Factors Associated With End Stage Liver Disease
Factors Associated With End Stage Liver Disease
100 ambulatory cirrhotic patients attending a liver transplant clinic will undergo a
 comprehensive clinical evaluation for severity of liver disease, anemia, depression, and
 fatigue. Fatigue will be assessed with the FIS and sub-maximal exercise capacity with the
 6-minute walk test (6MWT), a standardized exercise test that measures the distance that a
 patient is capable of walking in 6 minutes (6MWD). Depression will be assessed by using three
 well-known questionnaires. The SF-36, Beck's Depression Inventory (BDI-II), EQ-5D, and the
 Psychological General Well-Being Index (PGWBI). Univariate analysis will be performed to
 select the factors that potentially are associated with the scores as indicated by a P value
 <.20; the selected factors will then be entered in a stepwise regression to create a
 multivariate model giving the combination of factors that are significantly associated with
 the measure of fatigue and depression. Hemoglobin (Hb) levels will then be added to the model
 in order to test its significance while controlling for the other factors.
100 ambulatory patients with cirrhosis will be prospectively evaluated for severity of liver
 disease, anemia, and fatigue; exclusion criteria includes chronic renal insufficiency and
 recent alcohol use, gastrointestinal bleeding, and infection.

 Patients will first be identified and be asked to partake in the study. They will be asked to
 read over an informed consent form. Subsequently, they will be asked to fill out a depression
 questionnaire before performing the 6MWT. During the 6MWT the patient will be walking up and
 down two designated points 100 feet apart. They will be asked to walk for 6 minutes using any
 walking aids and resting as needed. Their final distance will be recorded. They will then be
 asked to fill out the FIS fatigue questionnaire.

 Severity of liver disease will be assessed through a detailed clinical examination of ascites
 grade, hepatic encephalopathy, history of complications from cirrhosis (hepatic coma,
 spontaneous bacterial peritonitis, gastrointestinal bleeding), standard liver tests (TBili,
 Albumin, INA), platelet count as a parameter of splenic sequestration and portal
 hypertension, Child-Pugh score, MELD (Model of End-stage Liver Disease) score. Anemia will be
 assessed with hemoglobin levels. Depression will be assessed with the following
 questionnaires: Beck Depression Inventory (BDI), EQ-5D, Psychological General Well-Being
 Index (PGWBI), LDQOL. Fatigue will be assessed with the FIS and 6 Minute Walk Test. Hepatic
 Encephalopathy will be assessed with the number connection, digit-symbol coding and
 inhibitory control test. Sexual function will be assessed by the Sexual Problems and Sexual
 Function scales of the LDQOL. The results will be scored and compared to depression quality
 of life, and end-stage liver disease factors.
Inclusion Criteria:

 -  male or female, age b/w 18-70 years, inclusive

 -  willingly and able to provide written consent

 -  Diagnosed with Cirrhosis

 -  Able to read and write in English

 Exclusion Criteria:

 -  Inability to provide consent

 -  Not within age range of 18-70 years, inclusive

 -  Not diagnosed with Cirrhosis

 -  Unable to read or write in English

 -  Unable to walk