Development and predictive validity of the cirrhosis-associated ascites symptom scale: A cohort study of 103 patients

Abstract

AIMTo develop a scale of domains associated with the health-related quality-of-life (HRQOL) in patients with cirrhosis-related ascites.METHODSWe initially undertook literature searches and a qualitative study in order to design a cirrhosis-associated ascites symptom (CAS) scale describing symptoms with a potential detrimental impact on health related quality of life (HRQL) (the higher the score, the worse the symptoms). Discriminatory validity was assessed in a validation cohort including cirrhotic patients with (1) tense/severe; (2) moderate/mild; or (3) no ascites (controls). Patients also completed chronic liver disease questionnaire (CLDQ) and the EuroQoL 5-Dimensions 5-Level (EQ-5D-5L) questionnaire evaluating HRQL. The relation between scale scores was analysed using Spearman correlations.RESULTSThe final CAS scale included 14 items. The equivalent reliability was high (Chronbach’s alpha 0.88). The validation cohort included 103 patients (72% men, mean age 62.4 years). The mean scores for each question in the CAS scale were higher for patients with severe/tense ascites than for mild/moderate ascites and controls. Compared with controls (mean = 9.9 points), the total CAS scale score was higher for severe/tense ascites (mean = 23.8 points) as well as moderate/mild ascites (mean = 18.6 points) (P < 0.001 both groups). We found a strong correlation between the total CAS and CLDQ score (rho = 0.82, P < 0.001) and a moderate correlation between the CAS and the EQ-5D-5L score (0.67, P < 0.001).CONCLUSIONThe CAS is a valid tool, which reflects HRQOL in patients with ascites.

Tunneled Peritoneal Catheter for Refractory Ascites in Cirrhosis: A Randomized Case-Series

“…The placement procedure of the PleurX catheter is previously described [8,9]. All patients received periprocedural intravenous Cefuroxime Health-related quality of life was assessed at baseline and monthly during the trial using the Cirrhosis-Associated ascites Symptom (CAS) score [10]. The CAS score is a validated 14-item scale addressing symptoms related to tense ascites.…”

Editorial: Percutaneous placement of a permanent tunnelled catheter for patients with non‐malignant ascites—Is it safe?

“…3 This can result in refractory ascites that has a major impact on quality of life. 4,5 The treatment of choice, if patients are not eligible for a liver transplant or transjugular intrahepatic portosystemic shunt, is repeated large-volume paracentesis. 3 For these patients, permanent indwelling catheters could be considered for palliative care.…”

“…The condition may become diuretic‐resistant, or patients may be unable to tolerate an effective diuretic dosage 3 . This can result in refractory ascites that has a major impact on quality of life 4,5 . The treatment of choice, if patients are not eligible for a liver transplant or transjugular intrahepatic portosystemic shunt, is repeated large‐volume paracentesis 3 .…”

A survey of practice in management of malignancy-related ascites in Japan

“…In addition, a large volume of ascites causes various types of discomfort such as pain, dyspnea, and early satiety. In one study evaluating the Health-Related Quality of Life (HRQoL) of 103 patients who had ascites due to cirrhosis, the severity of ascites was related to a lower HRQoL [2].…”