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. 2024 Jul-Aug;56(6):1378-1384.
doi: 10.1016/j.transproceed.2024.03.039. Epub 2024 Jul 17.

Patient-Reported Outcome Screens for Cognitive Dysfunction and Predicts Admissions in Cirrhosis

Avesh J Thuluvath  1 , Minjee Kim  2 , John Peipert  3 , Andrés Duarte-Rojo  4 , Alex Huang  5 , Osama Siddiqui  5 , Mohammad Nizamuddin  5 , Zachary Dietch  6 , Josh Levitsky  7 , Daniela P Ladner  8
Affiliations

Patient-Reported Outcome Screens for Cognitive Dysfunction and Predicts Admissions in Cirrhosis

Avesh J Thuluvath et al. Transplant Proc. 2024 Jul-Aug.

Abstract

Introduction: Hepatic encephalopathy (HE) is a frequent complication of cirrhosis, leading to preventable hospitalizations and increased mortality. Despite the availability of validated neuro-psychometric tests to diagnose HE, only 10% of clinicians regularly screen for HE due to lack of time, equipment, and trained personnel.

Materials and methods: We studied the association between patient-reported cognitive function and the National Institutes of Health Toolbox Cognition Battery (a validated measure of HE) in patients with cirrhosis. A single-center prospective study of adult patients undergoing liver transplantation evaluation was performed from 10/2020 to 12/2021. Cognition was assessed using the National Institutes of Health Toolbox Cognition Battery and a brief Patient-Reported Outcomes Measurement Information System (PROMIS) survey.

Results: Twenty-three liver transplantation candidates were enrolled; the mean age was 56.4 (±9.7) years, 39% were female and the most common etiologies of cirrhosis were primary biliary cirrhosis/primary sclerosing cholangitis/overlap syndrome (30%), hepatitis C (22%) and alcohol-associated liver disease (22%). The mean MELD-Na was 14.9 (±6.4). The mean PROMIS Cognitive Function T-score (PROMISCF) was 49.2 (±9.6). The mean T-scores for the List Sort Working Memory test, Flanker Inhibitory Control and Attention test, and Pattern Comparison Processing Speed test were 46.4 (±9.9), 37.8 (±6.2), and 50.22 (±16.4), respectively. PROMISCF correlated with the List Sort Working Memory test (r = 0.45, P = .03). The mean hospitalization rate was 1.6 days admitted per month. On adjusted multivariate analysis, PROMISCF predicted total hospitalization days (P < .001), hospital admissions (P = .01), and hospitalization rate (P < .001).

Conclusions: A brief survey can screen for HE and predict hospitalizations in patients with cirrhosis.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

Figures

Figure 1:
Figure 1:
PROMIS Cognitive Function Computer Adaptive Survey
Figure 1:
Figure 1:
PROMIS Cognitive Function Computer Adaptive Survey
See this image and copyright information in PMC

References

    1. Hirode G, Vittinghoff E, Wong RJ. Increasing Burden of Hepatic Encephalopathy Among Hospitalized Adults: An Analysis of the 2010–2014 National Inpatient Sample. Digestive Diseases and Sciences 2019;64:1448–57. 10.1007/S10620-019-05576-9/TABLES/4. - DOI - PubMed
    1. Rose CF, Amodio P, Bajaj JS, Dhiman RK, Montagnese S, Taylor-Robinson SD, et al. Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy. Journal of Hepatology 2020;73:1526–47. 10.1016/JJHEP.202b.07.013. - DOI - PubMed
    1. Davies P, Walters JRF, Paton A. A 20-year prospective study of cirrhosis. Br Med J (Clin Res Ed) 1981;282:263–6. 10.1136/BMJ.282.6260.263. - DOI - PMC - PubMed
    1. Neff G. Pharmacoeconomics of Hepatic Encephalopathy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 2010:30:28S–32S. 10.1592/PHCO.30.PT2.28S. - DOI - PubMed
    1. Cordoba J, Ventura-Cots M, Simón-Talero M, Amorós À, Pavesi M, Vilstrup H, et al. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF). Journal of Hepatology 2014;60:275–81. 10.1016/J.JHEP.2013.10.004. - DOI - PubMed