Relationship Between Pretransplantation Liver Status and Health-Related Quality of Life After Grafting: A Single-Center Prospective Study

Background

Severity of liver disease evaluated with Model for End-Stage Liver Disease (MELD)/Child-Pugh-Turcotte (CPT) score is of importance in liver transplantation (LTx) assessment. The Medical Outcomes Study Short Form (SF-36) is a widely used generic questionnaire of health-related quality of life (HRQoL). This study was a prospective analysis of the effect of pretransplantation liver status on HRQoL after the procedure.

Materials and Methods

One hundred and seven (62 male, 45 female, median age 52 years) consecutive patients were included. MELD/CPT score and diabetes status were evaluated during LTx assessment. Patients were divided into 3 groups depending on the period after LTx: 6 to 12 months (group I), 13 to 36 months (group II), and >37 months (group III). They also were divided into 2 groups depending on the age at LTx: group I (<50 years) and group II (>50 years). SF-36 was used in the assessment of HRQoL.

Results

Correlation between pretransplantation MELD/CPT score and HRQoL was only seen in the general health domain of the SF-36 in patients from group I (r = 0.64; P = .004 and r = 0.61; P = .02, respectively). Diabetes exerted a significant effect on the physical component summary (P = .02), again in group I. No significant correlation was observed between MELD/CPT score and the presence of diabetes in groups II and III. Regarding age at LTx, no significant correlation between MELD/CPT score and HRQoL was seen.

Conclusions

Liver status assessed with MELD and CPT scores before transplantation has a minor effect on HRQoL after LTx and exerts no significant effect in patients evaluated >12 months after LTx. Patients with diabetes seem to have worse quality of life early after surgery; however, diabetic and nondiabetic patients had comparable HRQoL scores later on after LTx.     

Validity of the Spanish version of the Chronic Liver Disease Questionnaire (CLDQ) as a standard outcome for quality of life assessment.

The Chronic Liver Disease Questionnaire (CLDQ) measures the impact on quality of life of chronic liver diseases, regardless of underlying etiology. The aim of this study was to develop a Spanish version of the CLDQ, and to assess its acceptability, reliability, validity, and sensitivity to change. The forward and back-translation method by bilingual translators, with expert panel and pilot testing on patients, was used for the adaptation. The final version was self-administered, together with the Short Form-36 Health Survey (SF-36), on 149 consecutive patients with chronic liver disease. Child-Turcotte-Pugh scores were evaluated by a physician. To assess reproducibility and responsiveness the CLDQ was readministered to a subsample of stable patients and to those who had received a liver transplant. Validity was evaluated via exploratory factor analysis, the CLDQ pattern across severity groups, and correlation coefficients with "itching" and SF-36 scores. Cronbach's alpha and Intraclass Correlation Coefficient for CLDQ global score were 0.93 and 0.90, respectively, demonstrating good reliability. Validity was supported by correlations of the CLDQ with SF-36 and "itching," and CLDQ severity gradient (global score means were 5.5, 5.2, 5.0, and 4.5 in patients with no cirrhosis, cirrhosis Child-Turcotte-Pugh A, B, and C, respectively; P = 0.012). Responsiveness was shown by a high CLDQ improvement in patients who had received liver transplant (mean change = -1.4; P < 0.001). In conclusion, the Spanish CLDQ is reliable, valid, responsive, and equivalent to the original. These findings support its use as a standard outcome for patients with chronic liver diseases within the whole severity range, from "no cirrhosis" to transplant recipients, both in Spanish and international studies.     

Proposal of a modified Child-Turcotte-Pugh scoring system and comparison with the model for end-stage liver disease for outcome prediction in patients with cirrhosis.

