Acute liver failure, acetaminophen overdose patients displayed reduced quality of life
BOSTON — The health-related quality of life for long-term survivors of acute liver failure, particularly among acetaminophen overdose patients, was significantly lower than that of the US general population in research presented at The Liver Meeting.
Using the SF-36 and the newer CDC-14 health-related quality of life (HRQOL) instrument, researchers evaluated 277 acute liver failure (ALF) patients in the ALFSG registry for 1 year and 2 years of follow-up. Researchers examined response rates to questions across different ALF subgroups and compared them to those of controls from the general population.
Among the ALF cohort, 123 liver transplant patients (LT) were compared with 154 spontaneous survivors (SS) that included 94 patients whose ALF was attributed to acetaminophen overdose (APAP-SS) and 60 others whose ALF was related to other etiologies (non-APAP-SS). CDC-14 assessments were completed at a median of 708 days after hospitalization for ALF.
The APAP-SS cohort exhibited significantly lower general health (34% of cohort compared with 14% of LT patients and 30% for non-APAP-SS patients; P=.0001) and more days of impaired physical health (9.5 vs. 6.2 and 5.6, respectively; P=.012). APAP-SS patients reported more days of anxiety, pain and depression than LT and non-APAP-SS patients (P<.0001).
In comparing SS patients with the general population, researchers said the APAP and non-APAP arms (primarily women aged younger than 55 years) reported a greater proportion of fair/poor health (32% vs. 16%) and more than 14 days of impaired mental health (31% vs. 10%) and impaired physical health (28% v. 11%) (P<.001 for all). LT patients showed similarly higher proportions than the general population for experiencing more than 14 days of impaired mental (20% vs. 10%) and physical health (20% vs. 11%) (P<.001 for both).
“Patients who spontaneously survive [ALF] tend to have poorer physical and mental health that they self-report compared with patients who get transplanted for acute liver failure,” Amol S. Rangnekar, MD, transplant hepatology fellow at Columbia University, told Healio.com. “If you specifically look among spontaneous survivors who don’t get transplanted, most of the poor health is reported by those patients who develop acute liver failure due to acetaminophen overdose.”
Rangnekar said future research could focus on whether there is a difference “between those who get transplanted for acetaminophen and those who did not. That would be the next step. We didn’t have enough of those patients to look at.”
Disclosure: The researchers report numerous financial disclosures.
For more information:
Rangnekar AS. #1636: Quality of life is significantly impaired in long-term survivors of Acute Liver Failure (ALF) and particularly in Acetaminophen Overdose Patients. Presented at: The Liver Meeting 2012; Nov. 9-13, Boston.