Social support and HRQoL decline in cirrhosis: a 12-month cohort in China

Abstract Health-related quality of life (HRQoL) is important in cirrhosis, but which social support domains are associated with clinically meaningful decline and whether associations vary by compensation status remain uncertain. In this 12-month Chinese cohort, adults with hepatologist-confirmed cirrhosis completed the Duke Social Support Index at baseline. Social Network and Social Interaction were count-based, whereas Subjective and Instrumental Support ranged from 0 to 40 and 0–52. HRQoL was assessed using the Chronic Liver Disease Questionnaire at baseline and 12 months. The primary outcome was a decrease of at least 0.5 points in mean CLDQ. Firth logistic regression estimated adjusted associations; compensation-status-stratified and interaction analyses assessed heterogeneity. Robust linear regression examined continuous change. Among 567 participants (72.0% compensated), 111 (19.6%) had MCID-defined decline. MCID-defined decline occurred in 11.5% of participants with compensated cirrhosis and 40.3% of those with decompensated cirrhosis. Higher Subjective Support (adjusted OR 0.62 per 5 points; 95% CI 0.43–0.88) and Instrumental Support (adjusted OR 0.38 per 5 points; 95% CI 0.27–0.53) were associated with lower odds of decline, whereas higher MELD-Na was associated with higher odds (adjusted OR 1.32 per point; 95% CI 1.20–1.46). The Instrumental Support association differed by compensation status (interaction p < 0.001); continuous-change findings were consistent. Subjective and Instrumental Support were associated with more favorable 12-month HRQoL trajectories. Multicentre replication is needed before support-based screening or care pathways are considered for routine implementation.