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Inicio Gastroenterología y Hepatología (English Edition) Inadequate social support decreases survival in decompensated liver cirrhosis pa...
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Vol. 46. Issue 1.
Pages 28-38 (January 2023)
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Vol. 46. Issue 1.
Pages 28-38 (January 2023)
Original article
Inadequate social support decreases survival in decompensated liver cirrhosis patients
El apoyo social inadecuado disminuye la supervivencia en pacientes con cirrosis hepática descompensada
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Natalia García Moralesa,b,c,
Corresponding author
natgmorales@gmail.com

Corresponding author.
, Margarita Fernández de la Vargad, Javier Pumares Péreze, Martín Menéndez Rodríguezb,c,f, Sagrario Gutiérrez Moratog, Carmen Castillo Cejasg, Victoria Aguilerah,i, Salvador Benllochi,j, Luis Menéndez Rodríguezk, Teresa Seoane Pilladob,l, Noel Pin Vieitom, Joaquín Cubiellab,i,m
a Gastroenterology and Hepatology Department, Complexo Hospitalario Universitario de Vigo (CHUVI), Sergas, Vigo, Spain
b Galicia Sur Health Research Institute (IIS Galicia Sur), Spain
c Epidemiology Department, Faculty of Medicine, University of Santiago de Compostela, Spain
d Gastroenterology and Hepatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
e Oncology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Spain
f Centro de Salud de Lavadores, Xerencia de Xestión Integrada de Vigo, Spain
g Social Work Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
h Hepatology and Liver Transplantation Unit, Hospital Universitario y Politécnico La Fe, IIS La Fe, Valencia, Spain
i Ciberehd, Instituto de Salud Carlos III, Madrid, Spain
j Gastroenterology and Hepatology Department, Hospital Arnau de Vilanova, Valencia, Spain
k Psychiatry Department, Complejo Hospitalario Universitario A Coruña, Hospital de Oza, Spain
l Unit of Preventive Medicine and Public Health, Department of Health Sciences, University of A Coruña, INIBIC, A Coruña, Spain
m Gastroenterology and Hepatology Department, Complexo Hospitalario Universitario de Ourense, Spain
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Abstract
Introduction

Inadequate social support is associated with higher mortality both in the general population and in patients with chronic diseases. There are no studies that have described social support in liver cirrhosis and its impact on prognosis.

Objectives

To analyze the impact social support has in the survival of patients with decompensated cirrhosis.

Methods

Prospective multicentric cohort study (2016–2019). Patients with decompensated liver cirrhosis were included. Epidemiological, clinical and social variables were collected, using the validated Medical Outcomes Study Social Support Survey, with a 12-month follow-up.

Results

A total of 127 patients were included, of which 79.5% were men. The most common etiology of cirrhosis was alcohol (74.8%), mean age was 60 years (SD 10.29), mean MELD was 15.6 (SD 6.3) and most of the patients had a Child–Pugh B (53.5%) or C (35.4%). In the assessment of social support, we observed that most of the patients (92.2%) had adequate global support. At the end of the follow-up (median 314 days), 70.1% of the patients survived. The 1-year survival rate in patients with inadequate global social support was 30%, compared to 73.5% in the presence of social support. In multivariate Cox regression analysis, inadequate social support predicted survival with an adjusted HR of 5.5 (95% CI 2,3-13,4) independently of MELD (HR 1.1, 95% CI 1–1.2), age (HR 1, 95% CI 1–1.1) and hepatocarcinoma (HR 10.6, 95% CI 4.1–27.4).

Conclusion

Adequate social support improves survival in liver cirrhosis, independently of clinical variables. Social intervention strategies should be considered for their management.

Keywords:
Liver cirrhosis
Mortality
Preventive health services
Survival analysis
Abbreviations:
LC
MELD
EASL
SS
LT
MOS-sss
SD
CI
ANOVa
Resumen
Introducción

El apoyo social se asocia a mortalidad en población general y en pacientes con enfermedades crónicas. No hay estudios que hayan descrito el apoyo social en cirrosis hepática y su impacto sobre el pronóstico.

Objetivo

Analizar el impacto del apoyo social en la supervivencia en cirrosis hepática descompensada.

Material y métodos

Estudio multicéntrico prospectivo de cohortes (2016–2019). Se incluyeron pacientes con cirrosis hepática descompensada. Se recogieron variables epidemiológicas, clínicas y sociales mediante la escala validada Medical Outcomes Study Social Support Survey (MOS), realizando un seguimiento de 12 meses.

Resultados

Se incluyeron 127 pacientes, el 79,5% eran hombres. La causa más común de la cirrosis hepática fue alcohol (74,8%), la edad media 60 años (DE: 10,29), la media de MELD 15,6 (DE: 6,3) y la mayoría tenían Child-Pugh B (53,5%) o C (35,4%). Se observó que la mayoría de pacientes (92,2%) tenían un apoyo social adecuado (MOS global>56). Al finalizar el seguimiento (mediana 314 días), el 70,1% de los pacientes sobrevivieron. La supervivencia al año en falta de apoyo social fue del 30%, comparado con el 73,5% en los que el apoyo social era adecuado. En el análisis de regresión multivariante el apoyo social predijo la supervivencia con un HR ajustado de 5,5 (IC 95%: 2,3-13,4) independientemente del MELD (HR: 1,1; IC 95%: 1-1,2), edad (HR: 1; IC 95%: 1-1,1) y hepatocarcinoma (HR: 10,6; IC 95%: 4,1-27,4).

Conclusión

El apoyo social inadecuado en pacientes con CH disminuye la supervivencia, independientemente de las variables clínicas. Se deberían plantear estrategias de intervención social para su manejo.

Palabras clave:
Cirrosis hepática
Mortalidad
Actividades preventivas
Análisis de supervivencia

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