Bewältigung chronischer Krankheiten am Beispiel der Leberzirrhose

Aim of this study is to investigate the influence of social, mental and physiological fac¬tors on survival with a chronic disease considering liver cirrhoses (LC) as an example. LC-patients seem to be a particularly neglected subgroup among the chroni¬cally ill: Most studies o LC focus on prognostic values of medical and laboratory parameters; little attention is paid to social and psychological coping facets. On longitudinal data from 673 patients with LC secondary analyses were conducted. Survival time defined by the period between date of first diagnosis of LC and death resp. end of the study was regarded as coping criterion. Primary objective was to examine, whether and to which extend social factors as gen¬der, alcohol consumption (measured by four categories of gamma glutamyl¬transferase levels (GGT)), employment and social class affect survival time with LC along with more medical variables like etiology of LC and disease severity score. Secondary objective was to identify predictive factors of the employment time (time remaining in employment after diagnosis of LC). Cox proportional hazards regression revealed four variables as independent predic¬tors of survival time after diagnosis of LC: disease severity score, gender, alcohol con¬sumption, age at diagnosis. As expected a higher disease severity score is associated with lower survival rates. Men showed a nearly twofold risk for death (HR 1.9; CI 1.4 ? 2.8; p< .001) compared to women. Patients with highly augmented alcohol intake had the worst prognosis: compared to patients with low or no alcohol intake they showed a more than threefold risk of death (HR 3.2; CI 2.0 ? 5.3; p< .0001). As ex¬pec¬ted older age at diagnosis is associated with shorter survival. The variable employ¬ment time could not be incorporated in the Cox model as its asso¬ciation to survival time exist in such a way that employment time is limited by survival time. Mean survival times (Kaplan Meier) were computed for three categories of em¬ployment time (ET): ET1: < 1 year, ET2: 1 year up to 5 yrs and ET3: >5yrs. remai¬ning in employment after diagnosis of LC. ET1 showed a more than twofold survival time (171 months; CI 150-192) compared to ET2 (82 months; CI 74-90). As expected ET3 showed the highest survivaltime (189 months; CI 169-209) (Log-Rank-test p< .0001). Similar differences in mean survival time between ET1 and ET2 exist in the two youn¬ger age groups and exist for men as well as for women. Etiology of LC and social class revealed no statistical association with survival time after diagnosis of LC. Age at diagnosis, disease severity score and gender turned out to be predictive factors for employment time. After diagnosis of LC women are more likely to get retired than men (HR 1.2; CI 1.0 ? 1.5; p = .049). GGT as indicator for alcohol consumption, etio¬¬logy of LC and social class were not significantly associated with employment time. Further studies, with similarly prolonged follow-up, are needed to exlore the role of psychosocial factors in coping with liver cirrhosis.