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

Figures

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  FIGURE 1. PRISMA flow diagram. This illustrates the study selection process for the systematic review, with the number of results at each stage and the reasons for exclusion. One study included in the review (Higuera-de la Tijera 2019)40 was only published as a conference abstract. Abbreviations: PROM, patient-reported outcome measure; RA, refractory ascites.

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  FIGURE 2. Risk of bias assessment of included studies. Panels (A–D) show the risk of bias assessment in studies grouped by the type of study. The assessment was carried out with the relevant JBI checklist for that study design. The risk of bias was in the context of the patient-reported outcomes of each study. Abbreviation: JBI, Joanna Briggs Institute.

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  FIGURE 3. Binary heatmap assessing tool breadth. Each row represents a validated patient (or caregiver)-reported outcome measure used in the included studies. Columns represent relevant domains, extracted from the Patient-Reported Outcome Measurement Information System (PROMIS) framework and grouped into 4 overarching themes (Physical, Mental, Social, and General). A filled cell indicates that a domain is covered by that specific tool. The right-hand column gives the percentage of domains covered by each tool (breadth).

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  FIGURE 4. Binary heatmap assessing domain prevalence in the literature. Each row represents a study included in the review. A filled cell indicates that a domain is covered by that study. The bottom row gives the percentage of studies that assessed each domain at least once (domain prevalence).

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  FIGURE 5. Comparison of health-related quality of life in patients with refractory ascites to those with cirrhosis. Each row shows the pooled point estimate (and 95% confidence intervals) from the meta-analysis of scores in each domain. Lower scores correlate with worse health-related quality of life. Values are compared against reported scores from a cohort of outpatients with cirrhosis. Panel on the left (A) demonstrates disease-specific scores in 8 generic SF-36 domains, and panel on the right (B) shows scores in 6 disease-specific CLDQ domains. The Z-statistic was used to test the significance of differences between disease states; ***p<0.001, **p<0.01, and *p<0.05. The shaded gray rectangle highlights the minimal clinically important difference (MCID) for each domain. The point estimates lying outside this zone signal a potential clinically meaningful difference between the 2 disease states. Abbreviations: CLDQ, chronic liver disease questionnaire; REML, restricted maximum-likelihood meta-analysis model; SF-36, short form-36.