Does The Severity Of Model For End-Stage Liver Disease Score Correlate With Poor Health Literacy Among Patients With Cirrhosis?

INTRODUCTION: The Model for End-stage Liver Disease (MELD-Na) score is a tool used to stratified patients with end stage liver disease for liver transplantation. Health literacy is the ability to receive and process information in order to make appropriate health care decisions. The aim of this study is to access the degree of health literacy among patients with cirrhosis and compare it with the severity of liver disease using the MELD- Na score. Clinically, this is important because low health care literacy has been tied to higher mortality and worse outcomes. METHODS: After Institutional Review Board approval was granted, we surveyed adults with cirrhosis using the Short Assessment of Health Literacy-English and Spanish (SAHL- E&S) survey as a marker for health care literacy. MELD-Na score was the marker for liver disease severity and was calculated by obtaining the levels of Sodium, International Normalized Ratio, Bilirubin, and Creatinine and Dialysis status. We obtain age, sex, ethnicity, education level, duration and etiology of liver disease and any active process of undergoing liver transplantation. Exclusion criteria were active diagnosis of decompensated cirrhosis, family amyloid polyneuropathy, hepatic artery thrombosis, hilar cholangiocarcinoma, primary hyperoxaluria, portopulmonary hypertension, and the use of coumadin. The survey was distributed in both the inpatient and outpatient setting and the data was recorded in an online secure software. RESULTS: A total of 36 patients were analyzed with a mean age of 62.53 and standard deviation of 10.17 years. There was a total of 22 males (61%) and 14 (39%) females. Mann-Whitney U test was run to determine if there were differences in MELD scores between low and high health literacy. Median MELD scores were significantly higher in patients with low health literacy score with P value = 0.02. Kruskal-Wallis test was conducted to determine if there were differences in MELD scores between various etiologies of cirrhosis, education, or ethnicity, but the results were not statistically significant. CONCLUSION: MELD scores were higher in patients with low health literacy and was statistically significant, whereas there was no association between education, etiology of cirrhosis, or ethnicity. The results of this study will help providers of patients with cirrhosis better understand how poor health care literacy can impact their patients and potentially stimulate the development of interventions to tailor patient education for better outcomes.Figure 1.: Mann-Whitney U test was run to determine if there were differences in MELD scores between Low and High Health Literacy. Median MELD scores were statistically significantly higher in low (median = 20.50, minimum = 13, maximum-36) than high (median = 13.00, minimum = 6. Maximum = 39) health literacy score, P value = 0.02.Figure 2.: MELD Score and Etiology: Kruskal-Wallis test was conducted to determine if there were differences in MELD scores between various etiologies. Alcoholic (median = 18.50, min = 6, max = 39), Viral (median = 9, min = 9, max = 36), NASH (median = 15, min = 10, max = 17) Cryptogenic (median = 14, min = 12, max = 16), Other (median = 24,min = 24mmax-24), Alcohalic + Viral (median = 11.50, min = 9, max = 29). Differences were not statistically significant, P = 0.6.Figure 3.: MELD Score and Ethnicity: Kruskal-Wallis test was conducted to determine if there were differences in MELD scores between various ethnicities. African-American (median = 9, min = 9, max = 36), Caucasian (median = 14, min = 6, max = 39), Hispanic (median = 19.50, min = 9, max = 21) Differences were not statistically significant, P = 0.8.