The model for end-stage liver disease (MELD) has a better predictive accuracy for survival than the Child-Turcotte-Pugh (CTP) system and has been the primary reference for organ allocation in liver transplantation. The CTP system, with a score range of 5-15, has a ceiling effect that may compromise its predictive power. In this study, we proposed a refined CTP scoring method and investigated its predictive ability. An additional point was given to patients with serum albumin < 2.3 g/dL, bilirubin > 8 mg/dL or prothrombin time prolongation > 11 seconds. The modified CTP system, containing class D, was compared to the MELD and original CTP system in 436 patients. There was a significant correlation between the MELD and modified CTP score (rho = 0.59, P< 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CTP system was 0.895 compared with 0.872 for MELD (P = 0.450) and 0.809 for original CTP system (P < 0.001) at 3 months; the area was 0.890, 0.837 and 0.756, respectively (P = 0.051 and < 0.001, respectively) at 6 months. The risk ratio per unit increase for the modified CTP score was 2.7 and 3.08 at 3 and 6 months respectively (P < 0.001). In conclusion, the modified CTP system can be proposed as an alternative prognostic model for cirrhotic patients. By extending the score range according to the influence of the laboratory-derived variables, the modified CTP system has a better performance than the original system and is as efficient as the MELD for outcome prediction.     

A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation.

The Model for End-Stage Liver Disease (MELD) score is now used for allocation in liver transplantation (LT) waiting lists, replacing the Child-Turcotte-Pugh (CTP) score. However, there is debate as whether it is superior to CTP score to predict mortality in patients with cirrhosis on the LT waiting list and after LT. We reviewed studies comparing the accuracy of MELD vs. CTP score in transplantation settings. We found that in studies of the LT waiting list (12,532 patients with cirrhosis), only 4 of 11 showed MELD to be superior to CTP in predicting short-term (3-month) mortality. In addition, 2 of 3 studies (n = 1,679) evaluating the changes in MELD score (DeltaMELD) showed that DeltaMELD had better prediction for mortality than the baseline MELD score. The impact of MELD on post-LT mortality was assessed in 15 studies (20,456 patients); only 6 (9,522 patients) evaluated the discriminative ability of MELD score using the concordance (c) statistic (the MELD score had always a c-statistic < 0.70). In 11 studies (19,311 patients), high MELD score indicated poor post-LT mortality for cutoff values of 24-40 points. In re-LT patients, 2 of 4 studies evaluated the discriminative ability of MELD score on post-LT mortality. Finally, several studies have shown that the predictive ability of MELD score increases by adding clinical variables (hepatic encephalopathy, ascites) or laboratory (sodium) parameters. On the basis of the current literature, MELD score does not perform better than the CTP score for patients with cirrhosis on the waiting list and cannot predict post-LT mortality.     

Can the model for end-stage liver disease be used to predict the prognosis in patients with Budd-Chiari syndrome?

The model for end-stage liver disease (MELD) is a widely accepted and objective scoring system for end-stage liver disease (ESLD) but has never been evaluated for Budd-Chiari syndrome (BCS). We investigated whether MELD can be used to predict survival in patients with BCS. Patients with BCS (n = 237) were obtained from a large international study. Patients with ESLD (n = 281) were used to compare the discriminative ability of MELD in BCS versus other chronic liver diseases. MELD and the Rotterdam BCS index, a recently developed prognostic index for BCS, were calculated with standard equations. Receiver operating characteristic curves and concordance statistics (c-statistics) were used to assess the models' ability to predict 1-year survival. The median MELD score was 12.5 (range = -7.4 to 43.4) for BCS and 11.3 (-3.0 to 49.5) for ESLD (P = 0.12). The c-statistic of MELD in BCS was 0.695 [95% confidence interval (CI) = 0.59-0.80], in contrast to 0.848 (95% CI = 0.80-0.90) in ESLD. Survival was significantly poorer in ESLD than in BCS (P < 0.001). The c-statistic of the Rotterdam BCS index was 0.760 (95% CI = 0.67-0.85). The correlation between MELD and the Rotterdam BCS index was 0.61, and most of the discrepancy existed in BCS patients with a high prevalence of ascites and encephalopathy and preserved liver function. The addition of ascites and encephalopathy to MELD improved the c-statistic to 0.751 (95% CI = 0.65-0.85). In conclusion, MELD showed a suboptimal discriminative ability to predict survival in BCS. This was explained by the highly variable degree of liver dysfunction and hence clinical outcome in BCS in contrast to ESLD.     

Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients

BACKGROUND: Cirrhotic patients who present for elective and emergent surgery pose a formidable challenge for the surgeon because of the high reported morbidity and mortality. The Child-Turcotte-Pugh (CTP) score previously has been used to evaluate preoperative severity of liver dysfunction and to predict postoperative outcome. Recently, a more objective scoring classification, the model for end-stage liver disease (MELD), has been shown to predict accurately the 3-month mortality for cirrhotic patients awaiting transplantation. We sought to compare the CTP and MELD scores in predicting outcomes in cirrhotic patients undergoing surgical procedures requiring general anesthesia. METHODS: During the study period, 40 patients with a history of cirrhosis who required elective (E) or emergent (EM) surgical procedures under general anesthesia were reviewed (E = 24, EM = 16). The preoperative CTP and MELD scores were calculated and patient short- (30-day) and long-term (3-month) outcomes were recorded. RESULTS: There was a significant difference in the 1-month and 3-month mortality rates between the emergent and elective groups (EM group: 1 mo = 19%, 3 mo = 44%; E group: 1 mo = 17%, 3 mo = 21%, P <0.05). There was good correlation between the CP and MELD scores, which was greater in the emergent groups as compared with the elective group (EM: r = 0.81; E: r = 0.65). CONCLUSIONS: Our study shows that cirrhotic patients who undergo surgery under general anesthesia have an extremely high 1- and 3-month mortality rate that progressively increases with severity of preoperative liver dysfunction. Additionally, the MELD score correlates well with the CTP score, providing a more objective predictor of postoperative mortality in cirrhotic patients undergoing surgery.     

Prognosis after liver transplantation predicted by preoperative MELD score

The model for end-stage liver disease (MELD) has been an excellent predictor of 3-month mortality among cirrhotic patients awaiting orthotopic liver transplantation (OLT). The aim of this study was to evaluate whether the preoperative MELD score predicts short-term prognosis after OLT. We enrolled 98 adult liver transplant patients performed at our center from January 2001 to December 2002. In univariate analysis of risk factors for death within 3 and 6 months after liver transplantation, serum total bilirubin, creatinine, MELD score, hyponatremia with ascites, Child-Turcotte-Pugh (CTP) score were statistically significant parameters (P < .05). By logistic regression, none of the risk factors were subjected to multivariate analysis showed statistical significance. The odds ratios of the MELD score, hyponatremia with ascites, CTP score within 3 months were 0.997, 1.151, and 0.726 with 95% confidence intervals of [0.899, 1.105], [0.102, 12.959], and [0.389, 1.352], respectively. The odds ratio of MELD score, hyponatremia with ascites, CTP score within 6 months were 0.996, 0.914, and 0.764, with 95% confidence intervals of [0.901, 1.102], [0.089, 9.369], and [0.417, 1.401], respectively. Although MELD score has been a good predictor of short-term prognosis before OLT, MELD did not show an influence on the short-term prognosis after liver transplantation in this study.     

Organ quality and quality of life after liver transplantation

Not only is there a limited supply of organs for liver transplantation, but the quality of the available organs is not uniform. Risk factors such as donor age and cause of death are known to predict graft failure, but their impact on the recipient's quality of life (QOL) has not been reported. We sent a QOL survey to 299 adults at our institution who had received a liver transplant 1 to 7 years before the study. For the 171 patients (57%) who completed the Medical Outcomes Study Short Form 36 (SF-36), the mean Physical Composite Score (PCS) and the mean Mental Composite Score (MCS) were 61 and 66, respectively; the highest scores were for the Social Functioning subscale, and the lowest scores were for the Role Functioning/Physical and Energy/Fatigue subscales. The mean donor risk index (DRI) of the organs that the subjects received was 1.4 (range = 0.8-2.4). There was no correlation between the SF-36 scores and the DRI [there were changes of -4.8 and -2.8 in the PCS and MCS per unit increase in the DRI (P = 0.4 and 0.6, respectively)], even though we controlled for potential confounders such as age, sex, hospitalization before transplantation, the Model for End-Stage Liver Disease score at transplantation, years since transplantation, previous transplantation, and the Charlson comorbidity index. In conclusion, we found no association between organ quality and QOL after liver transplantation. If this finding is confirmed in prospective, multicenter studies, it will be useful in counseling patients about the decision to accept or not accept high-risk organ offers.     

