Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing

Jonathan G. Stine, George J. Stukenborg, Jennifer Wang, Alden Adkins, Blake Niccum, Alex Zimmet, Curtis K. Argo

Research output: Contribution to journalArticle

Abstract

Introduction and objectives: Liver transplantation candidates are among the most comorbid patients awaiting lifesaving intervention. Health related quality of life (HRQOL) measured by instruments that incorporate dynamic computerized adaptive testing, could improve their assessment. We aimed to determine the feasibility of administration of the Patient-Reported Outcomes Measurement Information System (PROMIS-CAT) in liver transplant candidates. Materials and methods: Liver transplantation candidates were prospectively enrolled following a review of their available medical history. Subjects were given a tablet computer (iPad) to access the pre-loaded PROMIS CAT. Results: 109 candidates with mean age 55.6 ± 8.6 years were enrolled in this pilot study. Mean MELD-Na score was 16.3 ± 6.3; 92.6% had decompensated liver disease. Leading etiologies of cirrhosis included hepatitis C (34.8%), nonalcoholic steatohepatitis (25.7%) and alcohol (21.1%). Subjects with MELD-Na score > 20 had the most significant impairment in HRQOL (anxiety/fear + 5.9 ± 2.7, p = 0.0289, depression + 5.1 ± 2.5, p = 0.0428, fatigue + 4.3 ± 2.6, p = 0.0973) and physical impairment (−7.8 ± 2.5, p = 0.0022). Stage of cirrhosis and decompensated liver disease were predictive of impaired HRQOL but Child–Pugh Turcotte score was not. Hepatic encephalopathy was the strongest independent predictor of impaired HRQOL, with significant impairment across all domains of health. Conclusions: Liver transplant candidates have significantly impaired HRQOL across multiple domains of health as measured by PROMIS-CAT. HRQOL impairment parallels disease severity. Future study is needed to determine how best HRQOL could be systematically included in liver transplantation listing policy, especially in those candidates with hepatic encephalopathy.

Original languageEnglish (US)
Pages (from-to)62-68
Number of pages7
JournalAnnals of Hepatology
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Quality of Life
Transplants
Liver
Health
Liver Transplantation
Hepatic Encephalopathy
Liver Diseases
Fibrosis
Handheld Computers
Hepatitis C
Information Systems
Fear
Fatigue
Anxiety
Alcohols
Depression

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

Stine, Jonathan G. ; Stukenborg, George J. ; Wang, Jennifer ; Adkins, Alden ; Niccum, Blake ; Zimmet, Alex ; Argo, Curtis K. / Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing. In: Annals of Hepatology. 2020 ; Vol. 19, No. 1. pp. 62-68.
@article{58766866e3374a51a9ececbdaf53dd5e,
title = "Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing",
abstract = "Introduction and objectives: Liver transplantation candidates are among the most comorbid patients awaiting lifesaving intervention. Health related quality of life (HRQOL) measured by instruments that incorporate dynamic computerized adaptive testing, could improve their assessment. We aimed to determine the feasibility of administration of the Patient-Reported Outcomes Measurement Information System (PROMIS-CAT) in liver transplant candidates. Materials and methods: Liver transplantation candidates were prospectively enrolled following a review of their available medical history. Subjects were given a tablet computer (iPad) to access the pre-loaded PROMIS CAT. Results: 109 candidates with mean age 55.6 ± 8.6 years were enrolled in this pilot study. Mean MELD-Na score was 16.3 ± 6.3; 92.6{\%} had decompensated liver disease. Leading etiologies of cirrhosis included hepatitis C (34.8{\%}), nonalcoholic steatohepatitis (25.7{\%}) and alcohol (21.1{\%}). Subjects with MELD-Na score > 20 had the most significant impairment in HRQOL (anxiety/fear + 5.9 ± 2.7, p = 0.0289, depression + 5.1 ± 2.5, p = 0.0428, fatigue + 4.3 ± 2.6, p = 0.0973) and physical impairment (−7.8 ± 2.5, p = 0.0022). Stage of cirrhosis and decompensated liver disease were predictive of impaired HRQOL but Child–Pugh Turcotte score was not. Hepatic encephalopathy was the strongest independent predictor of impaired HRQOL, with significant impairment across all domains of health. Conclusions: Liver transplant candidates have significantly impaired HRQOL across multiple domains of health as measured by PROMIS-CAT. HRQOL impairment parallels disease severity. Future study is needed to determine how best HRQOL could be systematically included in liver transplantation listing policy, especially in those candidates with hepatic encephalopathy.",
author = "Stine, {Jonathan G.} and Stukenborg, {George J.} and Jennifer Wang and Alden Adkins and Blake Niccum and Alex Zimmet and Argo, {Curtis K.}",
year = "2020",
month = "1",
day = "1",
doi = "10.1016/j.aohep.2019.06.018",
language = "English (US)",
volume = "19",
pages = "62--68",
journal = "Annals of Hepatology",
issn = "1665-2681",
publisher = "Mexican Association of Hepatology",
number = "1",

}

Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing. / Stine, Jonathan G.; Stukenborg, George J.; Wang, Jennifer; Adkins, Alden; Niccum, Blake; Zimmet, Alex; Argo, Curtis K.

