COVID-19 emergency: Changes in quality of life perception in patients with chronic liver disease-An Italian single-centre study

Table 1 Questionnaire

Questions
First part
1 Are you aware that the novel coronavirus is transmitted to people?
2 Are you aware that symptoms including fever, cough, and breathing difficulties are signs of alarm?
3 Are you aware that people with chronic liver disease are at higher risk of developing a severe form of the disease?
4 Are you aware that when you go out, you always have to use personal protective equipment such as masks and gloves?
5 Do you always respect prevention and protection measures such as social distancing?
6 Do you use adequate hygiene measures such as frequently washing your hands?
7 During this period, did you need to contact your general physician for your liver disease?
8 If you answered yes, did you have difficulty in contacting him/her?
9 During this period, did you need to contact a gastroenterologist specialist for your liver disease?
10 If you answered yes, did you have difficulty in contacting him/her?
11 Have you received more detailed information about the management of your therapy?
12 Do you know that immunosuppressed patients are more at risk of getting severe acute respiratory syndrome coronavirus-2 infection?
13 Have you thought about modifying your immunosuppressive therapy on your own?
14 Did you manage to perform the six-month follow-up ultrasound for hepatocellular carcinoma surveillance?
Second part
1 How much of the time during the last two weeks have you been troubled by a feeling of abdominal bloating?
2 How much of the time have you been tired or fatigued during the last two weeks?
3 How much of the time during the last two weeks have you experienced bodily pain?
4 How often during the last two weeks have you felt sleepy during the day?
5 How much of the time during the last two weeks have you experienced abdominal pain?
6 How much of the time during the last two weeks has shortness of breath been a problem for you in your daily activities?
7 How much of the time during the last two weeks have you not been able to eat as much as you would like?
8 How much of the time in the last two weeks have you been bothered by having decreased strength?
9 How often during the last two weeks have you had trouble lifting or carrying heavy objects?
10 How often during the last two weeks have you felt anxious?
11 How often during the last two weeks have you felt a decreased level of energy?
12 How much of the time during the last two weeks have you felt unhappy?
13 How often during the last two weeks have you felt drowsy?
14 How much of the time during the last two weeks have you been bothered by a limitation of your diet?
15 How often during the last two weeks have you been irritable?
16 How much of the time during the last two weeks have you had difficulty sleeping at night?
17 How much of the time during the last two weeks have you been troubled by a feeling of abdominal discomfort?
18 How much of the time during the last two weeks have you been worried about the impact your liver disease has on your family?
19 How much of the time during the last two weeks have you had mood swings?
20 How much of the time during the last two weeks have you been unable to fall asleep at night?
21 How often during the last two weeks have you had muscle cramps?
22 How much of the time during the last two weeks have you been worried that your symptoms will develop into major problems?
23 How much of the time during the last two weeks have you had a dry mouth?
24 How much of the time during the last two weeks have you felt depressed?
25 How much of the time during the last two weeks have you been worried about your condition getting worse?
26 How much of the time during the last two weeks have you had problems concentrating?
27 How much of the time have you been troubled by itching during the last two weeks?
28 How much of the time during the last two weeks have you been worried about never feeling any better?

Table 2 Clinical characteristics of patients

Variable	n = 81
Sex, n (%)
Male	38 (47)
Female	43 (53)
Aetiology, n (%)
Cirrhosis	49
HBV	7 (8.6)
HCV	22 (27.2)
Cirrhosis Alcoholic-related	9 (11.1)
Cirrhosis HBV + alcoholic-related	1 (1.2)
Cirrhosis HCV + alcoholic-related	1 (1.2)
Cirrhosis Metabolic-related	9 (11.1)
AIH	8 (9.9)
Cirrhosis AIH-related	5 (6.2)
PBC	14 (17.3)
Cirrhosis PBC-related	3 (3.7)
PSC	2 (2.5)
Child-Pugh score, n (%)
A5	46 (80.7)
A6	6 (10.5)
B7	5 (8.8)

HBV: Hepatitis B virus; HCV: Hepatitis C virus; AIH: Autoimmune hepatitis; PBC: Primary biliary cirrhosis; PSC: Primary sclerosing cholangitis.

