The 6‐Minute Walk Test Distance Predicts Mortality in Cirrhosis: A Cohort of 694 Patients Awaiting Liver Transplantation

Abstract

Frailty is an important predictor of increased hospitalization risk, length of stay, and mortality in patients with cirrhosis. The American Society of Transplantation guidance statement supports the 6-minute walk test distance (6MWD) as 1 of 4 tools to be included in a cirrhosis frailty toolkit. (1) Although routinely used to support prognostication in patients with cardiopulmonary diseases and to select patients for heart and lung transplantation, (2) evidence for the use of the 6MWD with cirrhosis is evolving. The most commonly used cutoff to predict mortality in cirrhosis (<250 m) is derived from data by Carey et al. (3) in 121 patients listed for liver transplantation (LT) and later confirmed by Yadav et al. (4) in 213 transplantlisted patients. Building on existing work, the aim of this study was to evaluate the predictive value of the 6MWD in a larger sample of patients with cirrhosis who were being evaluated for LT.

A Telemedicine Alternative to the 6-Minute Walk Test Using Personal Activity Trackers in Liver Transplant Candidates

“…Using >450 m as a reference, this study showed that patients achieving <250 m during the tests have a threefold increase in mortality. 9 We had previously reported on the increased mortality among LT candidates walking <250 m during the 6MWT. 12 In the present study, we found 16% of subjects to be frail according to the 6MWT (ie, all subjects walking <250 m), which corresponds to a lower prevalence than we previously reported (26%).…”

Low Daily Step Count Is Associated With a High Risk of Hospital Admission and Death in Community-Dwelling Patients With Cirrhosis

“…Frailty in LT candidates is associated with increased mortality irrespective of the severity of liver disease. 12,18,19 Although a number of validated frailty tools exist, most tools require an in-person evaluation by a trained professional. Daily step count, on the other hand, can be easily measured remotely with a PAT, and is highly affordable and scalable.…”

Untitled

“…En cuanto a la supervivencia, los pacientes que recorrieron distancias menores a 387 metros presentan una mayor mortalidad 47, 48 . Con lo anterior se sugiere la pre-habilitación cardiaca y programas de ejercicio en pacientes que recorran menos de 400 metros para mejorar su rango anaerobio y de esta manera disminuir su mortalidad predicha 49 . El estado funcional físico no se recupera por completo 4 semanas después de THO, parece que el desarrollo de una estrategia para la prevención de la atrofia muscular antes y durante la recuperación del THO podría ser de gran utilidad 47 .…”