Frailty as Tested by Gait Speed Is a Risk Factor for Liver Transplant Respiratory Complications

Abstract

OBJECTIVES: Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events. METHODS: For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child–Turcotte–Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients. RESULTS: Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02–0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02–0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient −1.47, 95% CI −2.39 to −0.56) and KPS (coefficient −3.17, 95% CI −5.02 to −1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy. DISCUSSION: Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes.

Inpatient Frailty Assessment Is Feasible and Predicts Nonhome Discharge and Mortality in Decompensated Cirrhosis

“…( 2‐4 ) Frailty in decompensated liver disease portends a dismal prognosis including increased risk for falls, hospitalization, institutionalization, removal from the transplant waiting list, posttransplant complications, and increased waitlist mortality. ( 5‐8 ) Frailty is also associated with increased cost of care and disability. ( 7,9 ) The liver frailty index (LFI) is a widely used tool specifically validated to assess physical frailty in cirrhosis.…”

Introducing EL‐FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates

“…( 3,4 ) Frailty is present in 18% to 25% of patients with end‐stage liver disease (ESLD), and it is associated with nearly twice the mortality of reference populations as well as increased hospital admission, waitlist mortality, posttransplant complications, and health care costs. ( 3,5‐7 ) Frailty is also a progressive condition for patients on the waiting list as its prevalence doubles from the time of listing to the time of LT. ( 8,9 )…”

Patient Frailty Is Independently Associated With the Risk of Hospitalization for Acute‐on‐Chronic Liver Failure

“…However, in exploratory analyses, we found that increasing frailty was significantly associated with infection and HE as ADs leading to ACLF. These are intriguing findings because emerging literature suggests an association between frailty and the risk of pulmonary infections, (30) which may result from increased dysphagia and aspiration. Increased risk of infection in frail patients may also be related to immune senescence.…”