Impact of pretransplant MELD score on posttransplant outcome in orthotopic liver transplantation for patients with acute-on-chronic hepatitis B liver failure

This study was performed to evaluate the usefulness of the model for end-stage liver disease (MELD) score in comparison with the Child-Turcotte-Pugh (CTP) score to predict short-term postoperative survival and 3-month morbidity among patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation. METHODS: We retrospectively analyzed data from all patients undergoing orthotopic liver transplantation in our unit from December 1999 to November 2005, on the admission day MELD and CTP scores were calculated for each patient according to the original formula. We evaluated the accuracy of MELD and CTP to predict postoperative short-term survival and 3-month morbidity using receiver operating characteristic (ROC) analysis and Kaplan-Meier analysis, respectively. RESULTS: Seven of 42 patients died within 3-months follow-up. The MELD scores for nonsurvivors (32.97 +/- 7.11) were significantly higher than those for survivors (24.90 +/- 4.96; P < .05), CTP scores were significantly higher, too (12.57 +/- 0.98, 11.51 +/- 1.17; P < .05). ROC analysis identified the MELD best cut-off point to be 25.67 to predict postoperative morbidity (area under the curve [AUC] = 0.841; sensitivity = 85.7%; specificity = 60.0%), and the CTP best cut-off point was 11.5 (AUC = 0.747; sensitivity = 85.7%; specificity = 54.3%). MELD score was superior to CTP score to predict postoperative short-term survival and 3-month morbidity among patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation. CONCLUSION: MELD score was an objective predictive system and more efficient than CTP score to evaluate the risk of 3-month morbidity and short-term prognosis in patients with acute-on-chronic hepatitis B liver failure undergoing orthotopic liver transplantation.     

肝硬化患者肝移植术后生存质量的变化

目的调查肝硬化患者肝移植前后生存质量的变化情况。方法研究对象为在中山大学附属第三医院移植中心行首次肝移植手术的68例肝硬化患者。分别在术前,术后0～6个月、7～12个月、12个月以上对患者进行问卷调查。问卷采用健康调查简表(medical outcome study 36-item short form health survey,SF-36)与疾病专用调查表——慢性肝病问卷(chronic liver disease questionaire,CLDQ)。结果在肝移植术前,肝硬化患者的SF-36和CLDQ各维度评分均偏低。术后各时段SF-36的生理机能、躯体疼痛、一般健康、精力和CLDQ的腹部症状、乏力、全身症状、活动评分均较术前明显升高(均为P<0.05);与术前比较,术后0～6个月SF-36的生理职能、社会功能、情感职能、精神健康和CLDQ的情感功能、焦虑评分差异无统计学意义(均为P>0.05),但术后7～12个月、术后12个月以上述维度评分比较差异均有统计学意义(均为P<0.05);术后随着时间的推移,两表各维度得分逐步升高。结论肝硬化肝移植患者术后的生存质量与术前比较有明显改善,术后早期以生理功能方面改善明显,随时间的推移,生存质量其他指标如心理状态和社会功能也得到明显的改善。     

Assessment of quality of life and its influence factors in maintenance hemodialysis patients

Objective To investigate the quality of life (QOL) of maintenance hemodialysis （MHD）patients and its influencing factors. Methods A total of 257 MHD patients in our hospital were recruited in this study. Clinical data of the patients were collected, and the QOL was assessed by MOS 36 item short form health survey(SF-36). Nutritional status of patients was evaluated by modified quantitative subjective global assessment (MQSGA). Univariate analysis of variance,pearson correlation analysis and multiple linear stepwise regression analysis were performed to determine the effect of related factors on QOL scores. Results The scores of all scales of SF - 36 evaluation in MHD patients were relatively lower than that of general population as reported before. Their physiological component summary (PCS) score decreased gradually as age grew, nevertheless, the mental component summary (MCS) score was highest in the group aged 41 - 60. The score was lower in patients with moderate to severe malnutrition or diabetic nephropathy when compared with other patients. Univariate analysis of variance also revealed that high SF-36 scores associated with higher education or income. Multivariate analysis indicated that PCS score and total SF-36 score of MHD patients were positively correlated with body mass index (BMI) and cholesterol, but negatively correlated with diabetic nephropathy, pulmonary artery systolic pressure and MQSGA score (all P＜0.05). There was positive correlation between MCS score and income,yet negative correlation between MCS score and MQSGA score (all P＜0.05). Conclusion MHD patients had relatively poor QOL. Primary diseases and nutritional status were probably the main influencing factors. Age, educated level, family income and pulmonary artery systolic pressure might also have effects on their QOL.     

