Problematic alcohol use and its impact on liver disease quality of life in a multicenter study of patients with cirrhosis

Abstract

Background: Management of cirrhosis is challenging and has been complicated by the COVID-19 pandemic due to decreased access to care, increased psychological distress, and alcohol misuse. Recently, The National Institute on Alcohol Abuse and Alcoholism has broadened the definition of recovery from alcohol use disorder to include quality of life (QoL) as an indicator of recovery. This study examined the associations of alcohol-associated cirrhosis etiology and problematic drinking with liver disease QoL (LDQoL).

Methods: Patients with cirrhosis (N=329) were recruited from 3 sites (63% from 2 Veterans Affairs Health Care Systems and 37% from 1 safety net hospital) serving populations that are economically or socially marginalized. Cirrhosis etiology was ascertained by chart review of medical records. Problematic drinking was defined by ≥8 on the Alcohol Use Disorders Identification Test. Multivariable general linear modeling adjusting for age, sex, race/ethnicity, site, pandemic-related stress, and history of anxiety/depressive disorder were conducted. Sensitivity analyses further adjusted for indicators of liver disease severity.

Results: Participants were on average 64.6 years old, 17% female, 58% non-White, 44% with alcohol-associated cirrhosis, and 17% with problematic drinking. Problematic drinking was significantly associated with worse LDQoL scores in the overall scale and in the memory/concentration and health distress subscales. These associations remained significant after adjusting for indicators of liver disease severity, including Model for End-Stage Liver Disease-Sodium score and decompensated cirrhosis status.

Conclusions: Among patients with cirrhosis, problematic drinking was associated with worse LDQoL, especially in the domains of memory/concentration and health distress. Assessment and awareness of cognitive deficits and negative emotionality within the context of cirrhosis and problematic drinking may help clinicians provide better integrated care for this population.

Graphical abstract

FIGURE 1

Of the patients who met study inclusion criteria, 60% gave informed consent. Among those who gave informed consent, 96% completed the study interview.

FIGURE 2

Boxplots are used to show the dispersion of the data, and the mean is represented by the diamond symbol. In addition, the numerical values of means and standard deviations are presented for each pair of comparison. Cirrhosis etiology was not statistically associated with most LDQoL subscale scores (A-C, E-I), except for health distress (D), where patients with ALD etiology had lower LDQoL health distress subscale scores than patients with non-ALD etiology. *p<0.05. Abbreviations: ALD, alcohol-associated liver disease; LDQoL, liver disease quality of life.

FIGURE 3

Boxplots are used to show the dispersion of the data, and the mean is represented by the diamond symbol. In addition, the numerical values of means and standard deviations are presented for each pair of comparison. Problematic drinking was associated with lower LDQoL memory/concentration (C) and health distress (D) subscale scores, but was not statistically associated with the other LDQoL subscale scores (A-B, E-I). *p<0.05. Abbreviations: AUDIT, Alcohol Use Disorders Identification Test; LDQoL, liver disease quality of life.