Assessment of health-related quality of life and its contributing factors using the WHOQOL-BREF questionnaire in patients with chronic liver disease

Manjacheri Kuppadakath Sagara Vineesha Gangadharan Ranjith Sristhi Bipin Shaji Adithi Kellarai Juno Jerold Joel   

Open Access   

Published:  Feb 08, 2023

DOI: 10.7324/JAPS.2023.120282

Chronic liver disease (CLD) is a serious condition characterized by a progressive decline in liver functions, which leads to impaired quality of life (QOL). A prospective cross-sectional study was conducted with 165 patients to identify the health-related QOL in CLD, for 6 months. The QOL of CLD patients was assessed using the World Health Organization quality of life-BREF questionnaire and the severity of the disease was assessed using Child-Pugh Model for End-Stage Liver Disease (MELD) score. The incidence of CLD was found to be high in males (89.09%). While assessing, the overall QOL was identified as 50.96 ± 15.77. The highest score was observed in the social relationships domain (58.33 ± 19.34) followed by environment (54.74 ± 16.74), psychological (46.70 ± 19.81), and physical health (44.08 ± 18.64). The socio-demographic factors associated with QOL include body mass index, education, alcohol consumption, smoking, and tobacco. In the Child-Pugh MELD Score, the QOL was higher in class A (Good hepatic function) with a MELD score of 6–9 (1.9% mortality), the mean score being 60 ± 21 in contrast with the other classes. From the study, it is evident that CLD has a significant impact on the QOL. Patient-centric collaborative care, including physicians, nurses, pharmacists, and other health care providers are essential to improve the QOL.

Keyword:     Child-Pugh score chronic liver disease factors health-related quality of life MELD score WHOQOL-BREF


Sagara MK, Gangadharan V, Sristhi R, Shaji B, Kellarai A, Joel JJ. Assessment of health-related quality of life and its contributing factors using the WHOQOL-BREF questionnaire in patients with chronic liver disease. J Appl Pharm Sci, 2023.

Copyright: © The Author(s). This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

HTML Full Text


Adhikari S. Health related quality of life of patient with chronic liver disease in a tertiary hospital, Kathmandu. IJHSR, 2018; 8(10):178-88.

Afendy A, Kallman JP, Stepanova M, Younoszai Z, Aquino RD, Bianchi G, Marchesini G, Younossi ZM. Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther, 2009; 30(5):469-76.

Angermayr B, Cejna M, Karnel F, Gschwantler M, Koenig F, Pidlich J, Mendel H, Pichler L, Wichlas M, Kreil A, Schimid M, Ferlitsch A, Lipinski E, Brunner H, Lammer J, Ferenci P, Gangl A, Peck-Radosavljevic M. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut, 2003; 52(6):879-85.

Bhattarai S, Gyawali M, Dewan KR, Shrestha G. Demographic and clinical profile in patients with liver cirrhosis in a tertiary care hospital in central Nepal. JNMA J Nepal Med Assoc, 2017; 56(1):401-6.

Chang Y, Jung HS, Cho J, Zhang Y, Yun KE, Lazo M, Pastor- Barriuso R, Ahn J, Kim CW, Rampal S, Cainzos-Achirica M, Zhao D, Chung EC, Shin H, Guallar E, Ryu S. Metabolically healthy obesity and the development of nonalcoholic fatty liver disease. Am J Gastroeneterol, 2016; 111(8):1133-40.

Cheemerla S, Balakrishna M. Global epidemiology of chronic liver disease. Clin Liver Dis, 2021; 17(5):365-70.

Cortesi PA, Conti S, Scalone L, Jaffe A, Ciaccio A, Okolicsanyi S, Rota M, Fabris L, Colledan M, Fagiuoli S, Belli LS, Cesana G, Strazzabosco M, Mantovani LG. Health related quality of life in chronic liver diseases. Liver Int, 2020; 40(11):2630-42.

Durand F, Valla D. Assessment of the prognosis of cirrhosis: child-pugh versusMELD. J Hepatol, 2005; 42(1):S100-7.

Hussain KB, Fontana RJ, Moyer CA, Su GL, Sneed-pee N, Lok AS. Comorbidillness is an important determinant of health-related quality of life in patients with chronic hepatitis C. Am J Gastroenterol, 2001; 96(9):2737-44.

Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology, 2001; 33(2):464-70.

Kim HJ, Chu H, Lee S. Factors influencing on health-related quality of life in South Korean with chronic liver disease. Health Qual Life Outcomes, 2018; 16(1):1-8.

Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, Loguercio C, Apolone G, Niero M, Abbiati R, Italian Study Group for Quality of Life in Cirrhosis. Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology, 2001; 120(1):170-8.

Pradhan RR, Bhandari BK, Pathak R, Poudyal S, Anees S, Sharma S, Khadga P. The assessment of health-related quality of life in patients with chronic liver disease: a single-center study. Cureus, 2020; 12(9):1-10.

Ray I, Dutta D, Basu P, De BK. Quality of life assessment of patients with chronic liver disease in eastern India using a Bengali translation chronic liver disease questionnaire. Indian J Gastroenterol, 2010; 29(5):187-95.

Salama ZA, Darweesh SK, Shehab HM, Abd-Elhameed MA. Etiology and prevalence of fatigue in chronic liver disease: clinical view. Egypt J Intern Med, 2016; 28(2):78-85.

Salehitali S, Nooriyan K, Hafizi M, Dehkordi AK. Quality of life and its effectivefactors in tuberculosis patients receiving directly observed treatment short-course (DOTS). J Clin Tuberc Other Mycobact Dis, 2019; 15:100.

Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, Poustchi H. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet Gastroenterol Hepatol, 2020; 5:245-66.

Sharma A, Nagalli S. Chronic liver disease [book on the internet]. StatPearls Publishing, Treasure Island, FL, 2021. Available via https://www.

Sharma R, Yadav R, Sharma M, Saini V, Koushal V. Quality of life of multi drug resistant tuberculosis patient: a study of North India. Acta Medica Iranica, 2014; 52(6):448-53.

Shetty K, Rybicki L, Carey WD. The child-pugh classification as a prognostic indicator for survival in primary sclerosing cholangitis. Hepatology, 1997; 25(5):1049-53.

Skevington SM, Tucker C. Designing response scales for cross-cultural use in health care: data from the development of the UK WHOQOL. Br J Med Psychol, 1999; 72(1):51-61.

Sobhonslidsuk A, Silpakit C, Kongsakon R, Satitpornkul P, Sripetch C, Khanthavit A. Factors influencing health-related quality of life in chronic liver disease. World J Gastroenterol, 2006; 12(48):7786.

Stine JG, Stukenborg GJ, Wang J, Adkins A, Niccum B, Zimmet A, Argo CK. Liver transplant candidates have impaired quality of life across health domainsas assessed by computerized testing. Ann Hepatol, 2020; 19(1):62-8.

Article Metrics

2 Absract views 2 PDF Downloads 4 Total views

   Abstract      Pdf Download

Related Search

By author names

Citiaion Alert By Google Scholar

Name Required
Email Required Invalid Email Address

Comment required