Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
Department of Health Management, Tianjin Hospital, Tianjin, People's Republic of China.
Clin Interv Aging. 2024 Mar 21;19:551-560. doi: 10.2147/CIA.S444842. eCollection 2024.
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.
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.
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.
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.
欧洲五维健康量表（EQ-5D）在测量健康相关生活质量（HRQoL）方面的效用已得到验证；然而，在肝硬化方面，其预测性能仍存在知识空白。我们旨在确定风险分层的最佳阈值以及与较差结果相关的 EQ-5D 明显域。
使用 X-tile 项目获得阈值，考虑 1 年全因死亡率或再入院的复合结局。进行限制立方样条（RCS）以检验 EQ-5D 效用值与主要结局之间的非线性关系。构建了六个包含 EQ-5D 效用值和五个域中的每一个的多变量 Cox 回归模型。
设置/参与者：总共招募了 420 名肝硬化患者。
研究人群的中位效用值为 0.77，59.8%的患者报告至少有一个 EQ-5D 域受损。RCS 表明效用值与复合不良结局之间存在线性关系。X-tile 确定了一个效用值 0.59，根据该值将人群分为高风险和低风险组。肝硬化和 HRQoL 恶化（效用值≤0.59）的住院患者死亡或再入院的风险更高（调整后的 HR：2.18，P<0.001）。此外，行动能力和日常活动是与复合不良结局最相关的明显域。
效用值≤0.59可识别出 HRQoL 受损且具有较高死亡率/再入院风险的肝硬化住院患者。通过应用纵向测量并持续监测效用值来逆转降低的 HRQoL 是诱人的，而干预措施似乎主要集中在提高行动能力和日常活动上。
