ArticleScientific reports2026
Resilience and physical-functional HRQoL in cirrhosis: a cross-sectional study of nursing-relevant direct and indirect associations linked to psychological distress and frailty.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Patients with cirrhosis frequently experience functional limitations and impaired health-related quality of life (HRQoL). Patient-centered care frameworks increasingly recommend routine use of patient-reported outcomes to support nursing decisions. This study examined how resilience is statistically associated with Physical–Functional HRQoL and whether these associations are consistent with indirect pathways via performance-based frailty and psychological distress, overall and by disease stage. In a single-center cross-sectional study at Zhejiang Provincial People’s Hospital (December 2024 to August 2025), adults with cirrhosis were consecutively enrolled (n = 579; compensated n = 353, decompensated n = 226). Resilience was measured with the Brief Resilience Scale, frailty with the Liver Frailty Index, psychological distress with the DASS-21, and Physical–Functional HRQoL with a prespecified CLDQ composite. All constructs were assessed at the same visit. Multivariable linear regression estimated adjusted associations between resilience and HRQoL. Parallel indirect-effects models with bootstrap confidence intervals and HC3 corrections were used to decompose the cross-sectional association structure into direct and indirect components (associations consistent with mediation), not evidence of transmission or temporal ordering, adjusting for demographic, behavioral, and clinical covariates. Resilience was positively associated with HRQoL in the overall sample (standardized β = 0.174). The total indirect association was statistically significant and was largely accounted for by psychological distress, whereas the indirect association via frailty was small and not significant; the residual direct association was modest and imprecise. In compensated cirrhosis, both indirect and residual direct associations were observed. In decompensated cirrhosis, only the indirect association via psychological distress reached conventional significance, while total and direct associations were small and imprecise. In this single time point analysis, resilience showed statistical associations with better Physical–Functional HRQoL, with a larger distress-related indirect component, whereas frailty did not show consistent indirect associations (reflecting cross-sectional association structure only, with no inference about temporal ordering or causal transmission). These hypothesis-generating findings suggest that brief, nurse-executable bundles jointly assessing resilience, frailty, psychological distress, and HRQoL could be explored within stage-sensitive nurse-led care pathways. Longitudinal and interventional studies using time-lagged mediation models are needed to clarify temporal ordering and evaluate potential HRQoL benefits.
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