Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Cirrhosis is associated with disabling symptoms and diminished health-related quality of life (HRQOL). However, for patients with compensated disease, data are limited regarding associations with poor patient-reported outcomes (PROs). We prospectively enrolled 300 patients with cirrhosis and portal hypertension without a history of hepatic encephalopathy and reviewed medical and pharmacy records. We characterized determinants of PROs using the SF-8 scale (0-100) and sleep quality using the Pittsburgh Sleep Quality Index (poor sleep >5). Disability and frailty measures were assessed using Activities of Daily Living (ADL), falls, hand-grip and chair-stands. Cognitive function was measured using weighted-lures from the inhibitory control test [ICT]. The mean age of our cohort was 60 IQR (52-66) years, 56.3% were male, and 70% Child Class A. All patients had portal hypertension, 76% had varices and 41% had a history of ascites (predominantly well controlled). The median MELD-Na was 9 (IQR 7-13). The overall median SF-8 was 75 (59-86). Multivariate analysis showed that adjusting for age, sex, education, and MELD-Na, performance on chair-stands (9.28 HRQOL points (95% CI 4.76-13.8) per 10-stands), ADL dependence (-6.06 (-10.8- -1.36)), opiate use (-5.01 (-7.84- -2.19)), benzodiazepine use (-3.50 (-6.58- -0.42)), and ICT performance (-0.10 (-0.20 - 0.001) per weighted-lure) were significantly associated with HRQOL. Among patients completing the ICT, poor HRQOL (score<50) was significantly associated with chair-stands (odds ratio per 10-stands, 0.24 95%CI[0.11-0.56]) and weighted lures (OR per weighted-lure, 1.01 [1.00-1.03]). Poor sleep quality was associated with opiate use (OR 2.85 95%CI[1.11-7.29] and lures (OR per-lure, 1.03 [1.00-1.05]). Conclusion Disability, chair-stand performance, cognitive dysfunction, as well as psychoactive medication use are significantly associated with PROs in patients with clinically stable cirrhosis.