Background

The impact of alcoholic hepatitis (AH) on health-related quality of life (HRQOL) remains inadequately described. We aimed to describe HRQOL in AH and heavy drinkers (HD), its associations with clinical variables and outcomes.

Methods

This is a post-hoc analysis of the TREAT001 study participants (NCT02172898). HRQOL was measured using Short Form Health Survey (SF-36). Mean SF-36 scores were compared in AH and HD with two sample t-test. Associations between clinical characteristics, 30-day mortality and SF-36 mental and physical component scores (MC, PC) were investigated with generalized linear and logistic multivariate regression models. Trends of MC and PC scores were analysed using one-way ANOVA.

Results

Those with AH (n=258) and HD (n=181) had similar demographics. AH cases had mean Model for End-stage Liver Disease score (MELD) of 23(7). AH cases had lower PC scores [37(10) vs. 48(11), p<0.001] but higher MC scores [37(13) vs. 32(13), p<0.001]. MC scores were independently associated with age, male gender and daily alcohol consumption; PC scores were independently associated with age, BMI, ALT, ALP, WBC and ascites. With each 5-point decrease in the baseline PC score, the adjusted odds of dying within 30 days increased by 26.7%(95% CI 1%–46%). Over time, HRQOL in AH improved(day 0-day 180 delta PC score: 4.5±1.7, p=0.008; delta MC score: 9.8±2.0, p<0.001). Those with MELD<15 by day 180 had greater increases in PC scores than those with MELD≥15 (delta PC score 7.1±1.8 vs. -0.7+2.3, p=0.009) while those abstinent by day 180 had greater increases in MC scores than those not abstinent (delta MC score 9.1±1.8 vs. 2.8±2.4, p=0.044).

Conclusions

HRQOL is poor in AH and HD in a domain specific pattern. Independent of MELD, poorer baseline HRQOL is associated with higher 30-day mortality. Over time, HRQOL improved with greater gains seen in those with improvements in MELD and abstinence.