Abstract

Background: Quality of life and symptom management are important for patients with chronic liver disease (CLD), which can precede cirrhosis development. CLD patients with/without cirrhosis have mood disorders which affect cognition. Cognitive impairment is testing using simple (Animal naming, ANT) or more complicated [Stroop and Psychometric hepatic encephalopathy score (PHES)] but their impact on QOL across the spectrum of CLD is unclear. Aim: Evaluate determinants of poor QOL across the CLD spectrum in a multi-center study.

Methods: Outpatients with compensated cirrhosis and with pre-cirrhotic liver disease (F1-F3) were enrolled prospectively in 2 centers. Demographics, disease etiology, and co-morbid conditions were recorded. Fibroscan was performed. We evaluated depression & anxiety (Beck inventories BDI/BAI), PTSD, medications (psychoactive, PPI, diabetes), and alcohol use (AUDIT) and performed cognitive testing using ANT, PHES, and EncephalApp Stroop (has Off and OnTimes). Finally, the Sickness Impact Profile (SIP, generic QOL instrument with psychosocial and cognitive domains) was administered. Comparisons of those with/without cirrhosis were performed and Fibroscan kPa were correlated with cognition & QOL. Linear regression for prediction of physical & psychosocial SIP was performed for all pts using cirrhosis/not as a covariate.

Results: We included 116 outpatients (11 F2, 34 F3 and 72 F4) from USA & Denmark. As shown in table 1, pts with cirrhosis were older, more likely to have alcohol, and lower likelihood of NAFLD (FigA). Other demographic measures, BMI, & co-morbid conditions/medications were similar. Cirrhosis pts as expected had higher Fibroscan kPa & creatinine/bilirubin.
PROs: Beck inventories were worse in non-cirrhotic patients while frailty & alcohol intake were similar. QOL: SIP was higher (worse) in patients without cirrhosis, especially related to physical score. Cognitive testing: EncephalApp Off Time was higher in cirrhosis while other tests were statistically similar. Correlation with Fibroscan: EncephalApp OffTime (r=0.4, p<0.0001) and PHES Score (r=-0.4, p=0.003) were linked with kPa (Fig B/C). No correlation of kPa with SIP was seen. Regression: SIP physical: higher BDI (T-value 2.32, p=0.02), EncephalApp Offtime (2.80 p=0.006) and lower age (-2.59, p=0.01) were linked. SIP psychosocial: BDI (2.88, p=0.005) & EncephalApp Offtime (2.25, p=0.03) and BAI (4.09, p<0.0001) were linked. Cirrhosis status was not significant.

Conclusion: In a multi-center cohort of outpatients across the spectrum of CLD from F2 through compensated cirrhosis, we found that QOL was worse in pre-cirrhotic vs cirrhosis stages. Liver stiffness was linked with cognition, while QOL was correlated with mood disorders, which were higher in pre-cirrhotic stages. Mood disorders and impaired cognitive performance are independent determinants of QOL in a wider spectrum of CLD and should be elicited in all patients.