Exploratory analysis of allostatic load and mortality in patients with hepatocellular carcinoma

Hepatocellular carcinoma (HCC) disproportionately affects socially disadvantaged individuals. While tumor stage and liver function predict survival, biologic stress from chronic adversity, measured by allostatic load (AL), may provide additional prognostic insight. We aimed to evaluate the association between AL and mortality in patients with HCC and assess whether health literacy (HL) modifies this relationship.

We conducted a secondary analysis of 139 adults with HCC at two hospitals in Indianapolis (2019-2022). AL was calculated from six physiologic biomarkers, with scores ≥ 3 indicating high AL. HL and cumulative social disadvantage were measured using validated tools. Higher AL (HR 1.27; 95% CI 1.05-1.55) and lower HL (HR 1.83; 95% CI 1.10-3.05) were independently associated with mortality. After adjustment, AL remained significant but was attenuated when HL was included. Stratified analyses showed that AL predicted mortality only among patients with high HL. These exploratory findings suggest AL may help identify higher-risk patients, warranting validation in prospective, multi-center studies.