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Association Between Quality of Life Defined by EuroQol Group 5 Dimension and Composite Inferior Outcome Among Inpatients with Cirrhosis
Clinical Interventions in Aging ( IF 3.6 ) 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
Clinical Interventions in Aging ( IF 3.6 ) 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
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
中文翻译：
EuroQol Group 5 Dimension 定义的生活质量与肝硬化住院患者综合较差结果之间的关联
目的：测量健康相关生活质量 (HRQoL) 的 EuroQol Group 5 Dimension (EQ-5D) 的实用性已得到验证；然而，对于肝硬化的预测性能仍然存在知识差距。我们的目的是确定风险分层的最佳阈值以及 EQ-5D 中与不良结果相关的显着域。
患者和方法： X-tile 项目用于获取阈值，考虑 1 年全因死亡率或再入院的综合结果。进行限制三次样条 (RCS) 来测试 EQ-5D 效用值和主要结果之间的非线性关系。构建了包含 EQ-5D 效用值和五个域中每一个域的六个多元 Cox 回归模型。
地点/参与者：总共招募了 420 名肝硬化患者。
结果：研究人群的中位效用值为 0.77，59.8% 的人报告称至少有一个 EQ-5D 结构域存在缺陷。 RCS表明效用值和综合较差结果之间存在线性关系。 X-tile 根据结果将人群分为高风险组和低风险组，确定效用值为 0.59。肝硬化住院患者和 HRQoL 恶化（效用值 ≤ 0.59）的死亡或再入院风险较高（调整后 HR：2.18，P < 0.001）。此外，活动能力和日常活动是与综合较差结果相关的最明显的领域。
结论：效用值 ≤ 0.59 可以识别表现出 HRQoL 受损和死亡/再入院风险的肝硬化住院患者。通过应用纵向测量和持续监测效用价值来扭转 HRQoL 下降的趋势很诱人，而干预措施似乎主要集中在改善流动性和日常活动上。
关键词： EQ-5D，肝硬化，死亡率，再入院，伤残调整生命年
更新日期：2024-03-21
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
中文翻译：
EuroQol Group 5 Dimension 定义的生活质量与肝硬化住院患者综合较差结果之间的关联
目的：测量健康相关生活质量 (HRQoL) 的 EuroQol Group 5 Dimension (EQ-5D) 的实用性已得到验证；然而，对于肝硬化的预测性能仍然存在知识差距。我们的目的是确定风险分层的最佳阈值以及 EQ-5D 中与不良结果相关的显着域。
患者和方法： X-tile 项目用于获取阈值，考虑 1 年全因死亡率或再入院的综合结果。进行限制三次样条 (RCS) 来测试 EQ-5D 效用值和主要结果之间的非线性关系。构建了包含 EQ-5D 效用值和五个域中每一个域的六个多元 Cox 回归模型。
地点/参与者：总共招募了 420 名肝硬化患者。
结果：研究人群的中位效用值为 0.77，59.8% 的人报告称至少有一个 EQ-5D 结构域存在缺陷。 RCS表明效用值和综合较差结果之间存在线性关系。 X-tile 根据结果将人群分为高风险组和低风险组，确定效用值为 0.59。肝硬化住院患者和 HRQoL 恶化（效用值 ≤ 0.59）的死亡或再入院风险较高（调整后 HR：2.18，P < 0.001）。此外，活动能力和日常活动是与综合较差结果相关的最明显的领域。
结论：效用值 ≤ 0.59 可以识别表现出 HRQoL 受损和死亡/再入院风险的肝硬化住院患者。通过应用纵向测量和持续监测效用价值来扭转 HRQoL 下降的趋势很诱人，而干预措施似乎主要集中在改善流动性和日常活动上。
关键词： EQ-5D，肝硬化，死亡率，再入院，伤残调整生命年
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