The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study

Xu, Chelsea; Mohamad, Yara; Kappus, Matthew R.; Boyarsky, Brian J.; Ganger, Daniel; Volk, Michael L.; Rahimi, Robert S.; Duarte‐Rojo, Andrés; McAdams‐DeMarco, Mara; Segev, Dorry L.; Ladner, Daniela P.; Verna, Elizabeth C.; Grab, Joshua D.; Tincopa, Monica A.; Dunn, Michael A.; Lai, Jennifer C.

doi:10.1111/liv.15006

Cited by 23 publications

(24 citation statements)

References 14 publications

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“…The importance of these considerations is even more critical in light of the evolving epidemiology of LT candidates due to the increased prevalence of non-alcoholic steatohepatitis (NASH). A recent study investigating the relationship between frailty and cirrhosis etiology revealed that NASH patients were the frailest category of LT candidates, justifying particular attention to the liver functional reserve and malnourishment and immunologic impairment when a patient is transplanted (40).…”

Section: Discussionmentioning

confidence: 99%

CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study

et al. 2022

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Introduction: Liver transplantation (LT) is burdened by the risk of post-operative morbidity. Identifying patients at higher risk of developing complications can help allocate resources in the perioperative phase. Controlling Nutritional Status (CONUT) score, based on lymphocyte count, serum albumin, and cholesterol levels, has been applied to various surgical specialties, proving reliable in predicting complications and prognosis. Our study aims to investigate the role of the CONUT score in predicting the development of early complications (within 90 days) after LT.Methods: This is a retrospective analysis of 209 patients with a calculable CONUT score within 2 months before LT. The ability of the CONUT score to predict severe complications, defined as a Comprehensive Complication Index (CCI) ≥42.1, was examined. Inverse Probability Treatment Weighting was used to balance the study population against potential confounders.Results: Patients with a CCI ≥42.1 had higher CONUT score values (median: 7 vs. 5, P-value < 0.0001). The CONUT score showed a good diagnostic ability regarding post-LT morbidity, with an AUC = 0.72 (95.0%CI = 0.64–0.79; P-value < 0.0001). The CONUT score was the only independent risk factor identified for a complicated post-LT course, with an odds ratio = 1.39 (P-value < 0.0001). The 90-day survival rate was 98.8% and 87.5% for patients with a CONUT score <8 and ≥8, respectively.Conclusions: Pre-operative CONUT score is a helpful tool to identify patients at increased post-LT morbidity risk. Further refinements in the score composition, specific to the LT population, could be obtained with prospective studies.

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Section: Discussionmentioning

confidence: 99%

CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study

et al. 2022

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“…Moreover, among frail people, those with NFS score F3/F4 had a significantly greater hazard for dementia over a long period, as indicated in a multivariable model adjusted for clinical and laboratory parameters [ 40 ]. Recently, Xu et al , analyzing data from cirrhotic patients awaiting LT, showed that NAFLD patients had a higher median liver frailty index (LFI) compared to their non-NAFLD counterparts [ 41 ]. Moreover, the prevalence of frailty was higher in the NAFLD group of patients [ 41 ].…”

Section: Methodsmentioning

confidence: 99%

“…Recently, Xu et al , analyzing data from cirrhotic patients awaiting LT, showed that NAFLD patients had a higher median liver frailty index (LFI) compared to their non-NAFLD counterparts [ 41 ]. Moreover, the prevalence of frailty was higher in the NAFLD group of patients [ 41 ]. Nonetheless, in the multivariate analysis, adjusted for age, model for end-stage liver disease-sodium score and ascites, only ALD and other causes of liver disease were independently associated with frailty, whereas NAFLD was marginally correlated with frailty (P=0.05).…”

Section: Methodsmentioning

confidence: 99%

“…Nonetheless, in the multivariate analysis, adjusted for age, model for end-stage liver disease-sodium score and ascites, only ALD and other causes of liver disease were independently associated with frailty, whereas NAFLD was marginally correlated with frailty (P=0.05). Furthermore, the underlying etiology of cirrhosis was not significantly associated with waitlist mortality during a median follow up of 13 months [ 41 ].…”

Section: Methodsmentioning

confidence: 99%

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Frailty in metabolic syndrome, focusing on nonalcoholic fatty liver disease

Karakousis¹

2022

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In recent years, frailty has been increasingly recognized among researchers of distinct medical specialties worldwide. Frailty comprises a complex of multisystemic physiological decline, reduced physiologic reserve, and vulnerability to stressors. Frail people tend to have a shorter lifespan and greater disability, morbidity and mortality. In the field of hepatology, frailty is identified in nearly 50% of patients who have cirrhosis of any cause. The most predominant cause of chronic liver disease is nonalcoholic fatty liver disease (NAFLD), considered as the hepatic manifestation of the metabolic syndrome (MetS). Although it is viewed as a benign disease, it may progress to nonalcoholic steatohepatitis (NASH), characterized by the additional emergence of inflammation and hepatocyte ballooning, with or without fibrosis. During the progression of NAFLD to NASH and liver cirrhosis, NAFLD patients present sarcopenia along with lower skeletal muscle strength and function. Moreover, aging and the increased prevalence of comorbidities further exacerbate their physical performance. The aforementioned features are strongly associated with the frailty phenotype, implying that the latter could be associated with both MetS and NAFLD. Although it is a relatively new topic of research interest, in this review we aim to provide a synopsis of the current literature dealing with the interplay between frailty and MetS, and to shed more light on the association between NAFLD and frailty. Finally, we discuss the potential pathophysiological mechanisms linking the distinct features of MetS and NAFLD with aspects of the frailty phenotype.

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“…The importance of these considerations is even more critical in light of the evolving epidemiology of LT candidates due to the increased prevalence of non-alcoholic steatohepatitis (NASH). A recent study investigating the relationship between frailty and cirrhosis etiology revealed that NASH patients were among the frailest category of LT candidates, justifying specific consideration to the liver functional reserve and malnourishment and immunologic impairment when a patient is transplanted ( 5 ).…”

mentioning

confidence: 99%