Symptom burden in end-stage liver disease: a prospective cohort study of the symptoms experienced by patients and the role of palliative care

Background: Liver disease is a leading cause of morbidity and mortality. Patients with end-stage liver disease (ESLD) experience multiple physical symptoms. Despite the poor prognosis and significant symptom burden, palliative care integration remains limited. Objectives: To assess the symptom burden in ESLD patients, the viability of applying a symptom scale in routine evaluations, and to assess the impact of palliative care on symptom management. Design: Observational, prospective cohort study. Methods: We prospectively included patients with chronic liver disease following their first episode of decompensation or diagnosis of hepatocarcinoma (HCC). Data collected included patient demographics, ESLD etiology, history of decompensation, and patient-reported symptom burden. Two-sided tests were used to identify factors of disease severity and evaluate the benefits of palliative care intervention. Results: Forty-four patients were assessed, divided into two cohorts: palliative care cohort (52.3%; n  = 23) and hepatology care cohort (47.7%; n  = 21). Patients in the palliative care cohort were older (69.35 ± 11.71 vs 59.86 ± 7.11 years; p  = 0.002), had lower functional status (59.13 ± 2.51 vs 72.38 ± 2.92; p  = 0.002), and higher prevalence of unstable decompensated cirrhosis (60.9% vs 28.6%; p  = 0.043) and HCC ( p  < 0.001). This cohort reported a higher overall symptom burden, with rates of 82.6% for asthenia, 65.2% for pain, and 56.5% for anorexia. Palliative care interventions tended to reduce the prevalence of pain, anorexia, and dyspnea, with a significant decrease in pain intensity from 86.7% to 23.1% ( p  = 0.008) and asthenia intensity from 100% to 84.2% ( p  < 0.001). Conclusion: Significant differences in symptom prevalence were observed between the two cohorts, likely due to specific clinical characteristics of each group. The use of a symptom assessment scale proved to be simple and effective, revealing a high prevalence of symptoms. Palliative care was associated with a positive impact on symptom management. Trial registration: NCT06181474.