Poor Performance Status is Associated with Increased Mortality in Patients with Cirrhosis

Abstract

Background & Aims Functional status (a patient’s ability to perform activities that meet basic needs, fulfill usual roles, and maintain health and well being) has been linked to outcomes in patients with cirrhosis and can be measured by the Karnofsky performance status (KPS) scale. We investigated the association between KPS score and mortality in patients with cirrhosis. Methods We used the United Network for Organ Sharing database to perform a retrospective cohort study of patients listed for liver transplantation in the United States between 2005 and 2015. We used Cox proportional hazards and competing risk regression analyses to examine the association between KPS and mortality and transplantation. Results Of 79,092 patients, 44% were in KPS category A (KPS 80%–100%), 43% were in category B (KPS 50%–70%), and 13% were in category C (KPS 10%–40%). Between 2005 and 2015, the proportion of patients in category A decreased from 53% to 35%, whereas the proportions in categories B and C increased from 36% to 49% and from 11% to 16%, respectively. KPS was associated with mortality: compared to patients in KPS category A, the KPS B adjusted hazard ratio [HR] was 1.14 (95% confidence interval [CI], 1.11–1.18) and the KPS C adjusted HR was 1.63 (95% CI, 1.55–1.72). KPS was also associated with liver transplantation; compared to patients in KPS category A, the KPS B adjusted HR was 1.08 (95% CI, 1.06–1.11) and the KPS C adjusted HR was 1.35 (95% CI, 1.30–1.40). In competing risk analysis, only the relationship between KPS and mortality maintained significance and directionality. These relationships were most pronounced in patients without hepatocellular carcinoma. Conclusions Among patients with cirrhosis listed for liver transplantation, poor performance status, based on the KPS scale, is associated with increased mortality. In this population, performance status has decreased over time.