Relation between depression, some laboratory parameters, and quality of life in hemodialysis patients

Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality and morbidity. Several investigators have estimated that depression occurs in about 20% to 30% of dialysis patients. The aim of this study was to investigate the relationship between depression, some laboratory parameters, and quality of life (QOL) in hemodialysis patients. Forty-three hemodialysis patients (mean age 40.5+/-15.2; M=28, F=15) were included in the study. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and short form with 36 (SF-36) were used for evaluation. Subsequently, patients were divided into two groups according to HAMD scores: group 1, those who had a low HAMD score (between 0 and 7), and group 2, those who had a high HAMD score (over 7). The two groups were compared in terms of anxiety scores, QOL scores, and some laboratory parameters. The group 2 patients (n=21; M= 13, F=8) had lower levels of hemoglobin than the group 1 patients (9.5+/-1.7 vs. 10.7+/- 1.4 g/dL, respectively; p<0.01). Group 2 patients also had lower SF-36 scores than group 1 patients (91.5+/-21.3 vs. 74.9+/- 13.6, respectively; p=0.03). On the contrary, the patients of group 2 had higher HAMA scores than group 1 patients (16.6+/-6.9 vs. 6.3+/-3.5, respectively; p<0.01) and CRP level (10.7+/-4.6 vs. 4.5+/-3.8, respectively; p<0.001). A significant correlation was found between depression scores and C-reactive protein (CRP) (r= 0.57, p < 0.001) and HAMA scores (r=-0.43, p<0.05). In contrast, a negative correlation was found between HAMD scores and albumin (r=-0.43, p<0.05), hemoglobin (r=-0.38, p=0.015) and SF-36 scores (r=0.39, p=0.032). These findings demonstrate that there is a relationship among high depression score, low levels of hemoglobin and albumin, high CRP level, low SF-36 score, and high anxiety score. Evaluation of psychiatric status should be part of the care provided to hemodialysis patients.     

终末期肝病模型用于慢性重症肝炎患者肝移植预后的评估

目的 探讨终末期肝病模型(MELD)预测慢性重症肝炎患者肝移植后早期存活率的价值.方法 共有42例慢性重症肝炎患者接受了肝移植,所有患者的原发病均为乙型肝炎.按照2000年修订的重症肝炎临床分期标准,19例为早期,16例为中期,7例为晚期.Child-Pugh分级,除1例为B级外,其余均为C级.对所有患者进行MELD评分和Child-Pugh评分,并进行比较.绘制ROC曲线,根据ROC曲线下面积评估MELD评分和Child-Pugh评分对肝移植后早期死亡率的预测价值.依据两种评分的ROC曲线临界值,分别绘制Kaplan-Meier生存曲线,Log-Rank检验比较生存曲线的组问差异.采用Spearman等级相关检验分析两种评分方式的相关性.结果 随访至术后3个月,42例中,死亡7例.死亡者的MELD评分和Child-Pugh评分分别为(32.97±7.11)分和(12.57±0.98)分,明显高于存活者的(24.90)±4.96)分和(11.51±1.17)分(P＜0.01,P＜0.05).MELD评分评估患者术后3个月内存活率的最佳临界值是25.67,敏感性和特异性分别是85.7 %和60.0 %,ROC曲线下面积为0.841.Child-Pugh评分评估患者术后3个月内存活率的最佳临界值是11.5,敏感性和特异性分别是85.7 %和54.3 %,ROC曲线下面积为0.747.根据两种评分方法绘制的Kaplan-Meier生存曲线均能有效区分可能死亡和可能存活的患者.Spearman等级相关分析表明两种评分方法的相关系数为0.307(P＜0.05).结论 MELD评分和Child-Pugh评分对慢性重症肝炎患者肝移植后早期存活率均有预测价值;MELD评分能够更好的预测慢性重型肝炎患者术后近期死亡率.     

