Liver and Bile

Hepatology. 2022;75(3):600–9

Wang S, Whitlock R, Xu C, Taneja S, Singh S, Abraldes JG, Burak KW, Bailey RJ, Lai JC, Tandon P

Frailty is associated with increased risk of cirrhosis disease progression and death


Background and aims: The Liver Frailty Index (LFI) is a well-studied tool that evaluates frailty in patients with cirrhosis. Consisting of grip strength, chair stands, and balance testing, the LFI has been associated with increased mortality in patients awaiting liver transplant. The authors aimed to extend their understanding of frailty in cirrhosis by exploring the relationship between the LFI and the risk of (1) cirrhosis progression, (2) mortality, and (3) unplanned hospitalizations, in both compensated and decompensated disease.
Approach and results: Adult patients with cirrhosis from 4 centers in North America and 1 in India were included. Frailty was measured at baseline using the LFI and categorized as robust (LFI < 3.2), prefrail (LFI 3.2–4.5), and frail (LFI > 4.5). Progression of cirrhosis was defined by an increase in clinical stage, ranging from 1 to 5, from baseline using the D’Amico classification. Factors associated with progression, mortality, and hospitalizations were evaluated using multivariate regression models, with transplant as a competing risk. In total, 822 patients with cirrhosis were included. Average Model for End-stage Liver Disease (MELD) score was 15.5 ± 6.0. In patients with compensated cirrhosis, being frail versus robust was associated with increased risk of progression to the next cirrhosis stage or to death (hazard ratio [HR] = 2.45, 95% confidence interval [CI]: 1.14–5.29) and with an increased risk of unplanned hospitalizations (HR = 2.32, 95% CI: 1.13–4.79), after adjusting for age, sex, and MELD score. Similar HRs were observed in patients with decompensated cirrhosis.

Conclusions: Frailty was an independent predictor of cirrhosis progression or death and unplanned hospitalization across patients with compensated and decompensated cirrhosis. Future studies are needed to evaluate the possibility of slowing cirrhosis disease progression by reversing or preventing frailty.

Dr. P. Tandon, Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada,
E-Mail: ptandon@ualberta.ca

DOI: DOI: 10.1002/hep.32157

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