Jessica B.. Rubin, MD, MPH1, Rebecca Loeb, MS2, Fawzy Barry, BS2, Sri Seetharaman, BS2, Arjun Sharma, MA2, Karen H.. Seal, MD, MPH3, Jennifer C.. Lai, MD, MBA2 1University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA; 2University of California San Francisco, San Francisco, CA; 3University of California San Francisco and San Francisco VA Health Care System, San Francisco, CA
Introduction: Patients awaiting liver transplant have high rates of pain and anxiety/depression, both of which impair health-related quality-of-life (HRQL). We sought to explore the association between pain, anxiety/depression, and HRQL in cirrhosis patients undergoing liver transplant evaluation.
Methods: Among 62 cirrhosis patients enrolled in an ongoing prospective cohort study (FrAILT), we performed 4 validated assessments to better characterize: pain (Brief Pain Inventory-Short Form, BPI-SF), anxiety (Generalize Anxiety Disorder-7, GAD-7), depression (Patient Health Questionnaire-8, PHQ-8), and liver-specific HRQL (Chronic Liver Disease Questionnaire, CLDQ). The BPI-SF is a well-validated survey that measures both severity of pain (severity subscale, PS) and the impact of pain on daily functions (interference subscale, PI). “Clinically significant pain” was a non-zero average of either PS or PI subscale. We used linear regression to identify demographic/clinical factors predictive of PS and PI, and to evaluate the association between pain, anxiety/depression, and HRQL.
Results: Median age of our cohort was 54 (IQR 45-63); 44% were female and 82% were White. 45% had alcohol-related cirrhosis, 23% had HCC, 65% had ascites, and 53% had HE. 79% of patients had clinically significant pain; among whom median PS was 4/10 (IQR 3-6) and PI was 3/10 (IQR 1-6). 26% were clinically depressed (PHQ-8≥10) and 24% reported moderate-severe anxiety (GAD-7≥10). Demographic factors associated with increased pain (higher PS, PI, or both) included: younger age (bPS=-0.07, bPI=-0.8 per yr), high school education or less (bPS=1.5, bPI=2.2), and lack of a committed relationship (bPS = 1.83). Clinical factors associated with PI included frailty (bPI=1.3) and alcohol (vs-HCV)-related cirrhosis (bPI = 3.4); none were associated with PS. Depression/anxiety were correlated with pain (PI: r=0.7, PS: r=0.5). Neither liver disease severity (i.e. MELD-Na) nor its complications (i.e. HE, ascites) were associated with PS or PI. On multivariable regression, only depression—but not PS or any other covariate—was significantly associated with lower HRQL (badj=-0.23).
Discussion: Pain is present in nearly 80% of cirrhosis patients undergoing liver transplant evaluation. Depression occurs in 1/4 of cirrhosis patients: it is highly correlated with pain and appears to be a key driver of diminished HRQL in this population. Thus, mental health interventions should be explored as strategies for improving HRQL in cirrhosis patients with pain.
Disclosures:
Jessica Rubin indicated no relevant financial relationships.
Rebecca Loeb indicated no relevant financial relationships.
Fawzy Barry indicated no relevant financial relationships.
Sri Seetharaman indicated no relevant financial relationships.
Arjun Sharma indicated no relevant financial relationships.
Karen Seal indicated no relevant financial relationships.
Jennifer Lai: Flagship Pioneering – Grant/Research Support. Genfit – Consultant. Novo Nordisk – Advisory Committee/Board Member. Pliant – Grant/Research Support.
Jessica B.. Rubin, MD, MPH1, Rebecca Loeb, MS2, Fawzy Barry, BS2, Sri Seetharaman, BS2, Arjun Sharma, MA2, Karen H.. Seal, MD, MPH3, Jennifer C.. Lai, MD, MBA2, 43, The Complex Relationship Between Pain, Mental Health, and Quality-Of-Life in Cirrhosis Patients Awaiting Liver Transplant, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
