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Ascites-Q symptom assessment questionnaire shows high validity

The Ascites-Q symptom assessment questionnaire demonstrated superior validity compared with two other ascites-specific questionnaires, according to recently published data.

“The accumulation of fluid within the peritoneal cavity increases intra-abdominal pressure leading to pressure-related symptoms such as shortness of breath, abdominal distension, and decreased quality of life (QoL),” Myrte Neijenhuis, MD, PhD, from the Radboud University Nijmegen Medical Centre, the Netherlands, and colleagues wrote. “Symptom and QoL assessment become important outcomes when survival is unchanged.”

Neijenhuis and colleagues developed the Ascites-Q with a modified version of the polycystic liver disease questionnaire and included the following symptoms: abdominal fullness, anorexia, early satiety, nausea, abdominal pain, back pain, dyspnea, reduced mobility, fatigue, insomnia and abdominal distension.

The study comprised 90 patients scheduled for large-volume paracentesis. Patients completed the Ascites-Q assessment, the Functional Assessment of Chronic Illness Therapy-Ascites Index (FACIT-AI), the Ascites Symptom Inventory-7 (ASI-7), and a Quality of Life Visual Analog Scale (QoL VAS) questionnaire before paracentesis.

Higher scores on the Ascites-Q (r = 0.477; P < .001), the FACIT-AI (r = 0.317; P = .007) and the ASI-7 (r = 0.34; P = .004) correlated with lower QoL VAS scores, but only the Ascites-Q showed convergent validity.

Follow-up data available from 61 patients showed that Ascites-Q scores decreased significantly after paracentesis (57 vs. 34 points; P < .001) and all symptoms except fatigue decreased after therapy. FACIT-AI scores also decreased significantly (44 vs. 33; P < .001), but five of 13 symptoms did not decrease significantly, including anorexia, insomnia, vomiting, urinary frequency and emotional distress.

In a subanalysis including 70 controls, the Ascites-Q (P = .003) and ASI-7 (P = .021) discriminated between controls without ascites and those with diuretic-sensitive ascites. The Ascites-Q (P < .001) and ASI-7 (P < .001) also discriminated between diuretic-sensitive ascites and refractory ascites. The FACIT-AI could differentiate between controls with diuretic-sensitive ascites and those with refractory ascites (P < .001), but not between controls without ascites and those with diuretic-sensitive ascites.

“It is important that ascites-specific questionnaires are able to distinguish symptoms directly related to ascites rather than symptoms related to cirrhosis,” the researchers wrote. “This study supports the use of the Ascites-Q and the ASI-7 score in determining symptomatic improvement in patients with ascites. The FACIT-AI has unfavorable properties to reliably measure symptoms in cirrhotic ascites.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.