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Symptom frequency and distress underestimated in decompensated cirrhosis
Hansen, Lissi Chang, Michael F. Hiatt, Shirin Dieckmann, Nathan F. Lyons, Karen S. Lee, Christopher S.
Hansen, Lissi
Chang, Michael F.
Hiatt, Shirin
Dieckmann, Nathan F.
Lyons, Karen S.
Lee, Christopher S.
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
liver cirrhosis, end-stage liver disease, symptom distress, pain, depression
Date
2022
Type
Journal article
Journal
Digestive Diseases and Sciences
Book
Volume
67
Issue
8
Page Range
4234-4242
Article Number
ACU Department
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled