Patient-reported and caregiver-reported outcomes in refractory ascites secondary to cirrhosis: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis examined patient- and caregiver-reported outcomes in refractory ascites (RA) secondary to advanced chronic liver disease. Sixteen articles included 1040 patients and 47 caregivers; pooled scores from SF-36 and CLDQ studies were compared with scores reported in stable cirrhosis outpatients. RA was associated with lower scores in several health-related quality-of-life domains, including SF-36 social functioning (mean difference -18.8 [95% CI: -30.2 to -7.3]) and CLDQ abdominal symptoms (-1.5 [-2.3 to -0.7]). The review also found limited use of validated outcome measures and sparse assessment of caregivers.

Key findings

• Compared with stable cirrhosis outpatients, SF-36 scores were lower in 3/8 domains, including social functioning (mean difference -18.8 [95% CI: -30.2 to -7.3]).
• CLDQ scores were lower in 4/6 domains, including abdominal symptoms (-1.5 [-2.3 to -0.7]).
• Sixteen articles included 1040 patients and 47 caregivers; only 2 studies assessed informal caregivers.
• Fourteen patient-reported outcome measures were used; the Ascites Questionnaire was validated in RA, while the SFLDQoL was used once.

Why it matters

The findings indicate that refractory ascites affects multiple aspects of health-related quality of life, not only physical symptoms. Yet inconsistent measures and limited validation make outcomes difficult to assess and compare, and caregiver experiences are poorly represented. Better-suited outcome tools could support more informative research and a fuller understanding of patient and caregiver burden.

What to keep in mind

The evidence base was limited: pooled domain scores came from only 4 SF-36 and 3 CLDQ studies, and just 2 studies assessed informal caregivers. The review also identified a lack of validated outcome measures for this cohort.