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Development of a novel frailty index to predict mortality in patients with end‐stage liver disease
Open accessAbstract
Cirrhosis is characterized by muscle wasting, malnutrition, and functional decline that confer excess mortality not well quantified by the Model for End-Stage Liver Disease (MELD) Sodium (MELDNa) score. We aimed to develop a frailty index to capture these extrahepatic complications of cirrhosis and enhance mortality prediction in patients with cirrhosis. Consecutive outpatients listed for liver transplantation at a single transplant center without MELD exceptions were assessed with candidate frailty measures. Best subset selection analyses with Cox regression identified subsets of frailty measures that predicted waitlist mortality (=death or delisting because of sickness). We selected the frailty index by balancing statistical accuracy with clinical utility. The net reclassification index (NRI) evaluated the %patients correctly reclassified by adding the frailty index to MELDNa. Included were 536 patients with cirrhosis with median MELDNa of 18. One hundred seven (20%) died/were delisted. The final frailty index consisted of: grip strength, chair stands, and balance. The ability of MELDNa and the frailty index to correctly rank patients according to their 3-month waitlist mortality risk (i.e., concordance-statistic) was 0.80 and 0.76, respectively, but 0.82 for MELDNa+frailty index together. Compared with MELDNa alone, MELDNa+frailty index correctly reclassified 16% of deaths/delistings (P = 0.005) and 3% of nondeaths/delistings (P = 0.17) with a total NRI of 19% (P < 0.001). Compared to those with robust frailty index scores (<20th percentile), cirrhotics with poor frailty index scores (>80th percentile) were more impaired by gait speed, difficulty with Instrumental Activities of Daily Living, exhaustion, and low physical activity (P < 0.001 for each). CONCLUSION: Our frailty index for patients with cirrhosis, comprised of three performance-based metrics, has construct validity for the concept of frailty and improves risk prediction of waitlist mortality over MELDNa alone. (Hepatology 2017;66:564-574).
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“Finally, malnutrition [105], frailty [106, 107] and especially sarcopenia [108, 109, 110, 111] have become increasingly important in patients with advanced chronic liver disease and should be evaluated and treated in each patient.”
From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [106]
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BackgroundMethodInfluentialSelf-citationMotor and Cognitive Performance in Patients with Liver Cirrhosis with Minimal Hepatic Encephalopathy
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BackgroundCumulative Deficits Frailty Index Predicts Outcomes for Solid Organ Transplant Candidates
Varughese, R. A., Theou, O., Li, Y., Huang, X., Chowdhury, N., Famure, O., Selzner, N., MacIver, J., Mathur, S., Kim, S. J., et al. (2021) · Transplantation Direct · doi:10.1097/txd.0000000000001094 · Cited by 36
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BackgroundSelf-citationTapper, E. B., Derstine, B. A., Baki, J., & Su, G. L. (2019) · Digestive Diseases and Sciences · doi:10.1007/s10620-019-05713-4 · Cited by 33
Frailty, Sarcopenia, and Malnutrition in Cirrhotic Patients
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Self-citationFerreira, A. P., & Machado, M. V. (2021) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002291 · Cited by 33
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Self-citationDevelopment of the Lung Transplant Frailty Scale (LT-FS)
Singer, J. P., Christie, J. D., Diamond, J. M., Anderson, M. A., Benvenuto, L. J., Gao, Y., Arcasoy, S. M., Lederer, D. J., Calabrese, D. R., Wang, P., et al. (2023) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2023.02.006 · Cited by 33
Self-citationDuarte‐Rojo, A., Bloomer, P. M., Grubbs, R. K., Stine, J. G., Ladner, D. P., Hughes, C. B., Dunn, M. A., & Jakicic, J. M. (2023) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000601 · Cited by 34
Nutrition as Therapy in Liver Disease.
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“…frailty and sarcopenia add to the predictive validity of the Model for End-stage Liver Disease (MELD) score, particularly at lower values, [1,4 – 6] and are associated with lower transplant waitlisting, increased pretransplant mortality, becoming too sick for transplant, higher need for…”
BackgroundDefinition of Sarcopenia in Chronic Liver Disease
Son, S. W., Song, D. S., Chang, U. I., & Yang, J. M. (2021) · Life · doi:10.3390/life11040349 · Cited by 32
Skladaný, Ľ., Molčan, P., Vnenčáková, J., Vrbová, P., Kukla, M., Lafférs, L., & Koller, T. (2021) · Canadian Journal of Gastroenterology and Hepatology · doi:10.1155/2021/5576531 · Cited by 31
“Definition of frailty was adopted according to Lai et al. 2017 (LFI > 4.5) and by calculating the 80 th percentile of LFI in our entire cohort of 385 patients (LFI > 5.2).”
InfluentialSarcopenia and Frailty in Cirrhosis
Bunchorntavakul, C. (2023) · Medical Clinics of North America · doi:10.1016/j.mcna.2022.12.007 · Cited by 35
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Nonalcoholic fatty liver disease and sarcopenia: Where do we stand?
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“)e LFI consists of dominant HGS, time to do 5 chair stands and time holding 3 balance positions (feet side-by-side, semitandem, and tandem), and result in a continuous variable that can then be categorized into frail, prefrail, and robust and assessed longitudinally [85].”
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Chen, H., & Dunn, M. A. (2018) · Clinical Liver Disease · doi:10.1002/cld.691 · Cited by 30
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“Several populations that are currently disadvantaged may benefit from access to the expanded donor pool provided with HCV viremic liver allografts, including women and those of short stature, poor frailty index scores, and those with sarcopenia.(31-33) Implementation of a national liver review board in the United Stat…”
BackgroundSex Differences in the Association Between Frailty and Sarcopenia in Patients With Cirrhosis
Fozouni, L., Wang, C. W., & Lai, J. C. (2019) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000102 · Cited by 29
“Both sarcopenia and frailty are prevalent in patients with cirrhosis and have been shown to be critical determinants of mortality in this population (3, 4).”
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Frailty Assessment in Patients with Liver Cirrhosis
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Cognitive Impairment and Physical Frailty in Patients With Cirrhosis
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Self-citationControversies in Diagnosing Sarcopenia in Cirrhosis—Moving from Research to Clinical Practice
Sinclair, M. J. (2019) · Nutrients · doi:10.3390/nu11102454 · Cited by 28
“The Fried Frailty Index is an additional tool initially derived in the geriatric population that has since been modified in to a liver-specific tool called the Liver Frailty Index after analysis in a large cohort of cirrhotics awaiting liver transplant [27].”
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Self-citationElsheikh, M., Sabagh, A. E., Mohamed, I. B., Bhongade, M., Hassan, M. M., & Jalal, P. K. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i46.6028 · Cited by 28
“The LFI is a valuable tool for assessing frailty in hepatic patients, as it combines three performance-based evaluations: grip strength of the hand, the duration taken to perform five chair stands, and the duration of maintaining three different balance positions[152].”
Prevalence of frailty in patients with non-cirrhotic non-alcoholic fatty liver disease
Naimimohasses, S., O’Gorman, P., McCormick, E., Ferguson, D., Monaghan, A., McGrath, M., Robinson, M. W., Gormley, J., & Norris, S. (2022) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2021-000861 · Cited by 26
Contemporary management of pain in cirrhosis: Toward precision therapy for pain
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Sarcopenia in the Cirrhotic Patient: Current Knowledge and Future Directions
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A Comprehensive Review of Outcome Predictors in Low MELD Patients
Mazumder, N. R., Atiemo, K., Kappus, M. R., Cullaro, G., Harinstein, M. E., Ladner, D. P., Verna, E. C., Lai, J. C., & Levitsky, J. (2019) · Transplantation · doi:10.1097/tp.0000000000002956 · Cited by 26
“More recently, the Liver Frailty Index was developed in patients with cirrhosis awaiting liver transplantation out of individual components of these indices and consists of performance-based tests that capture malnutrition, muscle weakness, and poor neurocognitive coordination, 3 dominant domains of physical frailty.(…”
Self-citationACG Clinical Guideline: Perioperative Risk Assessment and Management in Patients With Cirrhosis
Mahmud, N., Fricker, Z. P., McElroy, L. M., Qayed, E. S., Wong, R. J., & Ioannou, G. N. (2025) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003616 · Cited by 25
Frailty is strongly associated with self-reported symptom burden among patients with cirrhosis
Deng, L. X., Bischoff, K. E., Kent, D. S., O’Riordan, D. L., Pantilat, S. Z., & Lai, J. C. (2021) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002113 · Cited by 25
Self-citationSiramolpiwat, S., Kiattikunrat, K., Soontararatpong, R., Pornthisarn, B., Vilaichone, R., Chonprasertsuk, S., Bhanthumkomol, P., Nunanun, P., & Issariyakulkarn, N. (2021) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2021.1957497 · Cited by 25
“So far, the LFI has been accepted as a feasible and reliable tool for frailty assessment in advanced cirrhotic patients because it has been shown to enhance prognostication of wait-list mortality over the MELD-Na score[4], improve subjective clinical assessment of a patients’ health [8], and was associated with physic…”
BackgroundMethodResultInfluentialClinical Overview of Sarcopenia, Frailty, and Malnutrition in Patients With Liver Cirrhosis
Kusnik, A. T., Penmetsa, A., Chaudhary, F., Renjith, K., Ramaraju, G. A., Laryea, M. A., & Allard, J. P. (2024) · Gastroenterology Research · doi:10.14740/gr1707 · Cited by 27
“Both the LFI and KPS can be used for periodic evaluations and to classify patients into three categories depending on the severity of frailty [82].”
BackgroundLiver transplantation for critically ill cirrhotic patients: Overview and pragmatic proposals
Artzner, T., Michard, B., Besch, C., Levesque, É., & Faitot, F. (2018) · World Journal of Gastroenterology · doi:10.3748/wjg.v24.i46.5203 · Cited by 24
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“Total hospital length of stay, days, median (IQR) 12 (7-15) 14.”
BackgroundInfluentialFrailty in outpatients with cirrhosis: A prospective observational study
Román, E. M., Parramón, M., Flavià, M., Gely, C., Poca, M., Gallego, A., Santesmases‐Masana, R., Martínez-Esparza, E. H., Nieto, J. C., Urgell, E., et al. (2020) · Liver International · doi:10.1111/liv.14694 · Cited by 26
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The Impact of Frailty, Sarcopenia, and Malnutrition on Liver Transplant Outcomes
Duong, N. K., Sadowski, B. W., & Rangnekar, A. S. (2021) · Clinical Liver Disease · doi:10.1002/cld.1043 · Cited by 24
Wong, R. J., Mohamad, Y., Srisengfa, Y. T., Kent, D. S., Seetharaman, S., Shah, R., & Lai, J. C. (2020) · American Journal of Transplantation · doi:10.1111/ajt.16131 · Cited by 24
“9 There are 3 requirements for resilience: (1) significant adversity/risk, (2) presence of assets or resources to offset the effects of the adversity, and (3) positive adaptation or the avoidance of a negative outcome.”
BackgroundSelf-citationShamseddeen, H., Pike, F., Ghabril, M., Patidar, K. R., Desai, A. P., Nephew, L. D., Anderson, M. D., Kubal, C. A., Chalasani, N., & Orman, E. S. (2020) · Clinical Transplantation · doi:10.1111/ctr.14190 · Cited by 23
“Studies of frailty in the larger population undergoing transplant evaluation continue to advance our understanding of this vulnerable group, and expansion of the literature to SLKT candidates is important to improve patient care 26–28 .”
BackgroundWearables, Physical Activity, and Exercise Testing in Liver Disease
Dunn, M. A., Kappus, M. R., Bloomer, P. M., Duarte‐Rojo, A., Josbeno, D. A., & Jakicic, J. M. (2021) · Seminars in Liver Disease · doi:10.1055/s-0040-1716564 · Cited by 23
A self-reported Frailty Index predicts long-term mortality in hospitalized patients with cirrhosis
Deng, Y., Lin, L., Hou, L., Fan, X., Zhao, T., Mao, L., Wang, X., Wang, B., Ma, Y., & Sun, C. (2020) · Annals of Translational Medicine · doi:10.21037/atm-20-943 · Cited by 23
“Frailty has recently been validated to predict 90-day and 1-year mortality in the pre-transplants population and cirrhotic outpatients (8,12).”
BackgroundMethodFrailty and the Risk of Acute Kidney Injury Among Patients With Cirrhosis
Cullaro, G., Verna, E. C., Duarte‐Rojo, A., Kappus, M. R., Ganger, D. R., Rahimi, R. S., Boyarsky, B. J., Segev, D. L., McAdams‐DeMarco, M., Ladner, D. P., et al. (2021) · Hepatology Communications · doi:10.1002/hep4.1840 · Cited by 23
“(3) Such data reinforce frailty’s utility as a practical clinical tool to help riskstratify patients with cirrhosis— with or without CKD.(11,28) We acknowledge the following limitations to this study.”
BackgroundInfluentialSelf-citationKlein, C. G., Malamutmann, E., Latuske, J., Tagay, S., Dörri, N., Teufel, M., Paul, A., & Oezcelik, A. (2021) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-021-02109-9 · Cited by 22
“The frailty index was calculated based on these measurements, and it was shown that the combination of the MELD score and frailty index was more likely to predict waitlist mortality than either theMELD score or the frailty index alone [21].”
MethodKochar, B. D., Ufere, N. N., Ritchie, C. S., & Lai, J. C. (2022) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000445 · Cited by 22
Self-citationYoo, J., Chang, J.-I., Moon, J. E., Sinn, D. H., Kim, S. G., & Kim, Y. S. (2023) · Liver Transplantation · doi:10.1097/lvt.0000000000000126 · Cited by 22
“[27,28] The newly developed MELD 3.0 has both advantages and disadvantages.”
InfluentialWang, M., Shui, A. M., Barry, F., Verna, E. C., Kent, D. S., Yao, F., Seetharaman, S., Berry, K., Grubbs, R. K., George, G., et al. (2023) · American Journal of Transplantation · doi:10.1016/j.ajt.2023.04.012 · Cited by 22
Self-citationMurphy, S. L., Tapper, E. B., Blackwood, J., & Richardson, J. K. (2018) · Digestive Diseases and Sciences · doi:10.1007/s10620-018-5333-8 · Cited by 22
Neurocognitive and Muscular Capacities Are Associated with Frailty in Adults with Cirrhosis
Murphy, S. L., Richardson, J. K., Blackwood, J., Martinez, B. A., & Tapper, E. B. (2020) · Digestive Diseases and Sciences · doi:10.1007/s10620-020-06099-4 · Cited by 22
Optimizing nutrition in hepatic cirrhosis: A comprehensive assessment and care approach
Méndez-Guerrero, O., Carranza-Carrasco, A., Chi‐Cervera, L. A., Torre, A., & Navarro–Álvarez, N. (2024) · World Journal of Gastroenterology · doi:10.3748/wjg.v30.i10.1313 · Cited by 21
“To assess frailty, the Liver Frailty Index (LFI) is utilized, previously validated in the population with hepatic cirrhosis[23,67,68].”
InfluentialSidhu, S. S., Saggar, K., Goyal, O., Varshney, T., Kishore, H., Bansal, N., & Sidhu, S. S. (2020) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000001761 · Cited by 21
Kukla, M., Skladaný, Ľ., Menżyk, T., Derra, A., Stygar, D. M., Skonieczna, M., Hudy, D., Nabrdalik, K., Gumprecht, J., Marlicz, W. M., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103158 · Cited by 21
“5, as these cutoffs have been associated with worse outcomes in patients awaiting liver transplant based on Lai’s study [11].”
BackgroundInfluentialJesse, M. T., Jackson, W. E., Liapakis, A., Ganesh, S., Humar, A., Goldaracena, N., Levitsky, J., Mulligan, D. C., Pomfret, E. A., Ladner, D. P., et al. (2023) · Clinical Transplantation · doi:10.1111/ctr.14954 · Cited by 21
Self-citationFrailty and Outcomes After Liver Transplantation
Tapper, E. B. (2019) · Current Transplantation Reports · doi:10.1007/s40472-019-0222-4 · Cited by 21
Women on the liver transplantation waitlist are at increased risk of hospitalization compared to men
Rubin, J. B., Sinclair, M. J., Rahimi, R. S., Tapper, E. B., & Lai, J. C. (2018) · World Journal of Gastroenterology · doi:10.3748/wjg.v25.i8.980 · Cited by 21
“…as outpatients at the University of California - San Francisco (UCSF) Liver Transplant Clinic, who were listed for liver transplantation at UCSF from March 2012 to December 2014, and subsequently enrolled prospectively in the Functional Assessment in Liver Transplantation (FrAILT) Study [10,11] .”
BackgroundInfluentialSelf-citationBhanji, R. A., & Watt, K. D. S. (2021) · Liver Transplantation · doi:10.1002/lt.26052 · Cited by 21
“Developed in 2017, the LFI is the only tool specifically designed for patients with cirrhosis.(31) The LFI includes hand grip strength, balance testing and time to perform 5 chair stands from a seated position.”
MethodSarcopenia in chronic advanced liver diseases: A sex-oriented analysis of the literature
Guarino, M., Cossiga, V., Becchetti, C., Invernizzi, F., Lapenna, L., Lavezzo, B., Lenci, I., Merli, M., PASULO, L., Zanetto, A., et al. (2021) · Digestive and Liver Disease · doi:10.1016/j.dld.2021.10.010 · Cited by 20
CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study
Spoletini, G., Ferri, F., Mauro, A., Mennini, G., Bianco, G., Cardinale, V., Agnes, S., Rossi, M., Avolio, A. W., & Lai, Q. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2021.793885 · Cited by 20
“, using nutritional supplementation, immunomodulation, exercise) (36, 37).”
Capuano, P., Hileman, B., Tigano, S., Magro, B., Re, V. L., Liotta, R., Sciveres, M., Ranucci, G., Provenzani, A., Burgio, G., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12155128 · Cited by 19
“Most of the studies in this review reported an outpatient evaluation [41,42], and little is known in terms of a functional evaluation performed on at-home patients.”
BackgroundPrehabilitation in patients awaiting liver transplantation
Benmassaoud, A., Martel, M., Carli, F., Geraci, O., Daskalopoulou, S. S., Sebastiani, G., & Bessissow, A. (2024) · Transplantation Reviews · doi:10.1016/j.trre.2024.100835 · Cited by 19
The stratification of cirrhosis
Maurice, J. B., & Pinzani, M. (2020) · Hepatology Research · doi:10.1111/hepr.13493 · Cited by 19
Román, E. M., Kaür, N., Sánchez, E., Poca, M., Padrós, J., Nadal, M. J., Cuyàs, B., Alvarado‐Tápias, E., Vidal, S., Ortiz, M. A., et al. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000443 · Cited by 19
“[1,5] Prefrail and frail patients were randomized by a nurse to the intervention group or the control group 1:1 using a computer-generated sequence in blocks of 4 and consecutively numbered opaque sealed envelopes.”
MethodGilbo, N., Jochmans, I., Sainz‐Barriga, M., Nevens, F., der Merwe, V., Laleman, W., Verslype, C., Cassiman, D. M., Verbeke, L., van Malenstein, H., et al. (2019) · Transplantation Direct · doi:10.1097/txd.0000000000000883 · Cited by 18
Frailty and Sarcopenia in Acute‐on‐Chronic Liver Failure
Puchades, L., López, J. H., Iranzo, M. À. C. I., Serrano, N. C., Maira, T. D., & Berenguer, M. (2021) · Hepatology Communications · doi:10.1002/hep4.1722 · Cited by 18
Santangeli, E., Abbati, C., Chen, R., di Carlo, A., Leoni, S., Piscaglia, F., & Ferri, S. (2024) · Nutrients · doi:10.3390/nu16030427 · Cited by 21
“Among them, the liver frailty index (LFI) measures physical frailty using the combination of three objective, performance-based tests of physical function: grip strength, chair stands (CST) and balance tests and defines patients as robust, prefrail and frail (liver frailty index ≥ 4.4) [172].”
MethodInfluentialFrailty in Patients With Cirrhosis
Kok, B., & Tandon, P. (2018) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-018-0179-x · Cited by 17
Sarcopenia in Liver Transplantation: an Update
Dhaliwal, A., Williams, F. R., El‐Sherif, O., & Armstrong, M. J. (2020) · Current Hepatology Reports · doi:10.1007/s11901-020-00515-z · Cited by 18
Williams, F. R., Quinlan, J. I., Freer, A., Morrison, B., Sitch, A. J., Hockey, F., Klas, N., Towey, J., Perera, T. P. R., Rajoriya, N., et al. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17834 · Cited by 17
“The prevalence of physical frailty within our UK-based study and its ability to predict mortality is similar to that reported by Lai and colleagues in the United States (Figure 2 ), 5,7 thereby further validating the use of LFI in ambulatory patients with CLD.”
MethodResultChallenges in Liver Transplantation for Hepatocellular Carcinoma: A Review of Current Controversies
Mauro, E., Sanduzzi‐Zamparelli, M., Jutras, G., Garcia, R., Soler, A., Llarch, N., Arce, V. H., Ruíz, P., Rimola, J., López, E., et al. (2024) · Cancers · doi:10.3390/cancers16173059 · Cited by 18
“Research using the LFI in LT candidates demonstrates a high prevalence of frailty, ranging from 15 to 43% [30,32].”
BackgroundMethodSelf-citationSkladaný, Ľ., Drotárová, Z., Vnenčáková, J., Janceková, D., Molčan, P., & Koller, T. (2021) · Croatian Medical Journal · doi:10.3325/cmj.2021.62.8 · Cited by 16
Farrugia, M. A., Garf, S. L., Chierici, A. P., Piche, T., Gual, P., Iannelli, A., & Anty, R. (2023) · Metabolites · doi:10.3390/metabo13030330 · Cited by 16
Zhou, K., Dodge, J. L., Xu, E., Emamaullee, J. A., & Kahn, J. A. (2021) · Clinical Transplantation · doi:10.1111/ctr.14527 · Cited by 15
Self-citationOrange, S. T., Hallsworth, K., Brown, M. C., & Reeves, H. L. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01069-1 · Cited by 15
“The LFI is a composite measure of hand grip strength, chair stands, and balance [34] and is calculated according to the following formula:”
MethodColosimo, S., Bertoli, S., & Saffioti, F. (2023) · Nutrients · doi:10.3390/nu15194190 · Cited by 15
Sengupta, S., Anand, A., Yang, Q., Reagan, M., Husted, M., Minnick, A., Nagy, L. E., Dasarathy, S., Sims, O. T., & Mellinger, J. L. (2025) · Hepatology Communications · doi:10.1097/hc9.0000000000000603 · Cited by 16
Poor Performance Status Predicts Mortality After Living Donor Liver Transplantation
Choudhary, N. S., Sonavane, A. D., Saraf, N., Saigal, S., Rastogi, A. N., Bhangui, P., Thiagrajan, S., Yadav, S. K., Saha, S., & Soin, A. S. (2019) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2019.06.006 · Cited by 15
“A combination of MELD-Na and frailty index (grip strength, chair stands, and balance) predicted mortality better than MELD-Na in a study by Lai et al.(19) Frailty strongly predicted waitlist mortality and quality of life, even after adjustment for liver disease severity scores.”
