubMedCrossRefGoogle Scholar
  41. Tarter RE, Switala J, Plail J, Havrilla J, Van Thiel DH. (1992). Arch Intern Med. 152: 2097–2101.PubMedCrossRefGoogle Scholar
  42. Toda K, Miwa Y, Kuriyama S, Fukushima H, Shiraki M, Murakami N, Shimazaki M, Ito Y, Nakamura T, Sugihara J, Tomita E, Nagata C, Suzuki K, Moriwaki H. (2005). J Gastroenterol. 40: 894–900.PubMedCrossRefGoogle Scholar
  43. Plas SM, van der Hansen BE, de Boer JB, Stijnen T, Passchier J, de Man RA, Schalm SW. (2003). BMC Gastroenterol. 3: 33.–1230X/1473/1433.
  44. Plas SM, van der Hansen BE, de Boer JB, Stijnen T, Passchier J, de Man RA, Schalm SW. (2004). Qual Life Res. 13: 1469–1481.PubMedCrossRefGoogle Scholar
  45. Wein C, Koch H, Popp B, Oehler G, Schauder P. (2004). Hepatology. 39: 739–745.PubMedCrossRefGoogle Scholar
  46. Wells CD, Murrill WB, Arguedas MR. (2004). Dig Dis Sci. 49: 453–458.PubMedCrossRefGoogle Scholar
  47. Younossi ZM, Boparai N, McCormick M, Price LL, Guyatt G. (2001a). Am J Gastroenterol. 96: 579–583.PubMedCrossRefGoogle Scholar
  48. Younossi ZM, Boparai N, Price LL, Kiwi ML, McCormick M, Guyatt G. (2001b). Am J Gastroenterol. 96: 2199–2205.PubMedCrossRefGoogle Scholar
  49. Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D. (1999). Gut. 45: 295–300.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • E. Kalaitzakis
    • 1
  1. 1.Section of Gastroenterology and Hepatology, Department of Internal MedicineSahlgrenska University HospitalGothenburgSweden

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