Impact of Disease Severity and Psychological Distress on Quality of Life in Patients with Alcoholic Liver Cirrhosis: A Cross-Sectional Observational Study from a Tertiary Care Hospital in Northern India

Background Alcoholic liver cirrhosis (ALC) imposes a profound physical and psychological burden, yet the independent and combined influences of disease severity and psychological distress on quality of life (QoL) remain incompletely characterised in South Asian populations. This study evaluated the independent, combined, and mediating impacts of disease severity (MELD score and CTP classification) and psychological distress (DASS-21) on QoL (CLDQ) in patients with ALC at a tertiary care centre in Northern India. Objective To evaluate the impact of liver disease severity and psychological distress on quality of life in patients with alcoholic liver cirrhosis, and to assess whether psychological distress mediates or modifies the relationship between disease severity and quality of life. Methods A cross-sectional observational study was conducted over six months at Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. Consecutive adult patients (n = 363) with confirmed ALC were enrolled. Disease severity was assessed by Model for End Stage Liver Disease 3.0 (MELD 3.0) score and Child-Turcotte-Pugh (CTP) classification, psychological distress by the 21-item Depression Anxiety Stress Scale (DASS-21), and QoL by the Chronic Liver Disease Questionnaire (CLDQ). Spearman rank correlation, Kruskal–Wallis tests with Bonferroni post-hoc correction, multiple linear regression, and PROCESS-based mediation analysis (5,000 bootstrap resamples) were performed using SPSS v27. Results Most patients had decompensated cirrhosis (89.3%) in which 53.2% were in CTP Class C. Median MELD score 17.93; IQR: 11.60. Extremely severe depression, anxiety, and stress were present in 86.2%, 48.2%, and 85.4% of patients, respectively. Median CLDQ score was 2.8, IQR: 1.5. All study variables correlated strongly and negatively with CLDQ score: MELD (rₛ = −0.755), CTP class (ρ = −0.786), depression (rₛ = −0.841), anxiety (rₛ = −0.881), and stress (rₛ = −0.862; all p < 0.001). A combined regression model (MELD + CTP class + anxiety) explained 86.7% of QoL variance (R² = 0.867). Mediation analysis confirmed that all three DASS-21 subscales significantly partially mediated the MELD–CLDQ pathway in which anxiety had the strongest indirect effect (B = − 0.0605; 95% BCI: −0.0693 to − 0.0517). Conclusions Disease severity and psychological distress are independent, synergistic determinants of QoL in ALC, with anxiety functioning as both the strongest independent predictor and the most potent mediator. These findings support routine psychological screening and integrated multidisciplinary management in patients with ALC.