Division of Gastroenterology and Hepatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
Liver Transpl. 2020 Nov;26(11):1409-1421. doi: 10.1002/lt.25830. Epub 2020 Oct 7.
The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplantation (LT) evaluation. From 2014 to 2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign, a brief validated assessment. Multivariate models assessed relationships between HL and clinical outcomes adjusting for clinical and psychosocial variables. The median Model for End-Stage Liver Disease-sodium score of the study sample was 15 (interquartile range, 11-19), 71 (25.7%) of candidates were frail, 117 (42.4%) had malnutrition, 151 (54.7%) had hepatic encephalopathy, 104 (37.7%) had low HL, and 85 (39.2%) had marginal or poor social support. Adjusting for education level, socioeconomic factors, and severity of illness, low HL was independently associated with physical frailty (adjusted odds ratio [aOR], 3.59; 95% confidence interval [CI], 1.50-8.59; P = 0.004) and not being wait-listed (aOR 1.96; 95% CI, 1.03-3.75; P = 0.04). Strong social support attenuated the relationship between low HL and not being wait-listed (aOR, 1.58; 95% CI, 0.74-3.36; P = 0.24). Low HL is common and a largely unrecognized risk factor for poor health outcomes among patients with ESLD. Patient-oriented infrastructure and support are needed at the health system level to ensure all patients can successfully navigate the complex process of LT evaluation and wait-listing.
低健康素养（HL）对终末期肝病（ESLD）结局的影响在很大程度上尚不清楚。本研究旨在前瞻性调查接受肝移植（LT）评估的 ESLD 门诊患者中低 HL 对临床结局的影响。2014 年至 2017 年，对 276 例接受 LT 评估的患者进行了评估，评估内容包括肝病严重程度、医疗和心理社会合并症、身体虚弱和营养不良。使用简短有效的 Newest Vital Sign 评估来衡量 HL。使用多变量模型，在调整临床和心理社会变量后，评估 HL 与临床结局之间的关系。研究样本的中位终末期肝病评分-钠评分 15（四分位距，11-19），71 例（25.7%）患者虚弱，117 例（42.4%）营养不良，151 例（54.7%）肝性脑病，104 例（37.7%）低 HL，85 例（39.2%）社会支持较差或较差。在调整教育水平、社会经济因素和疾病严重程度后，低 HL 与身体虚弱（调整后的优势比 [aOR]，3.59；95%置信区间 [CI]，1.50-8.59；P=0.004）和未被列入等待名单（aOR，1.96；95% CI，1.03-3.75；P=0.04）独立相关。强大的社会支持减轻了低 HL 与未被列入等待名单之间的关系（aOR，1.58；95% CI，0.74-3.36；P=0.24）。低 HL 很常见，是 ESLD 患者不良健康结局的一个主要未被识别的危险因素。需要在卫生系统层面上为患者提供以患者为中心的基础设施和支持，以确保所有患者都能成功地参与 LT 评估和等待名单的复杂过程。
