A self-reported Frailty Index predicts long-term mortality in hospitalized patients with cirrhosis

Deng, You; Lin, Lin; Hou, Lijun; Fan, Xiaofei; Zhao, Tianming; Mao, Leilei; Wang, Xiaoyu; Wang, Bangmao; Ma, Yingli; Sun, Chao

doi:10.21037/atm-20-943

Cited by 16 publications

(18 citation statements)

References 28 publications

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“…While prior studies have established frailty as a potent predictor of death and hospitalization in patients with cirrhosis, [ 4,6–10,16,17 ] our study offers two findings to narrow the knowledge gap of the role of frailty in this population. First, in our multicenter cohort of 822 patients with cirrhosis, we observed that frailty was an independent predictor of cirrhosis progression, as defined by an increase in clinical cirrhosis stage from baseline to a more advanced stage or death.…”

Section: Discussionmentioning

confidence: 89%

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

Wang

Whitlock

et al. 2021

Hepatology

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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. We aimed to extend our 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 four centers inNorth America and one 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 (HR, 2.45; 95% CI, 1.14-5.29) and with an increased risk of unplanned hospitalizations (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.

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Section: Discussionmentioning

confidence: 89%

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

Wang

Whitlock

et al. 2021

Hepatology

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“…At baseline, all participants had the multi-dimensional frail phenotype assessed by the Frailty Index which is revised from Carolina Frailty Index within 48 h of the first admission ( Supplemental Table S1 ). 8 , 14 Frailty Index is a self-reported questionnaire consisting of 36 items with regard to multiple aspects (see detail in our earlier publication). A valid questionnaire refers to each participant fulfilling at least 10 items.…”

Section: Methodsmentioning

confidence: 99%

“… 5 Moreover, we and others have proved that sarcopenia or frailty in isolation is capable of predicting mortality in the ambulatory and hospitalized patients with cirrhosis. 6 – 9 The underlying mechanism of sarcopenia and frailty is superimposed pathologically to some extent, including chronic inflammation, endotoxemia, gut dysbiosis, and endocrine disturbance. However, these two complications also exhibit conceptual discrepancy, and our previous findings demonstrated that sarcopenia is associated with multi-dimensional frailty in male patients with cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia and frailty combined increases the risk of mortality in patients with decompensated cirrhosis

Guo

Hui

et al. 2022

Therapeutic Advances in Chronic Disease

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Background: Both sarcopenia and frailty are prevalent in patients with decompensated cirrhosis and associated with negative outcomes. However, few studies investigated the impact of their coexistence on mortality. We aimed to evaluate the role of sarcopenia and frailty on survival in a cohort of hospitalized cirrhotics. Methods: This was an observational cohort study including 221 patients hospitalized for decompensated events. The cutoff for low skeletal muscle index (SMI) at the third lumbar vertebra level on computed tomography built by our previous work (male: SMI <46.96 cm2/m2; female: SMI <32.46 cm2/m2) was used for the diagnosis of sarcopenia. Individuals with a Frailty Index >0.38 were considered frail. The sample was divided into four groups: sarcopenia and frailty (SF); sarcopenia and non-frailty (SN); non-sarcopenia and frailty (NF); and non-sarcopenia and non-frailty (NN). Follow-up for survival lasted 2 years. Results: Sarcopenia and frailty were present in 21.7% and 14.5% of the patients, respectively. The frequency of frailty in the group of sarcopenic patients was significantly higher than in the patients without sarcopenia (27.1% versus 11%, p = 0.009). In the survival analysis, the SF group showed a higher hazard ratio (2.604 in model 1; 4.294 in model 2) for mortality when compared with the NN group. In addition, the concurrence of those two conditions does give rise to incremental risk for mortality when compared with the group with each disturbance separately, namely, the SN/NF group. Conclusion: In conclusion, cirrhotic patients with sarcopenia and frailty combined showed higher mortality risk.

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“…As deciphered in our previous work, Frailty Index derives from a self-reported scale, Carolina Frailty Index (CFI). 11 CFI is a questionnaire consisting of 36 items regarding various components, such as instrumental activities of daily living, physical function, unintentional weight loss, exhaustion, depression, and social activities. Taking account of the pathophysiological nature of cirrhosis, we modulated the original CFI and obtained a new Frailty Index (Supplemental Table S1).…”

Section: Frailty Index Assessmentmentioning

confidence: 99%

“…More recently, we have developed a self-reported Frailty Index for prognostication, which sounds more applicable, in comparison with physical tests, among severely frail cirrhotics with mobilizing difficulty. [11][12][13] The proposed scale allows us to converge on a relatively parsimonious number of tests relevant to physical frailty. Herein we aimed to investigate the association between sarcopenia and multi-dimensional frailty in hospitalized patients with cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Relationship between sarcopenia/myosteatosis and frailty in hospitalized patients with cirrhosis: a sex-stratified analysis

Feng

Wang

Mao

et al. 2021

Therapeutic Advances in Chronic Disease

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Background: Previous studies have shown that sarcopenia appears to be a significant contributor to physical frailty among outpatients with cirrhosis. However, the evidence is scant regarding the relationship between sarcopenia and multi-dimensional frailty among inpatients. We aimed to investigate the potential contribution of sarcopenia to frailty in hospitalized patients with cirrhosis in a sex-dependent manner. Methods: This cohort enrolled consecutive cirrhotics. Muscle quantity and quality were assessed using the computed tomography-based skeletal muscle index (SMI) and intramuscular adipose tissue content, respectively. Frailty phenotype was clarified by a self-reported Frailty Index. Multiple linear regression determined the association between sarcopenia and frailty phenotype. Results: A total of 202 cirrhotic patients with 48.5% male were included. The median Frailty Index was 0.13, rendering 17.3% subjects as frail. Among the 16 frail men, 68.8% had sarcopenia and 62.5% exhibited myosteatosis. In contrast, among the 19 frail women, 26.3% had sarcopenia and 15.8% exhibited myosteatosis. Frail patients had a significantly lower median SMI (42.80 cm2/m2) compared with those with pre-frailty (48.23 cm2/m2) and with robust status (50.82 cm2/m2) in the male but not the female group. In male patients, multivariate linear regression implicated age (β = 0.330, p < 0.001), SMI (β = −0.260, p < 0.001), albumin (β = −0.245, p = 0.005), and sodium (β = −0.179, p = 0.037) as independent risk factors for frailty. Conclusion: Sarcopenia is associated with multi-dimensional frailty in male patients with cirrhosis. It is tempting to incorporate sex-specific intervention with the purpose of mitigating frailty among inpatients.

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A self-reported Frailty Index predicts long-term mortality in hospitalized patients with cirrhosis

Cited by 16 publications

References 28 publications

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

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

Sarcopenia and frailty combined increases the risk of mortality in patients with decompensated cirrhosis

Relationship between sarcopenia/myosteatosis and frailty in hospitalized patients with cirrhosis: a sex-stratified analysis

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