Article Text


Symptom prevalence of patients with end-stage liver disease: a systematic review
  1. Jen-Kuei Peng,
  2. Nilay Hepgul,
  3. Irene J Higginson and
  4. Wei Gao
  1. Cicely Saunders Institute, King’s College London, UK


Introduction End-stage liver disease (ESLD) is a major cause of morbidity and mortality. However, little is known about symptom prevalence among this population.

Aim(s) To systematically review the prevalence of symptoms and how they are measured in patients with ESLD

Method(s) Eight electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, SCOPUS, Web of Science, and Cochrane Library) were searched from inception to December 2015 for studies investigating symptom prevalence in adult ESLD patients. No time or language limitations were applied. Articles focusing on acute liver failure, metabolic liver disease, cholestatic disease only, other terminal diseases, or on post liver transplantation were excluded.

Results We identified 31 studies with a total of 3630 ESLD patients. Most of them were middle-aged. The prevalence of pain ranged between 30% and 79%. Muscle cramps occurred in 56–68% of patients. Other most frequently reported physical symptoms were insomnia (26–77%), erectile dysfunction (53–93% in men), dyspnea (20–88%), and daytime sleepiness (33–71%). Surprisingly, fatigue and pruritus were only reported in one article for each, with a prevalence of 86% and 47%. Psychological symptoms included anxiety with a prevalence of 14–36%, while 4.5–64% of ESLD patients suffered from depression. The instruments for symptom measurement varied across studies.

Conclusion(s) We have identified the prevalence of a range of symptoms experienced by ESLD patients. There is high variability in symptom prevalence across different studies. Further studies on symptom prevalence and on developing consensus in symptom measurement are keys to improve the care of these patients.


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