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

Abstract

BACKGROUND AND AIMS\nThe 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: (i) cirrhosis progression, (ii) mortality and (iii) unplanned hospitalizations, in both compensated and decompensated disease.\n\n\nAPPROACH AND RESULTS\nAdult patients with cirrhosis from four centers in North America and one in India were included. Frailty was measured at baseline using the LFI and categorized as robust (LFI<3.2), pre-frail (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 MELD score was 15.5 ± 6.0. In patients with compensated cirrhosis, being frail vs robust was associated with increased risk of progression to the next cirrhosis stage or to death (HR 2.45, CI 1.14-5.29) and with an increased risk of unplanned hospitalizations (2.32, CI 1.13-4.79), after adjusting for age, sex, and MELD score. Similar hazard ratios were observed in patients with decompensated cirrhosis.\n\n\nCONCLUSIONS\nFrailty was an independent predictor of cirrhosis progression or death, and unplanned hospitalization across compensated and decompensated cirrhosis patients. Future studies are needed to evaluate the possibility of slowing cirrhosis disease progression by reversing or preventing frailty.