Applicability of the liver frailty index in cirrhotic patients evaluated for transplantation
DOI:
https://doi.org/10.59093/27112330.93Keywords:
cirrhosis, liver transplantation, frailty, index, Child-Pugh, MELD-Na.Abstract
Introduction. In recent decades, several scores and models have been proposed to predict prognosis in patients with advanced chronic liver disease. The most recognized and used are the Child-Pugh (CP) and the Model for End-stage Liver Disease (MELD) scores, but they lack tools to objectively evaluate other prognostic factors. For this reason, the concept of fragility has been incorporated into clinical hepatology. The objective of this study was to evaluate the applicability of the liver frailty index (LFI) in patients with cirrhosis evaluated for liver transplantation in Uruguay. Methodology. Observational, descriptive and retrospective study at the Hospital Central de las Fuerzas Armadas (HCFFAA) Liver Disease Service from January 2018 to December 2021. Results. A total of 78 patients were evaluated, 19 were excluded, culminating in a final sample of 59 patients. The mean age was 52 years, with 66% being men. The main etiology of cirrhosis was alcoholic and the most frequent comorbidity was overweight/obesity (66%). The mean LFI was 4.03 ± 0.45. 90% of patients were pre-fragile, 10% were fragile, and no patient was classified as non-fragile. 76% had an advanced stage of the disease at the time of evaluation: 42% CP stage B, 34% CP C, 24% CP A, with a mean MELD-Na of 17.8 ± 7.6. 17% had infectious complications. Overall mortality (n=78) was 12%, and that of patients with calculated LFI was 22%. Conclusions. The LFI can be calculated in cirrhotic patients, and it is an objective tool that provides a comprehensive view of the patient. LFI depends on the severity of the cirrhosis. However, this index is not a predictor of liver transplantation or death on the waiting list in our patients.
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References
Kim HJ, Lee HW. Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol 2013;19:105-115. https://doi.org/10.3350/cmh.2013.19.2.105.
Lai JC, Covinsky KE, Dodge JL, Boscardin WJ, Segev DL, Roberts JP, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology 2017;66:564-574. https://doi.org/10.1002/hep.29219.
Haugen CE, McAdams-DeMarco M, Holscher CM, Ying H, Gurakar AO, Garonzik-Wang J, et al. Multicenter study of age, frailty, and waitlist mortality among liver transplant candidates. Ann Surg 2020;271:1132-1136. https://doi.org/10.1097/sla.0000000000003207.
Lai JC, Dodge JL, Kappus MR, Dunn MA, Volk ML, Duarte-Rojo A, et al. Changes in frailty are associated with waitlist mortality in patients with cirrhosis. J Hepatol 2020;73:575-581. https://doi.org/10.1016/j.jhep.2020.03.029.
Fozouni L, Mohamad Y, Lebsack A, Freise C, Stock P, Lai JC. Frailty is associated with increased rates of acute cellular rejection within 3 months after liver transplantation. Liver Transpl 2020;26:390-396. https://doi.org/10.1002/lt.25669.
Valverde M. Cirrosis y sus complicaciones. Uruguay: Departamento de Educación Médica, Facultad de Medicina, Universidad de la República; 2020. Acceso 10 de mayo de 2023. Disponible en https://www.youtube.com/watch?v=iEYP8iJMFwU.
Tapper EB. Frailty and outcomes after liver transplantation. Curr Transplant Rep 2019;6:1-6. https://doi.org/10.1007/s40472-019-0222-4.
Kardashian A, Ge J, McCulloch CE, Kappus MR, Dunn MA, Duarte-Rojo A, et al. Identifying an optimal liver frailty index cutoff to predict waitlist mortality in liver transplant candidates. Hepatology 2021;73:1132-1139. https://doi.org/10.1002/hep.31406.
Laube R, Wang H, Park L, Heyman JK, Vidot H, Majumdar A, et al. Frailty in advanced liver disease. Liver Int 2018;38:2117-2128. https://doi.org/10.1111/liv.13917.
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59:255-263. https://doi.org/10.1093/gerona/59.3.m255.
Haugen CE, McAdams-DeMarco M, Verna EC, Rahimi RS, Kappus MR, Dunn MA, et al. Association between liver transplant wait-list mortality and frailty based on body mass index. JAMA Surg 2019;154:1103-1109. https://doi.org/10.1001/jamasurg.2019.2845.
Wang CW, Lebsack A, Chau S, Lai JC. The range and reproducibility of the liver frailty index. Liver Transpl 2019;25:841-847. https://doi.org/10.1002/lt.25449.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-M156. https://doi.org/10.1093/gerona/56.3.m146.
Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019;38:485-521. https://doi.org/10.1016/j.clnu.2018.12.022.
Lai JC, Rahimi RS, Verna EC, Kappus MR, Dunn MA, McAdams-DeMarco M, et al. Frailty associated with waitlist mortality independent of ascites and hepatic encephalopathy in a multicenter study. Gastroenterology 2019;156:1675-1682. https://doi.org/10.1053/j.gastro.2019.01.028.
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