Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA. Electronic address: Jennifer.firstname.lastname@example.org.
Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White, Dallas, TX, USA.
Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY.
Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC.
Center for Liver Diseases, Thomas A. Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
Division of Gastroenterology & Hepatology, and Transplantation Institute, Loma Linda University Health, Loma Linda, CA.
Division of Gastroenterology & Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR.
Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Dallas Veterans Administration Medical Center, Dallas, TX.
Department of Surgery, Division of Transplant Surgery, University of California-San Francisco, San Francisco, CA.
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
BACKGROUND & AIMS:
Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated liver frailty index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between LFI scores, ascites, and hepatic encephalopathy (HE) and mortality.
Adults without hepatocellular carcinoma who were on the liver transplant waitlist at 9 centers in the United States (n=1044) were evaluated using the LFI LFI scores of 4.5 or more indicated that patients were frail. We performed logistic regression analyses to assess associations between frailty and ascites or HE and competing risk regression analyses (with liver transplantation as the competing risk) to estimate subhazard ratios (sHR) of waitlist mortality (death or removal from the waitlist).
Of study subjects, 36% had ascites, 41% had HE, and 25% were frail. The odds of frailty were higher for patients with ascites (adjusted odd ratio, 1.56 95% CI, 1.15-2.14) or HE (OR, 2.45 95% CI, 1.80-3.33) than without these features. Higher proportions of frail patients with ascites (29%) or HE (30%) died while on the waitlist compared to patients who were not frail (17% of patients with ascites and 20% with HE). In univariable analysis, ascites (sHR, 1.52 95% CI, 1.14-2.05), HE (sHR, 1.84 95% CI, 1.38-2.45), and frailty (sHR, 2.38 95% CI, 1.77-3.20) were associated with waitlist mortality. In adjusted models, only frailty remained significantly associated with waitlist mortality (sHR, 1.82 95% CI, 1.31-2.52)-ascites and HE were not.
Frailty is a prevalent complication of cirrhosis that is observed more frequently in patients with ascites or HE and independently associated with waitlist mortality. LFI scores can be used to objectively quantify risk of death related to frailty - in excess of liver disease severity - in patients with cirrhosis.