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

Abstract

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.

The 5Ms of Geriatrics in Gastroenterology: The Path to Creating Age-Friendly Care for Older Adults With Inflammatory Bowel Diseases and Cirrhosis

“…Frailty, a measure of health reserve and mediator of health outcomes, serves as an example of the importance of incorporating geriatric principles into cirrhosis care to guide clinical decision-making. The Liver Frailty Index, an objective metric that uses grip strength, chair stands, and balance testing is a validated measure that is strongly associated with risk of cirrhosis disease progression, waitlist mortality, and death independent of the model for end-stage liver disease score (70–73). Frailty is now a well-accepted and validated construct in hepatology that can easily be incorporated into routine clinical care (74).…”

Improving the prognosis before and after liver transplantation: Is muscle a game changer?

“…In patients with cirrhosis (decompensated or not), frailty, easily measured by the LFI, is an independent predictor of death, cirrhosis progression and unplanned hospitalizations (mainly due to infections)[ 44 ]. Frail cirrhotic patients also have an increased risk of acute kidney injury[ 45 ] and hepatorenal syndrome[ 46 ].…”

Nutritional status in patients with hepatocellular carcinoma: Potential relevance for clinical outcome

“…Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide [1]. Impaired nutritional status is a frequent phenomenon in patients with cirrhosis with clear negative impact on clinical course [2][3][4][5][6][7]. Impaired nutritional status also frequently occurs in cirrhotic HCC patients.…”