Cirrhosis patients may have impaired QoL and cognition due to taste and smell impairment suggests a new study presented in the Liver meeting.

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