Altered cognition and patient-reported outcomes predict 1-year hospitalization risk in a multi-center outpatient cirrhosis cohort.

Authors

Jasmohan S Bajaj, Jacqueline G O'Leary, Jennifer C Lai, Puneeta Tandon, Florence Wong, Guadalupe Garcia-Tsao, Scott W Biggins, Philip Vutien, Hugo E Vargas, Patrick S Kamath, Jawaid Shaw, Tahira Shaikh, Stefanie Tsai, Dorothea Kent, Daniela Goyes, Brian J Bush, Scott Silvey, K Rajender Reddy

Published in

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Sep 25, 2026. Epub Sep 25, 2026.

Abstract

The clinical characteristics of cirrhosis are changing, and many continue to have complications despite having a controlled etiology. In a contemporary cohort, patient reported outcomes (PROs) and cognitive function were evaluated to assess their impact on risk for future hospitalization.
1007 outpatients with cirrhosis, median MELD 11, 39% compensated, 61% decompensated, all controlled etiology where possible (no alcohol, HCV SVR, suppressed HBV), were prospectively enrolled at 11 NACSELD-3 (North American Consortium for the Study of End-Stage Liver Disease) centers. Clinical, comorbidity and demographic data were captured. All patients underwent baseline and 6-month testing for SF-36 and Stroop and were systematically followed for 1-year. Time-to-event regression with competing risks for death/transplant for all-cause, liver-related, and HE-related hospitalizations was performed. By 1-year, one-third required hospitalization; two-thirds were liver-related, and one quarter of liver-related admissions were hepatic encephalopathy (HE)-driven. On multivariable modeling, higher Stroop time and lower SF-36 general health score independently predicted all-cause (Stroop/SF-36,p<0.001 each), liver-related (Stroop, p=0.01, SF-36, p<0.001) and HE-related (Stroop/SF-36, p=0.02 each) hospitalizations. Adding Stroop and SF-36 to models with traditional risk factors significantly improved C-index across all outcomes (all p<0.001).
In an outpatient cohort with etiology-controlled cirrhosis with a median MELD of 11, one-third required non-elective hospitalization by 1-year. PROs using SF-36 and cognitive performance measured by Stroop were independently additive to clinical parameters to predict future risk of all-cause, liver-related and HE-related hospitalization. Routine assessment of cognition and PROs could improve holistic outpatient management and prognostication in cirrhosis.

PMID:
42790836
Bibliographic data and abstract were imported from PubMed on 26 Sep 2026.

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