Symptom Frequency and Distress Underestimated in Decompensated Cirrhosis

Abstract

Background: Studies assessing multiple symptoms and the distress of these symptoms in decompensated cirrhosis are lacking.

Aims: The aims of this study were to assess symptom prevalence and distress among patients with decompensated cirrhosis and to describe medical management of the most prevalent symptoms.

Methods: Patients were recruited from hepatology clinics within two health-care systems. Eligibility criteria included a model for end-stage liver disease (MELD-Na) score ≥15. Patients completed the Condensed Memorial Symptom Assessment Scale and Patient Health Questionnaire. Comparative statistics were used to analyze the cross-sectional survey data.

Results: Of the sample (n = 146), most patients were Child-Turcotte-Pugh (CTP) class B (49.7%) and C (46.2%). Mean age was 56.5 years, 65.1% were male, and 88.4% were white. Average MELD-Na score was 19.1 ± 4.5. The most prevalent symptoms were lack of energy and feeling drowsy while the most distressing were lack of energy and difficulty sleeping. Only 24 patients (16.4%) were treated for their difficulty sleeping with sleep medication. Importantly, those prescribed sleep medications had similar distress (3.9 ± 1.2 vs. 3.5 ± 1.2, p = 0.229) compared with patients not prescribed sleep medications. Opioids were prescribed to 57 (39.0%) patients; antidepressants to 34 (23.3%). Forty patients (27.4%) who reported moderate or greater depression were not prescribed an antidepressant.

Conclusions: The study highlights the multiple symptoms and distress experienced by patients with decompensated cirrhosis, and the need for improved medical management by health-care providers through enhanced awareness and attention to these complex symptoms. Future research should focus on improvements in symptom management.

Keywords: Depression; End-stage liver disease; Liver cirrhosis; Pain; Symptom distress.

Flow Diagram 1.

Study Participant Eligibility, Recruitment, and Attrition Note. CG, Caregiver; PT: Patient; PI, Principal Investigator; TXP, Transplantation.

Diagram 2

The bars indicate physical and psychological symptom prevalence. The solid line indicates physical symptom distress and psychological symptom frequency.