Sex Differences in Patient-Reported Outcomes and Perception of Ascites Burden Among Outpatients With Decompensated Cirrhosis and Ascites

Abstract

INTRODUCTION: Perception of the ascites burden and its effects on quality of life may be different between sexes. This study assessed sex differences in perception of ascites burden and its impact on health-related quality of life (HRQoL) in patients with recurrent or refractory ascites. METHODS: The North American Consortium for the Study of End-stage Liver Disease prospectively enrolled outpatients with cirrhosis and large ascites requiring repeat large volume paracenteses. Demographics, laboratory results, comorbidities, medications, frailty measurements, and self-reported questionnaires related to functional status, physical activities, and HRQoL (generic 5 Short Form 36 and ascites specific 5 Ascites Questionnaire) were compared between sexes. RESULTS: In total, 392 men (59.6 6 10.7 years) and 184 women (59.5 6 11.1 years) with predominantly alcohol-related liver disease (51% and 43%, respectively) and median Model for End-Stage Liver Disease-Na: 13 were enrolled. Both groups had similar comorbidities and cirrhosis complications, ascites duration and severity, and frailty scores (P 5 0.94). Women had more symptoms related to their ascites (Ascites Questionnaire score 5 66 6 21 vs 60 6 21 in men, P 5 0.001) (higher value 5 feeling worse). 35% of women felt depressed vs 22% of men (P 5 0.0009), with lower mental but not physical functioning components of Short Form 36 (P 5 0.019). Women continued to conduct their daily activities as adequately as men as indicated by Duke Status Activity Index (P 5 0.27) and Godin Leisure Activity Index (P 5 0.47). DISCUSSION: Women with cirrhosis and ascites experienced worse emotional HRQoL than men without difference in daily function. Our analyses underscore the differences in the lived experience of women vs men with cirrhosis and highlight the need for patient-reported metrics to provide patient-centered care.