Background & aims

Patients with decompensated liver disease have been categorized by disease severity. This analysis sought to classify patients with end-stage liver disease based on symptoms rather than disease state and to identify distinct severity classes of physical and psychological symptoms.

Methods

Patients with a model for end-stage liver disease-sodium score of 15 or higher were recruited from liver clinics in 2 health care organizations. They completed the Condensed Memorial Symptom Assessment Scale, Revised Ways of Coping Checklist, Patient Health Questionnaire, Life Orientation Test-Revised, and the Short-Form Health Survey. Cross-sectional data were analyzed using latent class mixture modeling.

Results

The sample (N = 191; age, 56.6 ± 11.1 y; 33.5% ETOH; 28.3% nonalcoholic fatty liver disease; 13.1% autoimmune/primary biliary cholangitis/primary sclerosing cholangitis) was predominantly male (64.2%), Child–Turcotte–Pugh class C (49.5%), with an average model for end-stage liver disease-sodium score of 18.7 ± 4.9. Three distinct classes of symptoms were identified, as follows: mild (26.7%), moderate (41.4%), or severe (31.9%) symptoms. Symptom classes were independent of disease severity and demographic characteristics, except age. All Condensed Memorial Symptom Assessment Scale symptoms and Patient Health Questionnaire scores were significantly different across the 3 classes (P < .05). The symptom classes also differed significantly in physical and mental quality of life, optimism, and avoidance coping behaviors (all P < .001).

Conclusions

Patient-reported symptom severity occurred independent of disease severity, contrary to common assumptions. Focusing on the moderate and severe symptom classes as well as patient history of end-stage liver disease complications may enhance providers' ability to improve symptom management for this population.

中文翻译：

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失代偿性肝病的症状分类

背景与目标

失代偿性肝病患者已按疾病严重程度分类。该分析旨在根据症状而非疾病状态对终末期肝病患者进行分类，并确定不同严重程度的身体和心理症状类别。

方法

从 2 个医疗保健机构的肝脏诊所招募了终末期肝病模型 - 钠评分为 15 或更高的患者。他们完成了简明纪念症状评估量表、修订的应对方式清单、患者健康问卷、修订的生活取向测试和简短的健康调查。使用潜在类混合模型分析横截面数据。

结果

样本（N = 191；年龄，56.6 ± 11.1 岁；33.5% ETOH；28.3% 非酒精性脂肪肝；13.1% 自身免疫/原发性胆汁性胆管炎/原发性硬化性胆管炎）主要是男性（64.2%），Child-Turcotte-Pugh C 级（49.5%），终末期肝病模型的平均钠评分为 18.7 ± 4.9。确定了三种不同类别的症状，如下所示：轻度 (26.7%)、中度 (41.4%) 或重度 (31.9%) 症状。除年龄外，症状类别与疾病严重程度和人口统计学特征无关。所有简明纪念症状评估量表症状和患者健康问卷评分在 3 个班级之间存在显着差异（P< .05)。症状类别在身心生活质量、乐观和回避应对行为方面也存在显着差异（所有P < .001）。

结论

与常见假设相反，患者报告的症状严重程度与疾病严重程度无关。关注中度和重度症状类别以及终末期肝病并发症的患者病史可能会提高提供者改善该人群症状管理的能力。