Longitudinal health-related quality of life and associated factors in autoimmune liver diseases

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INTRODUCTION AND OBJECTIVES: Autoimmune liver diseases (AILD), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), can significantly influence patients' health-related quality of life (HRQOL). Understanding longitudinal HRQOL trends and associated factors may help identify patients at risk for poor HRQOL long-term. This longitudinal, single-center observational study aimed to assess longitudinal changes in HRQOL and identify baseline factors associated with HRQOL over time among patients with AILD. PATIENTS AND METHODS: Adult patients with AIH, PBC, and/or PSC enrolled in a single-center prospective autoimmune liver registry were included. HRQOL was assessed using the Chronic Liver Disease Questionnaire (CLDQ). Linear mixed-effects models evaluated longitudinal changes in HRQOL and identified baseline demographic and clinical factors associated with HRQOL. RESULTS: A total of 252 patients (mean follow-up=35.3 ± 23.5 months) were included. At baseline, CLDQ total scores indicated relatively preserved HRQOL (mean=5.47 ± 1.04) and showed a small but statistically significant increase over time (β=0.0018, p=0.03). The emotional and worry domains demonstrated modest improvement, whereas other domains remained stable. Male sex was associated with higher HRQOL (β=0.33, p=0.04), while the presence of other autoimmune diseases (β=-0.34, p=0.01), coexisting metabolic-associated steatotic liver disease (β=-0.39, p=0.04), and ascites (β=-1.24, p=0.002) were associated with poorer HRQOL over time. CONCLUSIONS: While HRQOL among patients with AILD remained largely stable over time, patients with other autoimmune and liver conditions experience lower HRQOL. These findings underscore the importance of identifying high-risk patients and providing tailored strategies to maintain and improve long-term HRQOL in this population.

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