Cirrhosis patients may have impaired QoL and cognition due to taste and smell impairment

Cirrhosis is linked with poor nutrition, which could partly be due to anorexia in hepatic encephalopathy (HE) & coexistent renal failure. Taste & smell perception affect appetite but their role in cirrhosis±dialysis are unclear. Aim: Define impact of cognitive impairment in cirrhosis±dialysis on taste & smell perception & study their impact on eating-related QOL.

Healthy people & outputs with cirrhosis (±decompensation), on dialysis underwent taste & smell tests, cognitive testing using (PHES, high=better, Stroop, high=worse), SAS questionnaire for olfactory impact on life (high=worse) and quality of life (QOL) testing using Sickness Impact Profile (SIP, high=worse), which also has an “eating” QOL component. Pts with past/current COVID-19, current/recent alcohol or tobacco use were excluded. Tastes studied were sweet, sour, salty, brothy & bitter. Smell was tested using the NIH toolbox. Taste & smell results were compared between groups & correlated with cognition. Multivariable analysis for taste/smell & eating portion of SIP was performed.

Results:

59 subjects (22 healthy, 21 cirrhosis & 16 dialysis), predominantly men, were included (fig A). Of the cirrhosis pts, 8 were compensated, 13 decompensated (11 HE; all lactulose/8 rifaximin, MELD 11). Diabetes was similar across diseased pts. Taste & smell test: Controls had the best taste discrimination while cirrhosis & dialysis pts were similarly impaired; no impact of HE was seen. Sweet & sour tastes were most affected. While smell detection was not different, diseased groups had worse SAS results (FigA). Correct taste and smell were linked (r=0.5,p<0.001). Diabetes did not affect taste/smell.

Cognitive tests & QOL: Eating-related and overall QOL was worst in advanced pts (Fig B). Stroop & PHES impairment were also worse in diseased pts vs controls. Taste was significantly correlated with PHES (r=0.4,p=0.02) and Stroop regardless of HE or dialysis (Fig B). Smell perception percentile was only correlated with Stroop (Fig C).

Multivariable analysis: for taste, high (or good) PHES (T value 2.5, p=0.01) & smell results (2.2, p=0.03) were contributory, while for smell, taste correct results (T value 2.6, p=0.02), low (=good) Stroop (-0.32, p=0.008) & age (2.2,p=0.03) were linked. Eating impairment on SIP was linked with high (=worse) Stroop (T value 2.2,p=0.03) & high (=worse) SAS smell QOL questionnaire (2.8, p=0.008).

Taste perception and smell-related quality of life in cirrhosis is significantly impaired compared to controls and is similar to dialysis pts. Smell-related QOL & advanced disease affected eating behaviour. Cognitive impairment, especially on Stroop, rather than simple HE/decompensation was linked with taste and smell. Altered taste and smell perception should be considered as a contributor towards poor nutrition, eating and QOL in patients with cirrhosis and renal failure, especially those with cognitive impairment.

Reference:

3109-A - TASTE AND SMELL CHANGES AFFECT EATING-RELATED QUALITY OF LIFE AND ARE LINKED WITH COGNITIVE IMPAIRMENT IN CIRRHOSIS AND RENAL FAILURE PATIENTS. The liver meeting.

Keywords:

Cirrhosis, patients, impaired, QoL, cognition, taste, smell, impairment, liver meeting