HEALTH LITERACY AS A DETERMINANT OF FRAILTY IN PATIENTS WITH LIVER CIRRHOSIS

Introduction and Objectives

Health literacy (HL) is a key social determinant of health, especially in chronic conditions like cirrhosis, where disease management depends heavily on patient comprehension and engagement. HL refers to the ability to access, understand, and use health information to make informed decisions. Frailty, a state of decreased physiological reserve and increased vulnerability, is a strong predictor of adverse outcomes in cirrhosis. Although the Liver Frailty Index (LFI) is commonly used to assess physical frailty, the role of HL in this context remains poorly explored. This study aimed to determine the association between HL and frailty in patients with cirrhosis.

Patients and Methods

We conducted a cross-sectional study among adults with confirmed cirrhosis attending outpatient hepatology clinics in Cartagena, Colombia, between September and December 2024. HL was measured using the Short Assessment of Health Literacy for Spanish Adults (SAHL-S), and frailty was assessed with the LFI, which includes grip strength, chair stands, and balance tests. Trained clinicians performed all tests using calibrated equipment. Demographic and clinical variables were obtained from records and structured interviews. Patients with encephalopathy or severe mobility limitations were excluded. Frailty was defined as LFI ≥ 4.5.

Results

Among 89 participants (57.3% women, mean age 64.8), 85.4% were Child-Pugh A. History of decompensation and variceal bleeding were present in 24.7% and 13.5%, respectively. LFI categorized 15.7% as robust, 65.2% as prefrail, and 19.1% as frail. In multivariable analysis, low HL (OR 2.8; 95% CI 1.3–6.0) and variceal bleeding (OR 3.2; 95% CI 1.4–7.1) independently predicted frailty.

Conclusions

Low HL independently predicts frailty and should be addressed to improve outcomes in cirrhosis care.