Different model for end-stage liver disease score block distributions may have a variable ability for outcome prediction

BACKGROUND: The model for end-stage liver disease (MELD) scoring system has become the prevailing criteria for organ allocation in liver transplantation. However, it is not clear if the predictive accuracy of MELD is equally homogeneous in different distribution of MELD score blocks. METHODS: We investigated 472 cirrhotic patients (mean MELD, 14.3+/-5.5), and compared the predictive accuracy of MELD and the corresponding Child-Turcotte-Pugh (CTP) scores in patients with low (<16), intermediate (10-20) and high (>14) MELD score range by using c-statistic for area under the receiver operating characteristic curve (AUC) at different time frames. RESULTS: The MELD scores well correlated with CTP scores at baseline (rho=0.492, P<0.001). Overall, MELD was significantly better than the CTP system to predict the risk of mortality. However, in stratified analysis there were no significant differences between MELD and CTP for the c-statistic in patients with low and intermediate range MELD scores at 3-, 6-, 9-, and 12-month (p values all > 0 1). Among patients with high MELD scores, MELD was consistently more accurate than the CTP system in predicting the mortality at 3- (AUC, 0.715 vs. 0.543, P=0.020), 6- (0.705 vs. 0.536, P=0.003), 9- (0.737 vs. 0.507, P<0.001) and 12-month (0.716 vs. 0.526, P<0.001), respectively. CONCLUSIONS: MELD has a better performance only in a subset of patients with higher MELD scores. The outcome in patients with lower range MELD scores cannot be reliably predicted solely with their MELD scores, and alternative prognostic markers should be used in conjunction to enhance the predictive accuracy.     

老年腹膜透析患者生存质量的影响因素

目的 探讨持续不卧床腹膜透析(CAPD)老年患者的生存质量状况,并初步探讨影响老年CAPD患者生存质量的各种因素.方法 选取我院2011年至2014年4月期间收治的年龄大于60岁的行持续不卧床腹膜透析治疗的63例老年患者,按年龄分为＜70岁和≥70岁两组,使用SF-36量表调查患者的生存质量.结果 两组患者年龄[(63.93±2.97)vs(73.57±3.22)岁]、Charlson合并症指数(3.4+±2.3 vs 5.0± 3.1)、Karnofsky活动指数(82±9 vs72± 16)、合并心血管并发症(x2=9.921,P=0.002)差异有统计学意义(均P＜0.05).两组患者SF-36量表中8个维度比较差异无统计学意义(均P＞ 0.05);在躯体健康相关生存质量方面差异有统计学意义(P=0.031).相关性分析显示,SF-36总分与Kamofsky活动指数(r=0.046,P=0.000)、残肾功能(r=0.314,P=0.012)呈正相关;与焦虑指数(r=-0.318,P=0.014)、抑郁指数(r=-0.341,P=0.006)呈负相关.躯体健康相关生存质量与年龄(r=-0.337,P=0.007)、是否合并心血管并发症(r=-0.333,P=0.008)、抑郁指数(r=-0.369,P=0.003)呈负相关;与Karnofsky活动指数(r=0.507,P=0.000)、残余肾功能(r=0.268,P=0.034)呈正相关性.精神健康相关生存质量与焦虑指数(r=-0.327,P=0.009)、抑郁指数(r=-0.267,P=0.034)呈负相关;与Karnofsky活动指数(r =0.321,P=0.01)、残余肾功能(r=0.283,P=0.025)呈正相关.结论 对于老年腹膜透析患者而言,年龄、焦虑指数、抑郁指数、Karnofsky活动指数、残肾功能、心血管并发症的发生都可能会影响其生存质量.     

Inguinal hernioplasty improves the quality of life in patients with cirrhosis

BACKGROUND: The optimal management of symptomatic inguinal hernia (SIH) in cirrhotics is still undefined. Both hernia and cirrhosis impair quality of life (QOL). The aim of this study was to evaluate QOL by a Short Form-36 (SF-36) questionnaire in cirrhotic patients undergoing inguinal hernioplasty. METHODS: Thirty-two cirrhotic patients undergoing inguinal hernioplasty were evaluated. They were classified according to Child's class and to the absence or presence of refractory ascites. The SF-36 questionnaire was administered the day before and 6 months after surgery. Global analyses of the 8 domains of SF-36 and of 2 comprehensive indexes of SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS), were performed. RESULTS: Lichtenstein hernioplasty for SIH originated no major complications. All 8 domains of SF-36 and MCS and PCS scores improved remarkably after hernioplasty especially in patients in Child's class C and/or with refractory ascites. CONCLUSIONS: Inguinal hernioplasty for SIH in patients with cirrhosis is a safe procedure. The improvement of QOL represents a clear cut indication for elective hernia repair.     

