肝硬化住院患者中以 EuroQol Group 5 维度定义的生活质量与综合恶化结果之间的关系

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-03-21 DOI:10.2147/cia.s444842

Yangyang Hui, Han Wang, Gaoyue Guo, Wanting Yang, Xuqian Zhang, Jie Yang, Fang Yang, Xiaoyu Wang, Xiaofei Fan, Binxin Cui, Xin Chen, Huanli Jiao, Chao Sun

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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. Results: 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. Conclusion: A utility value ≤ 0.59 can identify cirrhotic inpatients exhibiting compromised HRQoL and mortality/readmission risk. 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引用次数: 0

摘要

目的：EQ-5D（EuroQol Group 5 Dimension）测量与健康相关的生活质量（HRQoL）的实用性已得到验证；但在肝硬化的预测性能方面仍存在知识空白。我们的目标是确定风险分层的最佳阈值以及 EQ-5D 中与较差结果相关的明显领域：考虑到 1 年全因死亡率或再入院的综合结果，我们使用 X-tile 项目来获得阈值。采用受限立方样条曲线（RCS）测试 EQ-5D 效用值与主要结果之间的非线性关系。建立了六个包含 EQ-5D 实用价值和五个领域的多变量 Cox 回归模型：共招募了 420 名肝硬化患者：研究人群效用值的中位数为 0.77，59.8% 的患者报告在 EQ-5D 的最小一个领域出现了损伤。RCS显示效用值与综合劣质结果之间存在线性关系。X-tile精确定位效用值为0.59，根据结果将人群分为高风险组和低风险组。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较高（调整后 HR：2.18，P < 0.001）。此外，行动能力和日常活动是与综合较差结果相关的最明显领域：结论：效用值≤0.59可识别出HRQoL受损的肝硬化住院患者以及死亡/入院风险。通过应用纵向测量和对效用值的持续监测来扭转HRQoL的下降是很有诱惑力的，而干预措施似乎主要集中在改善移动性和日常活动上：EQ-5D、肝硬化、死亡率、再入院、残疾调整生命年

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Association Between Quality of Life Defined by EuroQol Group 5 Dimension and Composite Inferior Outcome Among Inpatients with Cirrhosis

Purpose: 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.
Patients and Methods: 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.
Results: 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.
Conclusion: 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.

Keywords: EQ-5D, liver cirrhosis, mortality, readmission, disability-adjusted life year

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.