Edmonton Symptom Assessment System is a Valid Tool to Measure Symptom Burden Among Decompensated Cirrhosis Patients (GP119)

Outcomes 1. Describe the psychometric properties of the revised Edmonton Symptom Assessment System among a longitudinal cohort of ambulatory patients with decompensated cirrhosis.2. Describe the contribution of symptom burden to health-related quality of life among a longitudinal cohort of ambulatory patients with decompensated cirrhosis. Key Message The revised Edmonton Symptom Assessment System (ESAS-r) was found to be a reliable and valid tool for longitudinally assessing symptom burden in a prospective cohort of 218 outpatients with decompensated cirrhosis. The ESAS-r can be used in clinical practice and clinical trials as a key outcome measure in cirrhosis care. Importance There is a growing need for interventions aimed at addressing physical and psychological symptom burden among patients with decompensated cirrhosis (DC). However, the lack of a validated symptom burden measure in this population is a critical barrier. Objective(s) This study investigated the psychometric properties of the revised Edmonton Symptom Assessment System (ESAS-r) in a longitudinal cohort of outpatients with DC. Scientific Methods Utilized Adult outpatients with DC were prospectively recruited from a single liver transplant center and completed the ESAS-r at baseline and at week 12. We examined the internal consistency reliability (Cronbach's alpha), structural validity (confirmatory factor analysis), known-groups validity (independent sample t-tests), and floor and ceiling effects. We assessed the convergent validity (Pearson correlations) and predictive validity (regression analysis) of ESAS-r with health-related quality of life (HRQOL) using the Short-Form Liver Disease Quality of Life (SF-LDQOL) questionnaire. Results From 7/2018-9/2022, 218 patients with DC (median age 60 years, median MELD-Na 16, 9% Child-Pugh A, 59% Child-Pugh B, 32% Child-Pugh C) completed baseline surveys; 122 completed week 12 surveys. Cronbach's alpha was 0.86, ESAS-r had strong model fit (comparative fit index 0.95), ESAS-r scores significantly increased with increasing disease severity (Child-Pugh A: 25.1 vs. Child-Pugh B: 37.5 vs. Child-Pugh C: 41.4, p=0.006), and there was a floor effect of 9% and ceiling effect of 0.5%. ESAS-r had strong correlation with SF-LDQOL (r= -0.67) and the change in ESAS-r score from baseline to week 12 was a significant predictor of change in SF-LDQOL score (β= -0.36, p< 0.001), accounting for 30% of the change. Conclusion(s) The ESAS-r is a reliable and valid tool for longitudinally assessing symptom burden in patients with DC and can predict changes in HRQOL. Impact Future directions include implementation of ESAS-r clinical practice and research as a key outcome measure in cirrhosis care.