The Braden Scale, A standard tool for assessing pressure ulcer risk, predicts early outcomes after liver transplantation

Abstract

The Braden Scale is a standardized tool to assess pressure ulcer risk that is reported for all hospitalized patients in the United States per requirements of the Center for Medicare and Medicaid Services. Previous data have shown the Braden Scale can predict both frailty and mortality risk in patients with decompensated cirrhosis. Our aim was to evaluate the association of the Braden Scale score with short-term outcomes after liver transplantation (LT). We performed a retrospective cohort study of deceased donor LT recipients at 2 centers and categorized them according to the Braden Scale at hospital admission as low (>18), moderate (16-18), or high risk (<16) for pressure ulcer. We created logistic and Poisson multiple regression models to evaluate the association of Braden Scale category with in-hospital and 90-day mortality, length of stay (LOS), nonambulatory status at discharge, and discharge to a rehabilitation facility. Of 341 patients studied, 213 (62.5%) were low risk, 59 (17.3%) were moderate risk, and 69 (20.2%) were high risk. Moderate- and high-risk patients had a greater likelihood for prolonged LOS, nonambulatory status, and discharge to a rehabilitation facility, as compared with low-risk patients. High-risk patients additionally had increased risk for in-hospital and 90-day mortality after LT. Multiple regression modeling demonstrated that high-risk Braden Scale score was associated with prolonged LOS (IRR, 1.56; 95% confidence interval [CI], 1.47-1.65), nonambulatory status at discharge (odds ratio [OR], 4.15; 95% CI, 1.77-9.71), and discharge to a rehabilitation facility (OR, 5.51; 95% CI, 2.57-11.80). In conclusion, the Braden Scale, which is currently assessed in all hospitalized patients in the United States, independently predicted early disability-related outcomes and greater LOS after LT. Liver Transplantation 23 1153-1160 2017 AASLD.

Frailty in liver transplantation: An expert opinion statement from the American Society of Transplantation Liver and Intestinal Community of Practice

“…Importantly, "physical frailty," as investigated in patients with cirrhosis, is a critical determinant of adverse health outcomes in this population, including waitlist mortality, [6][7][8][9][10][11] mortality after hospitalization and after liver transplantation, [12][13][14][15] need for hospitalization, length of stay, 14,[16][17][18] and discharge location (ie, rehabilitation facility) 13,14 (Table 1).…”

“…1With respect to the application of frailty tools in the clinical arena, we recommend that every transplant center should incorporate a standardized tool to measure frailty in their liver transplant patients both at initial evaluation and longitudinally on the waitlist. This recommendation was based on evidence that standardized frailty metrics can improve the accuracy of the "eyeball test" and traditional liver disease metrics to predict mortality in patients with cirrhosis 5,[7][8][9][10][11][12][13][14]21.…”

Report from the American Society of Transplantation on frailty in solid organ transplantation

“…53 Frailty has consistently been shown to be a critical determinant of liver transplant outcomes, including hospitalizations, and mortality both before 2,52,54-57 and after liver transplantation. 53,[58][59][60][61] A range of tools to measure frailty and physical function have been studied in this population, and recent efforts to standardize frailty measurement in liver transplantation have yielded the Liver 2. Frailty measurements should be standardized and performed routinely in patients undergoing evaluation for liver transplantation.…”

Frailty and Outcomes After Liver Transplantation

“…(8) Following transplant, Braden scores were linked with prolonged hospital length of stay, nonambulatory status at discharge, and discharge to a rehabilitation facility. (15) Second, the Fried physical frailty phenotype (PFP) is the most widely validated tool for frailty assessment. Consisting of patient reported weight loss, activity, and exhaustion as well as measured weakness (hand-grip) and walking speed, the PFP is scored from 0 to 5 based on frail performance for each categories with scores ≥3 generally indicating frailty.…”