Table 3 Questionnaire and answers

Questions	Patients’ answer “YES” number (%)	Patients’ answer “NO” number (%)
1 Are you aware that the novel coronavirus is transmitted to people?	76 (93.8)	5 (6.2)
2 Are you aware that symptoms including fever, cough, and breathing difficulties are signs of alarm?	76 (93.8)	5 (6.2)
3 Are you aware that people with chronic liver disease are at higher risk of developing a severe form of the disease?	69 (85)	12 (15)
4 Are you aware that when you go out, you always have to use personal protective equipment such as masks and gloves?	77 (95)	4 (5)
5 Do you always respect prevention and protection measures such as social distancing?	60 (74)	21 (26)
6 Do you use adequate hygiene measures such as frequently washing your hands?	60 (74)	21 (26)
7 During this period, did you need to contact your general physician for your liver disease?	12 (15%)	69 (85)
8 If you answered yes, did you have difficulty in contacting him/her?	11 (91.7)1	1 (8.3)
9 During this period, did you need to contact a Gastroenterologist specialist for your liver disease?	12 (15%)	69 (85)
10 If you answered yes, did you have difficulty in contacting him/her?	8 (67%)2	4 (33.3)
11 Have you received more detailed information about the management of your therapy?	5 (15.6)	27 (84.4)
12 Do you know that immunosuppressed patients are more at risk of getting severe acute respiratory syndrome coronavirus 2-infection?	29 (90.6%)	3 (9.4%)
13 Have you thought about modifying your immunosuppressive therapy on your own?	9 (28.2%)	23 (71.8%)
14 Did you manage to perform the six-month follow-up ultrasound for hepatocellular carcinoma surveillance?	29 (60%)3	20 (40%)

¹Data refer to the number of patients answering positively to question 7.

²Data refer to the number of patients answering positively to question 9.

³Data refer to the number of patients who were scheduled to undergo liver ultrasound during lockdown timeframe.

Data are expressed as number (%).

Table 4 Total chronic liver disease questionnaire pooled scores for each single quality of life perception domain in all patients enrolled in the study

Items	Median, t0	Range interquartile, t0	Median, t1	Range interquartile, t1	P value
Abdominal symptoms: 1, 5, 17	1	1-2	1	1-2	aP < 0.0001
Fatigue: 2, 4, 8, 11, 13	2	1-2	2	1-2	bP < 0.0001
Systemic symptoms: 3, 6, 21, 23, 27	1	1-2	1	1-2	cP < 0.0001
Activity: 7, 9, 14	2	1-5	3	1-5	dP = 0.0245
Emotional function: 10, 12, 15, 16, 19, 20, 24, 26	2	1-2	2	1-3	eP < 0.0001
Worry: 18, 22, 25, 28	2	1-2	2	1-3	fP < 0.0001

Table 5 Total chronic liver disease questionnaire pooled scores for each quality of life perception domain in patients with autoimmune liver disease enrolled in the study

Items	Median t0	Range interquartile t0	Median t1	Range interquartile t1	P value
Abdominal symptoms: 1, 5, 17	1	1-1	1	1-2	aP = 0.0045
Fatigue: 2, 4, 8, 11, 13	1	1-2	1	1-2	bP < 0.0001
Systemic symptoms: 3, 6, 21, 23, 27	1	1-2	1	1-2	cP < 0.0004
Activity: 7, 9, 14	2	1-5	2	1-5	dP = 0.0938
Emotional function: 10, 12, 15, 16, 19, 20, 24, 26	1	1-2	2	1-3	eP < 0.0001
Worry: 18, 22, 25, 28	1	1-2	2	1-3	fP < 0.0001