Article

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

Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI.
Liver Transplantation (Impact Factor: 4.24). 09/2013; 19(9). DOI: 10.1002/lt.23688
Source: PubMed

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, 2013. © 2013 AASLD.

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    • "In the first of two recent studies, social problems post-transplant as a cause of death or graft failure including non-adherence to immunosuppression were nearly 10% higher in the paracetamol overdose cases than for other etiologies [50]. In the second study, the non-transplanted spontaneous survivors had the greatest decrease in quality of life with high rates of psychiatric disease and substance abuse raising further questions as to the appropriateness of ELT for this category of ALF [53]. The question of whether better medical care is altering the values of prognostic indices of long-established criteria used in transplant selection is a difficult one. "
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