Rationale: Advances in the management of cystic fibrosis have led to a significant improvement in survival although marked differences between individuals are still observed. The value of patient-reported health-related quality of life scores in predicting survival in adults with cystic fibrosis is unknown. Objective: To evaluate whether patient-reported health-related quality of life could predict survival in cystic fibrosis. Measurements: During 1996-1997 a consecutive series of 223 patients were recruited to evaluate the Cystic Fibrosis Quality of Life Questionnaire. Demographic (age, gender), clinical (FEV₁% predicted, BMI, diabetes, B. Cepacia complex, intravenous access device, nutritional and lung transplant status) and health-related quality of life variables were recorded (Cystic Fibrosis Quality of Life Questionnaire and the SF-36). These data were used as baseline measures to explore the prognostic association of health-related quality of life and subsequent survival. Main Results: At the census date (31^st December 2006) 154 (69.1%) adults were alive, 66 (29.6%) had died and three (1.3%) were lost to follow-up. Cox proportional hazards models and bootstrapping procedures examined if health-related quality of life domains predicted survival after adjusting for the demographic and clinical factors. The physical functioning domain of the Cystic Fibrosis Quality of Life Questionnaire and the pain domain of the SF-36 had the strongest statistical associations with survival. Conclusions: Aspects of patient-reported quality of life act as prognostic measures of survival beyond a number of previously known factors in cystic fibrosis. This needs to be investigated further in a larger longitudinal study.