In: Annals of Hepatology, Vol. 19, No. 1, 01.01.2020, p. 62-68.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Liver transplant candidates have impaired quality of life across health domains as assessed by computerized testing

AU - Stine, Jonathan G.

AU - Stukenborg, George J.

AU - Wang, Jennifer

AU - Adkins, Alden

AU - Niccum, Blake

AU - Zimmet, Alex

AU - Argo, Curtis K.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Introduction and objectives: Liver transplantation candidates are among the most comorbid patients awaiting lifesaving intervention. Health related quality of life (HRQOL) measured by instruments that incorporate dynamic computerized adaptive testing, could improve their assessment. We aimed to determine the feasibility of administration of the Patient-Reported Outcomes Measurement Information System (PROMIS-CAT) in liver transplant candidates. Materials and methods: Liver transplantation candidates were prospectively enrolled following a review of their available medical history. Subjects were given a tablet computer (iPad) to access the pre-loaded PROMIS CAT. Results: 109 candidates with mean age 55.6 ± 8.6 years were enrolled in this pilot study. Mean MELD-Na score was 16.3 ± 6.3; 92.6% had decompensated liver disease. Leading etiologies of cirrhosis included hepatitis C (34.8%), nonalcoholic steatohepatitis (25.7%) and alcohol (21.1%). Subjects with MELD-Na score > 20 had the most significant impairment in HRQOL (anxiety/fear + 5.9 ± 2.7, p = 0.0289, depression + 5.1 ± 2.5, p = 0.0428, fatigue + 4.3 ± 2.6, p = 0.0973) and physical impairment (−7.8 ± 2.5, p = 0.0022). Stage of cirrhosis and decompensated liver disease were predictive of impaired HRQOL but Child–Pugh Turcotte score was not. Hepatic encephalopathy was the strongest independent predictor of impaired HRQOL, with significant impairment across all domains of health. Conclusions: Liver transplant candidates have significantly impaired HRQOL across multiple domains of health as measured by PROMIS-CAT. HRQOL impairment parallels disease severity. Future study is needed to determine how best HRQOL could be systematically included in liver transplantation listing policy, especially in those candidates with hepatic encephalopathy.

AB - Introduction and objectives: Liver transplantation candidates are among the most comorbid patients awaiting lifesaving intervention. Health related quality of life (HRQOL) measured by instruments that incorporate dynamic computerized adaptive testing, could improve their assessment. We aimed to determine the feasibility of administration of the Patient-Reported Outcomes Measurement Information System (PROMIS-CAT) in liver transplant candidates. Materials and methods: Liver transplantation candidates were prospectively enrolled following a review of their available medical history. Subjects were given a tablet computer (iPad) to access the pre-loaded PROMIS CAT. Results: 109 candidates with mean age 55.6 ± 8.6 years were enrolled in this pilot study. Mean MELD-Na score was 16.3 ± 6.3; 92.6% had decompensated liver disease. Leading etiologies of cirrhosis included hepatitis C (34.8%), nonalcoholic steatohepatitis (25.7%) and alcohol (21.1%). Subjects with MELD-Na score > 20 had the most significant impairment in HRQOL (anxiety/fear + 5.9 ± 2.7, p = 0.0289, depression + 5.1 ± 2.5, p = 0.0428, fatigue + 4.3 ± 2.6, p = 0.0973) and physical impairment (−7.8 ± 2.5, p = 0.0022). Stage of cirrhosis and decompensated liver disease were predictive of impaired HRQOL but Child–Pugh Turcotte score was not. Hepatic encephalopathy was the strongest independent predictor of impaired HRQOL, with significant impairment across all domains of health. Conclusions: Liver transplant candidates have significantly impaired HRQOL across multiple domains of health as measured by PROMIS-CAT. HRQOL impairment parallels disease severity. Future study is needed to determine how best HRQOL could be systematically included in liver transplantation listing policy, especially in those candidates with hepatic encephalopathy.

UR - http://www.scopus.com/inward/record.url?scp=85072383755&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072383755&partnerID=8YFLogxK

U2 - 10.1016/j.aohep.2019.06.018

DO - 10.1016/j.aohep.2019.06.018

M3 - Article

C2 - 31558420

AN - SCOPUS:85072383755

VL - 19

SP - 62

EP - 68

JO - Annals of Hepatology

JF - Annals of Hepatology

SN - 1665-2681

IS - 1

ER -