Prospective analysis of health-related quality of life and clinical evaluations in patients with anterior cruciate ligament injury undergoing reconstruction

Introduction

This study aimed to evaluate the treatment outcome of patients with anterior cruciate ligament (ACL) injury using the patient-based quality of life (QOL) survey SF-36, and investigate the correlation with conventional objective assessment methods. Our hypothesis that SF-36 is a useful assessment method for QOL in patients with ACL injury, and this assessment clarifies the concord and the discord between doctor-based objective assessment.

Patients and methods

A prospective study was conducted on patients who underwent ligament reconstruction. Eighty-one patients with a mean age of 27.4?years were analyzed. Clinical evaluations comprising SF-36 survey, Lysholm scoring, and anterior tibial translation measurement were conducted before as well as after surgery. The changes over time and the correlation between these evaluation methods were analyzed.

Results

All SF-36 subscales were significantly improved after surgery. Regarding QOL of patients with ACL injury, the preoperative scores of all the subscales except vitality and mental health were lower than the national standard values, while the postoperative scores of all subclasses were not different from the national standards. A correlation was found between Lysholm score and all SF-36 subscale scores except general health before surgery, but a correlation was observed only with physical functioning, bodily pain and role emotional at 6?months after surgery, and with physical functioning, role physical, bodily pain and vitality at 12?months. No correlation between SF-36 scores and distance of anterior tibial translation was observed both before and after surgery.

Discussion

The QOL of patients with ACL injury as assessed by SF-36 improved significantly after reconstruction surgery. The mental health subscales of SF-36 correlate with Lysholm score before surgery suggesting that apart from the physical impairment, lowered mental health is also an important clinical issue in patients with ACL injury.     

肩袖撕裂患者肩部力量和肩部功能的相关性研究

目的探讨肩袖撕裂患者手术前肩部力量和肩部功能状况及两者之间的关系。 方法选择2016年3月至2019年7月在本院进行手术治疗的全层肩袖撕裂患者243例。在患者手术前应用等速肌力测试检测患者肩部力量，应用临床评分系统测量患者肩部功能。根据患者撕裂程度大小将患者分为4组：小型撕裂组、中型撕裂组、大型撕裂组、巨大型撕裂组。分析每组患者肩部力量和肩部功能的相关性。 结果在肩袖小型撕裂患者中，外展力量和视觉模拟评分（visual analogue scale，VAS）存在负相关（r=-0.307，P=0.018）；在肩袖中型撕裂患者中，外展力量和美国加州大学肩关节评分系统（ University of California at Los Angeles ,UCLA）（r=0.262，P=0.015）、SF-36躯体健康总评（physical component summary,PCS）（r=0.226，P=0.038）存在正相关；外旋力量和UCLA评分存在正相关（r=0.289，P=0.007）；在肩袖大型撕裂患者中，外展力量和Constant评分（r=0.282，P=0.043）、加州大学肩关节评分系统（American shoulder and elbow surgeon' form , ASES）（r=0.309，P=0.026）、SF-36PCS评分（r=0.317，P=0.022）存在正相关；外旋力量和UCLA评分（r=0.288，P=0.038）、Constant评分（r=0.293，P=0.035）、ASES评分（r=0.329，P=0.017）存在正相关；内旋力量和UCLA评分（r =0.383，P=0.005）、Constant评分（r=0.401，P=0.003）、ASES评分（r=0.314，P=0.023）、SF-36PCS评分（r=0.285，P=0.041）、SF-36精神健康总评（mental component summary , MCS）（r=0.304，P=0.028）存在正相关；在肩袖巨大型撕裂患者中，外展力量和VAS评分（r=-0.308，P=0.035）存在负相关，和UCLA评分（r=0.413，P=0.004）、Constant评分（r=0.489，P=0.000）、ASES评分（r=0.473，P=0.001）、SF-36PCS评分（r=0.772，P=0.000）、SF-36 MCS评分（r=0.293，P=0.046）存在正相关；外旋力量和VAS评分（r=-0.292，P=0.046）存在负相关，和UCLA评分（r=0.629，P=0.000）、Constant评分（r=0.413，P=0.004）、ASES评分（r=0.695，P=0.000）、SF-36 PCS评分（r=0.583，P=0.000）存在正相关；内旋力量和VAS评分（r=-0.309，P=0.035）存在负相关，和UCLA评分（r=0.512，P=0.000）、Constant评分（r=0.709，P=0.000）、ASES评分（r=0.802，P=0.000）、SF-36PCS评分（r=0.501，P=0.000）存在正相关。 结论撕裂程度可能是决定患者肩部力量和肩部功能相关程度的关键因素，部分修复不可修复的巨大撕裂非常重要。     

