Hugo M Oliveira, Filipa Ribeiro, Graça Lopes, Eliana Frias, Filipe Andrade, Verónica Guiomar, Eduardo Eiras, Francisca Rego, Rui Nunes
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Despite the poor prognosis and significant symptom burden, palliative care integration remains limited.</p><p><strong>Objectives: </strong>To assess the symptom burden in ESLD patients, the viability of applying a symptom scale in routine evaluations, and to assess the impact of palliative care on symptom management.</p><p><strong>Design: </strong>Observational, prospective cohort study.</p><p><strong>Methods: </strong>We prospectively included patients with chronic liver disease following their first episode of decompensation or diagnosis of hepatocarcinoma (HCC). Data collected included patient demographics, ESLD etiology, history of decompensation, and patient-reported symptom burden. Two-sided tests were used to identify factors of disease severity and evaluate the benefits of palliative care intervention.</p><p><strong>Results: </strong>Forty-four patients were assessed, divided into two cohorts: palliative care cohort (52.3%; <i>n</i> = 23) and hepatology care cohort (47.7%; <i>n</i> = 21). Patients in the palliative care cohort were older (69.35 ± 11.71 vs 59.86 ± 7.11 years; <i>p</i> = 0.002), had lower functional status (59.13 ± 2.51 vs 72.38 ± 2.92; <i>p</i> = 0.002), and higher prevalence of unstable decompensated cirrhosis (60.9% vs 28.6%; <i>p</i> = 0.043) and HCC (<i>p</i> < 0.001). This cohort reported a higher overall symptom burden, with rates of 82.6% for asthenia, 65.2% for pain, and 56.5% for anorexia. Palliative care interventions tended to reduce the prevalence of pain, anorexia, and dyspnea, with a significant decrease in pain intensity from 86.7% to 23.1% (<i>p</i> = 0.008) and asthenia intensity from 100% to 84.2% (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Significant differences in symptom prevalence were observed between the two cohorts, likely due to specific clinical characteristics of each group. The use of a symptom assessment scale proved to be simple and effective, revealing a high prevalence of symptoms. 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引用次数: 0
摘要
背景：肝脏疾病是发病率和死亡率的主要原因。终末期肝病（ESLD）患者会出现多种身体症状。尽管预后不良和显著的症状负担，姑息治疗整合仍然有限。目的：评估ESLD患者的症状负担，在常规评估中应用症状量表的可行性，并评估姑息治疗对症状管理的影响。设计：观察性、前瞻性队列研究。方法：我们前瞻性地纳入首次失代偿发作或诊断为肝癌（HCC）的慢性肝病患者。收集的数据包括患者人口统计学、ESLD病因学、失代偿史和患者报告的症状负担。采用双侧检验来确定疾病严重程度的因素，并评估姑息治疗干预的益处。结果：44例患者被评估，分为两组：姑息治疗组（52.3%）；N = 23)和肝病护理队列(47.7%；n = 21)。姑息治疗组患者年龄较大（69.35±11.71 vs 59.86±7.11岁）；P = 0.002)，功能状态较低(59.13±2.51 vs 72.38±2.92；P = 0.002)，不稳定失代偿期肝硬化患病率较高(60.9% vs 28.6%；p = 0.043)和HCC (p = 0.008)，虚弱程度从100%到84.2% (p结论：两组之间的症状患病率存在显著差异，可能与每组特定的临床特征有关。使用症状评估量表被证明是简单有效的，揭示了症状的高患病率。姑息治疗与症状管理的积极影响相关。试验注册：NCT06181474。
Symptom burden in end-stage liver disease: a prospective cohort study of the symptoms experienced by patients and the role of palliative care.
Background: Liver disease is a leading cause of morbidity and mortality. Patients with end-stage liver disease (ESLD) experience multiple physical symptoms. Despite the poor prognosis and significant symptom burden, palliative care integration remains limited.
Objectives: To assess the symptom burden in ESLD patients, the viability of applying a symptom scale in routine evaluations, and to assess the impact of palliative care on symptom management.
Design: Observational, prospective cohort study.
Methods: We prospectively included patients with chronic liver disease following their first episode of decompensation or diagnosis of hepatocarcinoma (HCC). Data collected included patient demographics, ESLD etiology, history of decompensation, and patient-reported symptom burden. Two-sided tests were used to identify factors of disease severity and evaluate the benefits of palliative care intervention.
Results: Forty-four patients were assessed, divided into two cohorts: palliative care cohort (52.3%; n = 23) and hepatology care cohort (47.7%; n = 21). Patients in the palliative care cohort were older (69.35 ± 11.71 vs 59.86 ± 7.11 years; p = 0.002), had lower functional status (59.13 ± 2.51 vs 72.38 ± 2.92; p = 0.002), and higher prevalence of unstable decompensated cirrhosis (60.9% vs 28.6%; p = 0.043) and HCC (p < 0.001). This cohort reported a higher overall symptom burden, with rates of 82.6% for asthenia, 65.2% for pain, and 56.5% for anorexia. Palliative care interventions tended to reduce the prevalence of pain, anorexia, and dyspnea, with a significant decrease in pain intensity from 86.7% to 23.1% (p = 0.008) and asthenia intensity from 100% to 84.2% (p < 0.001).
Conclusion: Significant differences in symptom prevalence were observed between the two cohorts, likely due to specific clinical characteristics of each group. The use of a symptom assessment scale proved to be simple and effective, revealing a high prevalence of symptoms. Palliative care was associated with a positive impact on symptom management.
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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