Undiagnosed anxiety present in 17% of patients with cirrhosis

Using a cirrhosis-centric model, researchers found a high prevalence for anxiety in patients with cirrhosis, according to a presentation at The Liver Meeting Digital Experience.

“The prevalence of anxiety on cirrhosis remains poorly established,” Kinjal Patel, MD, internal medicine resident at the University of Alberta in Canada, said during her presentation.

“In this study, we essentially used the Mini International Neuropsychiatric Interview to determine the prevalence of anxiety and its association with clinical outcomes in cirrhosis and develop a rapid cirrhosis-specific anxiety screening nomogram,” Patel said.

The researchers recruited 304 patients with cirrhosis aged 18 to 80 years from three tertiary care clinics in Alberta, Canada, to participate in the prospective study. Patients were screened for anxiety using the Hospital Anxiety and Depression Scale and diagnosed with anxiety using the Mini International Neuropsychiatric Interview. The researchers utilized the Chronic Liver Disease Questionnaire (CLDQ) and EQ-VAS score to determine the health-related quality of life. Patients were then followed for up to 6 months virtually to determine if any unplanned hospitalizations or deaths occurred.

Researchers diagnosed 17.1% with anxiety and 8.2% with undiagnosed comorbid depression. As compared to patients without anxiety, those with anxiety had a lower health-related quality of life as assessed by both CDLQ (3.61 vs. 4.96; P = .001) and EQ-VAS (51.8 vs. 65.2; P = .001) and a higher clinical frailty score (3.65 vs. 3.15; P = .004). Those with combined anxiety and depression compared with subjects with only anxiety or depression also had worse CLDQ (3.01 vs. 3.95; P = .001), EQ-VAS (48.6 vs. 54.7; P = .001) and clinical frailty scores (3.72 vs. 3.7; P = .001).

“Interestingly, there was no statistically significant difference in hospitalizations or death within 6 months between anxious and non-anxious groups. We postulate that that might be because there wasn’t enough study time. If had we potentially followed these patients for longer, we potentially may have seen a difference,” Patel said.

Through multivariable analysis, the study found active smoking and three Hospital Anxiety and Depression Scale subcomponents were independent predictors of anxiety, which were then used by researchers to develop an anxiety screening nomogram.

“We hope that the developed cirrhosis-specific nomogram can help rapidly screen for anxiety within the cirrhosis population and to help address gaps in diagnosis and treatment. This is especially relevant during the COVID-19 pandemic as we expect mental health disorders to increase in prevalence in the general population as well as their patients with cirrhosis,” Patel said.