Predictors of early quality-of-life improvement after laparoscopic gastric bypass surgery

BACKGROUND: Quality of life is getting more attention in the medical literature. Treatment outcomes are now gauged by their effect on quality of life (QOL), along with their direct effect on diseases they are targeting. Similarly, in obesity, consensus has been reached on the importance of QOL as an independent outcome measure for obesity surgery along with weight loss and comorbidity. Therefore, the aim of this study was to assess the impact of patient demographics and comorbidities on short-term QOL improvement after laparoscopic gastric bypass (LGB) surgery. METHODS: The change in QOL after LGB was assessed in 171 patients (147 women, 24 men; mean age, 43.1 y) using the Short-Form-36 (SF-36) questionnaire. Multivariate logistic regression analysis was used to identify patients' demographics and comorbidities predictive of major QOL improvement. RESULTS: Body mass index decreased significantly at 3 months (48.5 +/- 5.8 to 38.4 +/- 5.4 kg/m2; P < .001) with excess weight loss of 37.4% +/- 9.2%. The SF-36 follow-up evaluation showed significant improvement (44.2 +/- 15.7 to 78.6 +/- 15.5; P < .001). A significant inverse correlation was found between QOL (before and after bypass) and the number of comorbidities (r = .29, P = .001; R = .22, P = .005; respectively), but the magnitude of QOL change did not correlate with the number of comorbidities (P = .5). When the entire cohort of patients was dichotomized according to their magnitude of change in SF-36 scores, the univariate analysis showed that the group of patients with no improvement or minor improvement in their SF-36 was characterized by a higher percentage of male sex and a lower prevalence of diabetes. These 2 preoperative factors remained statistically significant in the multivariate analysis. Preoperative diagnosis of type 2 diabetes increased the likelihood of major improvement in QOL after LGB by 6.2 times, whereas being a woman increased this likelihood by 16.1 times. CONCLUSIONS: Significant weight loss was achieved as early as 3 months after LGB, causing substantial improvement in QOL in more than 95% of patients. Women with type 2 diabetes have the highest odds to achieve a major QOL improvement after LGB and therefore they should represent the ideal target population for surgical weight loss programs.     

Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome.

OBJECTIVE: Randomized, double-blinded, placebo-controlled, clinical trial to determine the effectiveness of palatal implants for treatment of mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). STUDY DESIGN AND SETTING: Sixty-two non-obese adults with history of snoring, daytime sleepiness, and mild/moderate OSAHS, were randomized to receive palatal implants (n = 31) or placebo procedure (n = 31). Complete follow-up including quality of life (QOL, SF-36), snoring visual analog scale (VAS), and Epworth Sleepiness Scale (ESS) data were obtained in 62 patients. Seven patients refused follow-up polysomnography for a total of 55 patients (29 implant and 26 placebo). RESULTS: The treatment group (change in score of -7.9 +/- 7.7) was significantly improved compared with the placebo group (change in score of 0.9 +/- 4.3) for apnea/hypopnea index (AHI) (P < 0.0001), QOL, SF-36 (P < 0.0001), snoring VAS (P < 0.0001), and ESS (P = 0.0002). CONCLUSIONS: Palatal implants improve AHI, QOL, snoring intensity, and daytime sleepiness for selected patients with mild/moderate OSAHS.