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Symptom Domain Groups of the Patient-Reported Outcomes Measurement Information System Tools Independently Predict Hospitalizations and Re-hospitalizations in Cirrhosis

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Abstract

Background

Patient-Reported Outcomes Measurement Information System (PROMIS) tools can identify health-related quality of life (HRQOL) domains that could differentially affect disease progression. Cirrhotics are highly prone to hospitalizations and re-hospitalizations, but the current clinical prognostic models may be insufficient, and thus studying the contribution of individual HRQOL domains could improve prognostication.

Aim

Analyze the impact of individual HRQOL PROMIS domains in predicting time to all non-elective hospitalizations and re-hospitalizations in cirrhosis.

Methods

Outpatient cirrhotics were administered PROMIS computerized tools. The first non-elective hospitalization and subsequent re-hospitalizations after enrollment were recorded. Individual PROMIS domains significantly contributing toward these outcomes were generated using principal component analysis. Factor analysis revealed three major PROMIS domain groups: daily function (fatigue, physical function, social roles/activities and sleep issues), mood (anxiety, anger, and depression), and pain (pain behavior/impact) accounted for 77% of the variability. Cox proportional hazards regression modeling was used for these groups to evaluate time to first hospitalization and re-hospitalization.

Results

A total of 286 patients [57 years, MELD 13, 67% men, 40% hepatic encephalopathy (HE)] were enrolled. Patients were followed at 6-month (mth) intervals for a median of 38 mths (IQR 22–47), during which 31% were hospitalized [median IQR mths 12.5 (3–27)] and 12% were re-hospitalized [10.5 mths (3–28)]. Time to first hospitalization was predicted by HE, HR 1.5 (CI 1.01–2.5, p = 0.04) and daily function PROMIS group HR 1.4 (CI 1.1–1.8, p = 0.01), independently. In contrast, the pain PROMIS group were predictive of the time to re-hospitalization HR 1.6 (CI 1.1–2.3, p = 0.03) as was HE, HR 2.1 (CI 1.1–4.3, p = 0.03).

Conclusions

Daily function and pain HRQOL domain groups using PROMIS tools independently predict hospitalizations and re-hospitalizations in cirrhotic patients.

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Abbreviations

HE:

Hepatic encephalopathy

MELD:

Model for End-Stage Liver Disease Health-Related Quality of Life (HRQOL)

PRO:

Patient-reported outcomes

PROMIS:

Patient-Reported Outcomes Measurement Information System

CAT:

Computerized adaptive measurement system

IRQ:

Interquartile range

HR:

Hazards ratio

CI:

Confidence interval

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Acknowledgments

This study was partly supported by the NIDDK RO1DK087013 and VA Merit Review Grant CX10076 awarded to Jasmohan S. Bajaj.

Author’s contributions

JSB contributed to study concept and design. LRT, JSB, and KRP analyzed the data. Manuscript preparation was carried out by KRP, JSB, and LRT. JSB, RKS, AJS, RTS, SM, MS, VL, MF, PP, MBW, AF, JBW, and EAG recruited the patients and conducted the study. Manuscript was reviewed by all the authors.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, USA

    Kavish R. Patidar, Melanie B. White, Edith A. Gavis, Andrew Fagan, Richard K. Sterling, Michael Fuchs, Mohammad S. Siddiqui, Scott Matherly, Richard T. Stravitz, Arun J. Sanyal, Puneet Puri, Velimir A. Luketic & Jasmohan S. Bajaj

  2. Department of Psychiatry, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA

    James B. Wade

  3. Department of Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA

    Leroy R. Thacker

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  1. Kavish R. Patidar
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Correspondence to Jasmohan S. Bajaj.

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Patidar, K.R., Thacker, L.R., Wade, J.B. et al. Symptom Domain Groups of the Patient-Reported Outcomes Measurement Information System Tools Independently Predict Hospitalizations and Re-hospitalizations in Cirrhosis. Dig Dis Sci 62, 1173–1179 (2017). https://doi.org/10.1007/s10620-017-4509-y

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