Altered Cognition and Patient-Reported Outcomes Predict 1-Year Hospitalization Risk in a Multicenter Outpatient...

The clinical characteristics of cirrhosis are changing, and many continue to have complications despite having a controlled etiology. In a contemporary cohort, patient-reported outcomes (PROs) and cognitive function were evaluated to assess their impact on the risk for future hospitalization.

A total of 1007 outpatients with cirrhosis (with a median Model for End-stage Liver Disease score of 11; 39% who were compensated; 61% who were decompensated; and all of whom had a controlled etiology where possible [no alcohol, hepatitis C virus sustained virologic response, suppressed hepatitis B virus]), were prospectively enrolled at 11 North American Consortium for the Study of End-Stage Liver Disease (NACSELD-3) centers. Clinical, comorbidity, and demographic data were captured. All patients underwent baseline and 6-month testing for the Short Form-36 (SF-36) and Stroop and were systematically followed for 1 year. Time-to-event regression with competing risks for death or transplant for all-cause, liver-related, and hepatic encephalopathy (HE)-related hospitalizations was performed.

By 1 year, one-third required hospitalization; two-thirds were liver-related, and one-quarter of liver-related admissions were HE-driven. On multivariable modeling, higher Stroop time and lower SF-36 general health score independently predicted all-cause (Stroop and SF-36, P < .001 each), liver-related (Stroop, P = .01; SF-36, P < .001), and HE-related (Stroop and SF-36, P = .02 each) hospitalizations. Adding Stroop and SF-36 to models with traditional risk factors significantly improved the concordance index across all outcomes (all P < .001) CONCLUSIONS: In an outpatient cohort with etiology-controlled cirrhosis with a median Model for End-stage Liver Disease score of 11, one-third required nonelective hospitalization by 1 year. PROs using SF-36 and cognitive performance measured by Stroop were independently additive to clinical parameters to predict future risk of all-cause, liver-related, and HE-related hospitalization. Routine assessment of cognition and PROs could improve holistic outpatient management and prognostication in cirrhosis.