Influence of psychiatric comorbidities on outcomes in cirrhosis: A propensity-matched cohort analysis

Cirrhosis is a progressive liver disease associated with high morbidity and reduced quality of life. Mood disorders are common in chronic liver disease and may worsen outcomes through inflammation, poor adherence and reduced care engagement. Their specific impact on cirrhosis outcomes, however, remains unclear.

Using the TriNetX global research network, we conducted a retrospective cohort study of adults with cirrhosis, comparing those with comorbid mood disorders to those without. Propensity score matching (1:1) was performed using demographic variables. Outcomes included variceal bleeding, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, hepatorenal syndrome, liver transplantation, and all-cause mortality.

After matching, cirrhotic patients with mood disorders had significantly higher complication rates than controls, including varices (RR 1.19), ascites (RR 1.13), SBP (RR 1.40), hepatic encephalopathy (RR 1.52), and hepatorenal syndrome (RR 1.34) (all p<0.001). They were also more likely to undergo liver transplantation (RR 1.76) and had a modest increase in all-cause mortality (RR 1.06).

Mood disorders in cirrhosis are associated with increased decompensation, transplant utilization, and mortality, highlighting the need for integrated psychiatric care and further prospective evaluation.