Clinical and Demographic Determinants of Adherence to Digital Monitoring in Cirrhosis: A Prospective Cohort Analysis

Cirrhosis has a high burden of care and frequent hospitalizations. Remote monitoring with digital wearable technology may improve early diagnosis and intervention with passive, convenient data collection and transmission, but its usability has not been systematically assessed in cirrhosis. We evaluate the factors associated with adherence to longitudinal monitoring in a diverse, prospective study of patients with cirrhosis.

Patients with cirrhosis were prospectively enrolled from 2023-2025. Baseline clinical, laboratory, survey and cognitive data were collected, and each participant provided with an Oura 3.0 ring. Adherence was defined as the frequency of days with at least 80% of the day with wearable data transmission. Additional factors related to adherence, including data quality, dropout and attrition were assessed. Associations between clinical and sociodemographic variables and likelihood of adherence were assessed in mixed effects models.

Of 111 participants were enrolled, at least 80% data transmission occurred in 65.6% of eligible days. Across the study period, collected days had high data completeness (> 95%). Sociodemographic factors were not associated with adherence, but patients with decompensated cirrhosis or Child-Turcotte-Pugh B/C had lower adherence. In adjusted analysis, impaired cognition (OR 0.26 [95% CI 0.10, 0.68]) or a history of hepatic encephalopathy (HE) (OR 0.30 [95% CI 0.13, 0.71]) at baseline were the strongest predictors of reduced adherence.

We observed high adherence to wearable fitness tracking in cirrhosis, with significant within-day data quality, suggesting feasibility of remote monitoring. Contrary to expectation, severity of liver disease, especially cognition/HE, predicted adherence, not sociodemographics. While wearables are likely readily feasible in compensated cirrhosis patients for detecting progression, making remote monitoring successful in high-risk patients will require strategies to facilitate engagement and retention.