Hepatic Encephalopathy is the Key Driver of Symptom Burden in a Longitudinal Cohort of Patients With Advanced Chronic Liver Disease: PAL-LIVER Substudy.
Elliot B Tapper, Christopher D Woodrell, Mina Rakoski et al.
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In 30 seconds
This secondary analysis of the 19-site PAL-LIVER cluster-randomized trial examined symptom and caregiver-burden trajectories among patients with decompensated cirrhosis and/or hepatocellular carcinoma. Of 935 enrolled patients, 823 had hepatic encephalopathy (HE) information, and 368 had HE at baseline. Across assessments extending to 12 months, symptom-burden trajectories were stable. HE was the strongest and most consistent independent predictor of high burden, including overall symptoms (odds ratio 1.83, 95% CI 1.38-2.41), depression, and caregiver burden.
Key findings
- HE was associated with high overall symptom burden (Edmonton Symptom Assessment Scale odds ratio 1.83, 95% CI 1.38-2.41).
- HE was associated with depression (Patient Health Questionnaire-9 odds ratio 1.93, 95% CI 1.44-2.60).
- HE was associated with greater caregiver burden (Zarit Burden Interview-12 odds ratio 1.53, 95% CI 1.02-2.30).
- Symptom trajectories remained stable over 12 months; caregiver burden was generally low and stable.
Why it matters
The findings identify HE as a consistent marker of physical, psychological, and caregiver burden in advanced liver disease. Recognising this relationship may help clinicians assess symptoms and caregiver needs alongside HE, rather than focusing only on liver-disease severity. The stable trajectories also suggest that high-burden subgroups may remain in need of support over time.
What to keep in mind
This was a secondary analysis of a trial, and the reported associations do not establish that HE causes symptom or caregiver burden.