Patient-Reported Outcome Screens for Cognitive Dysfunction and Predicts Admissions in Cirrhosis

Introduction. Hepatic encephalopathy (HE) is a frequent complication of cirrhosis, leading to preventable hospitalizations and increased mortality. Despite the availability of validated neuropsychometric tests to diagnose HE, only 10% of clinicians regularly screen for HE due to lack of time, equipment, and trained personnel. Materials and Methods. We studied the association between patient-reported cognitive function and the National Institutes of Health Toolbox Cognition Battery (a validated measure of HE) in patients with cirrhosis. A single-center prospective study of adult patients undergoing liver transplantation evaluation was performed from 10/2020 to 12/2021. Cognition was assessed using the National Institutes of Health Toolbox Cognition Battery and a brief Patient-Reported Outcomes Measurement Information System (PROMIS) survey. Results. Twenty-three liver transplantation candidates were enrolled; the mean age was 56.4 (+/- 9.7) +/- 9.7) years, 39% were female and the most common etiologies of cirrhosis were primary biliary cirrhosis/primary sclerosing cholangitis/overlap syndrome (30%), hepatitis C (22%) and alcohol- associated liver disease (22%). The mean MELD-Na was 14.9 (+/- 6.4). +/- 6.4). The mean PROMIS Cognitive Function T-score (PROMISCF) CF ) was 49.2 (+/- 9.6). +/- 9.6). The mean T-scores for the List Sort Working Memory test, Flanker Inhibitory Control and Attention test, and Pattern Comparison Processing Speed test were 46.4 (+/- 9.9), +/- 9.9), 37.8 (+/- 6.2), +/- 6.2), and 50.22 (+/- 16.4), +/- 16.4), respectively. PROMISCF CF correlated with the List Sort Working Memory test (r r = 0.45, P = .03). The mean hospitalization rate was 1.6 days admitted per month. On adjusted multivariate analysis, PROMISCF CF predicted total hospitalization days (P P < .001), hospital admissions (P P = .01), and hospitalization rate (P P < .001). Conclusions. A brief survey can screen for HE and predict hospitalizations in patients with cirrhosis.