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Depression in cirrhosis – a prospective evaluation of the prevalence, predictors and development of a screening nomogram
Author(s) -
BuganzaTorio Elizabeth,
Mitchell Nicholas,
Abraldes Juan G.,
Thomas Lesley,
Ma Mang,
Bailey Robert J.,
Tandon Puneeta
Publication year - 2019
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15068
Subject(s) - medicine , depression (economics) , cirrhosis , nomogram , anxiety , quality of life (healthcare) , odds ratio , hospital anxiety and depression scale , prospective cohort study , psychiatry , nursing , economics , macroeconomics
Summary Background Depression is associated with substantial morbidity and mortality in cirrhosis, but is underdiagnosed and undertreated. Aims Using the Mini International Neuropsychiatric Interview (MINI) as a gold‐standard, to determine prevalence, predictors, and outcomes of depression, and to develop a screening nomogram for use in cirrhosis patients. Methods Cirrhotic outpatients 18‐80 years of age, not on anti‐depressants, were consecutively recruited from liver clinics at three tertiary care hospitals. Baseline health‐related quality of life (HRQoL) and frailty were determined by the chronic liver disease questionnaire, EQ‐VAS, Clinical Frailty Scale and Fried Frailty Criteria. Depression was identified using the MINI and participants were followed up to 6 months to determine unplanned hospitalization/death. Results Of 305 patients, 62% were male; mean age 55(10) years; mean MELD 12.5(5), 61% Child Pugh B/C. Prevalence of depression 18% by MINI. Patients with depression had lower baseline HRQoL and higher frailty scores. Five independently predictive factors were used to develop a clinical nomogram for the diagnosis of clinical depression. These included three Hospital Anxiety and Depression Screening tool variables: “I have lost interest in my appearance” (adjusted odds ratio [aOR] 2.2, P = 0.006), “I look forward with enjoyment to things” (aOR 2.0, P = 0.02), “I feel cheerful” (aOR 2.8, P = 0.002), and two demographic variables: younger age (aOR 0.92, P = 0.001) and not being married or in a common‐law relationship (aOR 0.30, P = 0.008). Conclusions Depression is common in patients with cirrhosis. It has a significant impact on HRQoL and functional status. The developed clinical nomogram is promising for the rapid screening of depression in patients with cirrhosis.