Trajectories of symptom burden and associated factors in patients with liver cirrhosis: a prospective study

Liver cirrhosis is frequently accompanied by multiple concurrent symptoms that cluster together, resulting in a high symptom burden and impairments in patients' quality of life and functional status. However, most existing studies rely on cross-sectional or static observational designs, which limit the exploration of the temporal sequence and potential causal relationships among symptoms. This study aimed to identify trajectories of symptom burden in patients with liver cirrhosis and to explore predictors of trajectory heterogeneity using latent class growth modeling (LCGM).

A prospective longitudinal study was conducted from August 2023 to June 2024. A total of 223 hospitalized patients with liver cirrhosis were recruited from the Department of Infectious Diseases, a tertiary hospital in Zunyi, Guizhou Province, China, using convenience sampling. Data were collected at four time points-baseline (T₀, within 1 day of admission), 1 month (T₁), 3 months (T₂), and 6 months (T₃) after discharge-using a general information questionnaire and the Chinese version of the Memory Symptom Assessment Scale. Data were analyzed using SPSS 29.0 and Mplus 8.3.

Three distinct trajectories of symptom burden were identified: a high symptom-level risk group (C1, 12.56%), a moderate symptom-level decreasing group (C2, 36.32%), and a low symptom-level decreasing group (C3, 51.12%). Multinomial logistic regression analysis indicated that sex, average daily exercise duration, and Child-Pugh classification were significant predictors of trajectory membership (p < 0.05). Notably, one month after discharge appeared to be a critical turning point for patients transitioning to the high symptom-level risk trajectory.

The trajectories of symptom burden in patients with liver cirrhosis exhibit significant heterogeneity. Female sex, average daily exercise duration of less than 1 h, and Child-Pugh class C were associated with unfavorable symptom burden trajectories. Early identification of high-risk patients may help healthcare providers implement timely and targeted interventions to reduce symptom burden and improve clinical outcomes and quality of life.