Wong Randi J, Loeb Rebecca, Seal Karen H, Barry Fawzy, Stark Kent Dorothea, Seetharaman Sri, Sharma Arjun, Lai Jennifer C, Rubin Jessica B
University of California, San Francisco, Department of Medicine San Francisco, CA.
University of South Florida Morsani College of Medicine, Department of Medicine Tampa, FL.
J Clin Gastroenterol. 2025;59(5):464-471. doi: 10.1097/MCG.0000000000002028. Epub 2024 Jul 16.
Patients with cirrhosis undergoing liver transplant evaluation have high rates of pain and mental health comorbidities; both may significantly impair health-related quality of life (HRQL). We investigated the association between pain, anxiety/depression, and HRQL in this population.
In 62 patients with cirrhosis undergoing liver transplant evaluation, we performed 4 validated assessments to characterize: pain (Brief Pain Inventory-Short Form, BPI-SF), anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-8), and liver-specific HRQL (Chronic Liver Disease Questionnaire). The presence of pain was determined using the BPI-SF screening question. Linear regression was used to identify demographic or clinical factors predictive of pain severity (PS) and interference (PI) and to evaluate the association between pain, anxiety/depression, and HRQL.
Seventy-one percent of patients reported pain, 26% had clinical depression, and 24% had moderate-severe anxiety. Neither liver disease severity, nor its complications were associated with pain (PS or PI), but anxiety and depression were predictors of pain on bivariate analysis. Only depression remained a significant predictor of PS ( b =0.28, P<0.05 ) and PI ( b =0.30, P <0.05) in multivariable models. HRQL was inversely associated with PS, PI, depression, and anxiety, but only anxiety ( b =-0.14, P =0.003) remained associated with HRQL in the adjusted model.
Pain is present in over 70% of patients with cirrhosis undergoing liver transplant evaluation. Anxiety and depression were highly correlated with pain and appeared to be key drivers in predicting poor HRQL. Evaluating and managing mental health comorbidities should be explored as a strategy to improve HRQL in patients with cirrhosis and pain.
接受肝移植评估的肝硬化患者疼痛和心理健康合并症发生率较高；两者均可能显著损害健康相关生活质量（HRQL）。我们调查了该人群中疼痛、焦虑/抑郁与HRQL之间的关联。
在62例接受肝移植评估的肝硬化患者中，我们进行了4项经过验证的评估，以表征：疼痛（简明疼痛问卷简表，BPI-SF）、焦虑（广泛性焦虑障碍量表-7）、抑郁（患者健康问卷-8）以及肝脏特异性HRQL（慢性肝病问卷）。使用BPI-SF筛查问题确定疼痛的存在。采用线性回归来识别预测疼痛严重程度（PS）和干扰（PI）的人口统计学或临床因素，并评估疼痛、焦虑/抑郁与HRQL之间的关联。
71%的患者报告有疼痛，26%有临床抑郁，24%有中度至重度焦虑。肝病严重程度及其并发症均与疼痛（PS或PI）无关，但在双变量分析中，焦虑和抑郁是疼痛的预测因素。在多变量模型中，只有抑郁仍然是PS（b =0.28，P<0.05）和PI（b =0.30，P <0.05）的显著预测因素。HRQL与PS、PI、抑郁和焦虑呈负相关，但在调整模型中，只有焦虑（b =-0.14，P =0.003）仍然与HRQL相关。
超过70%接受肝移植评估的肝硬化患者存在疼痛。焦虑和抑郁与疼痛高度相关，似乎是预测HRQL不佳的关键因素。应探索评估和管理心理健康合并症，作为改善肝硬化和疼痛患者HRQL的一种策略。
