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

Kavish R Patidar; Leroy R Thacker; James B Wade; 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

doi:10.1007/s10620-017-4509-y

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

Dig Dis Sci. 2017 May;62(5):1173-1179. doi: 10.1007/s10620-017-4509-y. Epub 2017 Mar 3.

Authors

Affiliations

¹ Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, USA.
² Department of Biostatistics, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA.
³ Department of Psychiatry, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA.
⁴ Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, USA. jsbajaj@vcu.edu.

PMID: 28258378
DOI: 10.1007/s10620-017-4509-y

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.

Keywords: Cirrhosis; Healthcare-related quality of life; Hepatic encephalopathy; Patient-Reported Outcomes Measurement Information System; Patient-reported outcomes.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Diagnosis, Computer-Assisted*
Female
Health Status Indicators
Health Surveys*
Hospitalization*
Humans
Liver Cirrhosis / pathology*
Male
Middle Aged
Quality of Life
Risk Factors

Grants and funding

R01 DK058701/DK/NIDDK NIH HHS/United States