Development and Predictive Validity of the Cirrhosis-associated Ascites Symptom Scale: A Cohort Study of 103 Patients

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2018 Apr 25

PMID 29686472

Citations 2

Authors

Agnete Nordheim Riedel

Nina Kimer

Anne-Sofie Houlberg Jensen

Emilie Kristine Dahl

Mads Israelsen

Luise Aamann

Lise Lotte Gluud

Affiliations

Soon will be listed here.

Abstract

Aim: To develop a scale of domains associated with the health-related quality-of-life (HRQOL) in patients with cirrhosis-related ascites.

Methods: We initially undertook literature searches and a qualitative study in order to design a cirrhosis-associated ascites symptom (CAS) scale describing symptoms with a potential detrimental impact on health related quality of life (HRQL) (the higher the score, the worse the symptoms). Discriminatory validity was assessed in a validation cohort including cirrhotic patients with (1) tense/severe; (2) moderate/mild; or (3) no ascites (controls). Patients also completed chronic liver disease questionnaire (CLDQ) and the EuroQoL 5-Dimensions 5-Level (EQ-5D-5L) questionnaire evaluating HRQL. The relation between scale scores was analysed using Spearman correlations.

Results: The final CAS scale included 14 items. The equivalent reliability was high (Chronbach's alpha 0.88). The validation cohort included 103 patients (72% men, mean age 62.4 years). The mean scores for each question in the CAS scale were higher for patients with severe/tense ascites than for mild/moderate ascites and controls. Compared with controls (mean = 9.9 points), the total CAS scale score was higher for severe/tense ascites (mean = 23.8 points) as well as moderate/mild ascites (mean = 18.6 points) ( < 0.001 both groups). We found a strong correlation between the total CAS and CLDQ score (rho = 0.82, < 0.001) and a moderate correlation between the CAS and the EQ-5D-5L score (0.67, < 0.001).

Conclusion: The CAS is a valid tool, which reflects HRQOL in patients with ascites.

Citing Articles

Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series.

Kimer N, Riedel A, Hobolth L, Mortensen C, Madsen L, Andersen M Medicina (Kaunas). 2020; 56(11).

PMID: 33121063 PMC: 7692861. DOI: 10.3390/medicina56110565.

A survey of practice in management of malignancy-related ascites in Japan.

Kanai Y, Ishiki H, Maeda I, Iwase S PLoS One. 2019; 14(8):e0220869.

PMID: 31398238 PMC: 6688816. DOI: 10.1371/journal.pone.0220869.

References

Sola E, Watson H, Graupera I, Turon F, Barreto R, Rodriguez E . Factors related to quality of life in patients with cirrhosis and ascites: relevance of serum sodium concentration and leg edema. J Hepatol. 2012; 57(6):1199-206. DOI: 10.1016/j.jhep.2012.07.020. View

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011; 20(10):1727-36. PMC: 3220807. DOI: 10.1007/s11136-011-9903-x. View

Ahluwalia V, Heuman D, Feldman G, Wade J, Thacker L, Gavis E . Correction of hyponatraemia improves cognition, quality of life, and brain oedema in cirrhosis. J Hepatol. 2014; 62(1):75-82. PMC: 4272614. DOI: 10.1016/j.jhep.2014.07.033. View

Les I, Doval E, Flavia M, Jacas C, Cardenas G, Esteban R . Quality of life in cirrhosis is related to potentially treatable factors. Eur J Gastroenterol Hepatol. 2009; 22(2):221-7. DOI: 10.1097/MEG.0b013e3283319975. View

Hauser W, Schnur M, Steder-Neukamm U, Muthny F, Grandt D . Validation of the German version of the Chronic Liver Disease Questionnaire. Eur J Gastroenterol Hepatol. 2004; 16(6):599-606. DOI: 10.1097/00042737-200406000-00014. View

Thiele M, Askgaard G, Timm H, Hamberg O, Gluud L . Predictors of health-related quality of life in outpatients with cirrhosis: results from a prospective cohort. Hepat Res Treat. 2014; 2013:479639. PMC: 3896069. DOI: 10.1155/2013/479639. View

Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C . Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology. 2001; 120(1):170-8. DOI: 10.1053/gast.2001.21193. View

Sogaard R, Christensen F, Videbaek T, Bunger C, Christiansen T . Interchangeability of the EQ-5D and the SF-6D in long-lasting low back pain. Value Health. 2009; 12(4):606-12. DOI: 10.1111/j.1524-4733.2008.00466.x. View

. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16(3):199-208. DOI: 10.1016/0168-8510(90)90421-9. View

10.

Bajaj J, Wade J, Gibson D, Heuman D, Thacker L, Sterling R . The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol. 2011; 106(9):1646-53. PMC: 3989143. DOI: 10.1038/ajg.2011.157. View

11.

Younossi Z, Guyatt G, Kiwi M, Boparai N, King D . Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut. 1999; 45(2):295-300. PMC: 1727607. DOI: 10.1136/gut.45.2.295. View

12.

Gines P, Cardenas A, Arroyo V, Rodes J . Management of cirrhosis and ascites. N Engl J Med. 2004; 350(16):1646-54. DOI: 10.1056/NEJMra035021. View

13.

Gines P, Quintero E, Arroyo V, Teres J, Bruguera M, Rimola A . Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987; 7(1):122-8. DOI: 10.1002/hep.1840070124. View

14.

Linde L, Sorensen J, Ostergaard M, Horslev-Petersen K, Hetland M . Health-related quality of life: validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol. 2008; 35(8):1528-37. View

15.

Younossi Z, Boparai N, Price L, Kiwi M, McCormick M, Guyatt G . Health-related quality of life in chronic liver disease: the impact of type and severity of disease. Am J Gastroenterol. 2001; 96(7):2199-205. DOI: 10.1111/j.1572-0241.2001.03956.x. View

16.

Prasad S, Dhiman R, Duseja A, Chawla Y, Sharma A, Agarwal R . Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology. 2007; 45(3):549-59. DOI: 10.1002/hep.21533. View

17.

Ong J, Oehler G, Kruger-Jansen C, Lambert-Baumann J, Younossi Z . Oral L-ornithine-L-aspartate improves health-related quality of life in cirrhotic patients with hepatic encephalopathy: an open-label, prospective, multicentre observational study. Clin Drug Investig. 2011; 31(4):213-20. DOI: 10.2165/11586700-000000000-00000. View

18.

Rojas-Loureiro G, Servin-Caamano A, Perez-Reyes E, Servin-Abad L, Higuera-De La Tijera F . Malnutrition negatively impacts the quality of life of patients with cirrhosis: An observational study. World J Hepatol. 2017; 9(5):263-269. PMC: 5316846. DOI: 10.4254/wjh.v9.i5.263. View

19.

Haraguchi M, Miyaaki H, Ichikawa T, Shibata H, Honda T, Ozawa E . Glucose fluctuations reduce quality of sleep and of life in patients with liver cirrhosis. Hepatol Int. 2016; 11(1):125-131. DOI: 10.1007/s12072-016-9762-1. View

20.

Sidhu S, Goyal O, Mishra B, Sood A, Chhina R, Soni R . Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy (the RIME Trial). Am J Gastroenterol. 2010; 106(2):307-16. DOI: 10.1038/ajg.2010.455. View