BackgroundDeng, Y., Lin, L., Fan, X., Cui, B., Hou, L., Zhao, T., Hou, J., Mao, L., Wang, X., Zhao, W., et al. (2020) · Therapeutic Advances in Chronic Disease · doi:10.1177/2040622320922023 · Cited by 15
Risks and Rewards of Bariatric Surgery in Advanced Chronic Liver Diseases
Mendoza, Y. P., Becchetti, C., Watt, K. D. S., & Berzigotti, A. (2021) · Seminars in Liver Disease · doi:10.1055/s-0041-1731705 · Cited by 16
Serum Zinc Level Is Associated with Frailty in Chronic Liver Diseases
Nishikawa, H., Yoh, K., Enomoto, H., Iwata, Y., Sakai, Y., Kishino, K., Shimono, Y., Ikeda, N., Takashima, T., Aizawa, N., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9051570 · Cited by 15
S2k-Leitlinie Klinische Ernährung in der Hepatologie
Plauth, M., Bechmann, L. P., Grajecki, D., Gundling, F., Kramer, L., Kremer, A. E., Rau, M., Schneider, A., Tacke, F., & van Thiel, I. (2024) · Aktuelle Ernährungsmedizin · doi:10.1055/a-2338-1144 · Cited by 14
Applying Administrative Data‐Based Coding Algorithms for Frailty in Patients With Cirrhosis
Louissaint, J., Murphy, S. L., Sonnenday, C. J., Lok, A. S.-F., & Tapper, E. B. (2021) · Liver Transplantation · doi:10.1002/lt.26078 · Cited by 14
Systematic review: the role of frailty in advanced chronic liver disease
Bowers, S. P., Brennan, P., & Dillon, J. F. (2022) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17324 · Cited by 14
Cellular Senescence and Frailty in Transplantation
Lorenz, E. C., Hickson, L. J., Khairallah, P., Najafi, B., & Kennedy, C. C. (2023) · Current Transplantation Reports · doi:10.1007/s40472-023-00393-6 · Cited by 14
Hey, P., Chapman, B., Wong, D. J., Gow, P. J., Testro, A., Terbah, R., & Sinclair, M. J. (2023) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002592 · Cited by 14
Nutrition in cirrhosis: Dos and Don’ts
Merli, M. (2020) · Journal of Hepatology · doi:10.1016/j.jhep.2020.07.019 · Cited by 14
Kriss, M. S., & Biggins, S. W. (2020) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000000829 · Cited by 14
Becchetti, C., Lange, N. F., Delgado, M., Brönnimann, M. P., Maurer, M. H., Dufour, J., & Berzigotti, A. (2023) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2023.102080 · Cited by 14
Ravaioli, F., Maria, N. D., Marco, L. D., Pivetti, A., Casciola, R., Ceraso, C., Frassanito, G., Pambianco, M., Pecchini, M., Sicuro, C., et al. (2023) · Nutrients · doi:10.3390/nu15122778 · Cited by 16
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“More recently, the functional measurements of grip strength and balance have been incorporated into scoring systems for nutritional status, but these still require validation in larger populations (13).”
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Using a genetic algorithm to derive a highly predictive and context-specific frailty index
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Sarcopenia in cirrhosis: epidemiology, diagnosis, management and prognosis
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Metadata
- Authors
- Lai, J. C., Covinsky, K. E., Dodge, J. L., Boscardin, W. J., Segev, D. L., Roberts, J. P., & Feng, S.
- Affiliations
- University of California, San Francisco (US)
- Johns Hopkins University (US)
- Corresponding author
- Lai, Jennifer C.
- ORCID
- Venue
- Hepatology
- Published
- 2017-06-28
- Volume
- 66
- Issue
- 2
- Pages
- 564-574
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- PMC
- PMC5519430
- OpenAlex
- W2606209221
- Cited by
- 556
- References
- 34
- Citations by year
- 2026: 75 · 2025: 62 · 2024: 71 · 2023: 62 · 2022: 50 · 2021: 69 · 2020: 60 · 2019: 59 · 2018: 35 · 2017: 10
- FWCI
- 27.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- American College of Gastroenterology (K23AG048337, P30 DK026743, P30AG044281)
- National Institutes of Health
- University of California, San Francisco (P30 AG044281, P30DK026743)
- National Institute on Aging (K23AG048337, R01AG042504, R03AG045072, P30AG044281)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK101828, P30DK026743)
- Liver Center, University of California, San Francisco (P30 DK026743, DK026743)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Keywords
- frailty index, end-stage liver disease, liver cirrhosis, waitlist mortality, MELD-Na, liver transplantation, mortality prediction, grip strength, chair stand, balance, net reclassification improvement, instrumental activities of daily living, walking speed, exhaustion, physical activity
- MeSH terms
- Activities of Daily Living, Cause of Death, Disability Evaluation, Female, Humans, Liver Cirrhosis, Male, Middle Aged, Physical Fitness, Predictive Value of Tests, Prognosis, Retrospective Studies, Severity of Illness Index, Waiting Lists, Reproducibility of Results, Cohort Studies, Survival Rate, Liver Transplantation, Databases, Factual, Risk Assessment, End Stage Liver Disease
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