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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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MethodResultLower-extremity function in persons over the age of 70 years as a predictor of subsequent disability
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- 2005, Model building in PROC PHREG with automatic variable selection and information criteria, Stat Data Anal, SUGI 30, 206
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“Indeed, previous work has demonstrated that chair stand score is a strong predictor of transplant waiting list mortality (Lai et al., 2017).”
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“[13] Excluded from the FrAILT Study are those who speak a language other than English, Spanish, or Chinese and those with severe HE.”
Self-citationHallsworth, K., McCain, M. V., Fallen-Bailey, R., Brown, M. C., Orange, S. T., & Reeves, H. L. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-082155 · Cited by 13
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MethodAI-Cirrhosis-ECG (ACE) score for predicting decompensation and liver outcomes
Ahn, J. C., Rattan, P., Starlinger, P. P., Juanola, A., Moreta, M. J., Colmenero, J., Aqel, B. A., Keaveny, A. P., Mullan, A. F., Liu, K., et al. (2025) · JHEP Reports · doi:10.1016/j.jhepr.2025.101356 · Cited by 17
“…fi able for the purpose of allocation policy, several subjective cirrhosis and portal hypertension-related complications, such as degree of hepatic encephalopathy, refractory ascites and even sarcopenia with frailty 11 are known to be highly associated with worse prognosis in advanced liver disease.”
Yoon, U., Topper, J., & Goldhammer, J. E. (2020) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2020.08.022 · Cited by 14
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Kaps, L., Lukac, L., Michel, M. S., Kremer, W. M., Hilscher, M., Gairing, S. J., Galle, P. R., Schattenberg, J. M., Wörns, M., Nagel, M. C., et al. (2022) · Diagnostics · doi:10.3390/diagnostics12051069 · Cited by 13
“LFI is based on three objective physical performance tests, including hand-grip strength, chair stands, and balance exercises, and has been shown to improve risk prediction for mortality in cirrhotic patients awaiting liver transplantation [9].”
BackgroundThuluvath, A. J., Duarte‐Rojo, A., Lai, J. C., Peipert, J. D., Dietch, Z. C., Siddiqui, O., Morrissey, S., Belfanti, K., Zhao, L., Guo, K., et al. (2023) · Transplantation · doi:10.1097/tp.0000000000004741 · Cited by 13
“19 The LFI provides an additional prognostic tool to complement the Child-Pugh and Model of End-stage Liver Disease (MELD-Na) scores, 2 widely used scores that do not capture frailty 19-21 and are thus limited in predicting pre-and posttransplant outcomes.”
BackgroundMethodResultSelf-citationAssociation of Cardiac Abnormalities to the Frail Phenotype in Cirrhotic Patients on the Waitlist
Puchades, L., Chau, S., Dodson, J. A., Mohamad, Y., Mustain, R., Lebsack, A. E., Aguilera, V., Prieto, M., & Lai, J. C. (2017) · Transplantation · doi:10.1097/tp.0000000000002025 · Cited by 13
Self-citationClinical and biomarker assessment of frailty in liver transplantation
Ayorinde, T., Panayotova, G. G., Sharma, A., & Lunsford, K. E. (2021) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000000911 · Cited by 13
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Ferreira, S. C., de Souza, N. P., Amado, L. R. D. N., Melo, J. O. F., Reis, I. A., & Anastácio, L. R. (2023) · Nutrition · doi:10.1016/j.nut.2023.112021 · Cited by 12
Nathiya, D., Raj, P., Singh, P., Bareth, H., Tejavath, A. S., Suman, S., Tomar, B. S., & Rai, R. R. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165348 · Cited by 12
“It is particularly crucial in chronic diseases such as liver cirrhosis as it encapsulates the repercussions of the disease and its treatment on the patient’s everyday life [6,7].”
BackgroundSkladaný, Ľ., Líška, D., Gurín, D., Molčan, P., Bednar, R., Vnenčáková, J., & Koller, T. (2023) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.23.08130-3 · Cited by 12
Nutritional aspects of prehabilitation in adults with cirrhosis awaiting liver transplant
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Self-citationSingh, N., Faye, A. S., Abidi, M. Z., Grant, S. J., DuMontier, C., Iyer, A. S., Jain, N., Kochar, B. D., Lieber, S. B., Litke, R. R., et al. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.19268 · Cited by 12
“25,26 This is due to the heterogeneous way in which frailty has been assessed.”
Frailty in Lung Transplantation: Candidate Assessment and Optimization
Agarwal, A., & Neujahr, D. C. (2021) · Transplantation · doi:10.1097/tp.0000000000003671 · Cited by 12
Hosoda, K., Shimizu, A., Kubota, K., Notake, T., Masuo, H., Yoshizawa, T., Sakai, H., Hayashi, H., Yasukawa, K., & Soejima, Y. (2022) · Annals of Gastroenterological Surgery · doi:10.1002/ags3.12596 · Cited by 12
Recent advances in liver transplantation
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Orman, E. S., Johnson, A. W., Ghabril, M., & Sachs, G. A. (2021) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2021.1892487 · Cited by 11
Nutritional Management of a Liver Transplant Candidate
Mishra, S., & Premkumar, M. (2023) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2023.03.012 · Cited by 12
Lai, M., Fenton, C. L., Ge, J., Rubin, J. B., Lai, J. C., & Cullaro, G. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000255 · Cited by 11
“The details of this cohort have been published.[9,10] Briefly, the FrAILT study included patients 18 years or older with a diagnosis of cirrhosis, an active listing for liver transplantation, and seen in the ambulatory setting.”
MethodSelf-citationChoudhury, A. K., Adalı, G., Kaewdech, A., Giri, S., & Kumar, R. (2024) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2024.101347 · Cited by 18
Harris, S. J., & Stine, J. G. (2024) · Liver International · doi:10.1111/liv.15986 · Cited by 11
“32 The LFI improves mortality prediction compared to clinician assessment alone or MELDNa alone.”
The Liver Frailty Index enhances mortality risk prediction above and beyond MELD 3.0 alone
Wang, M., Shui, A. M., Huang, C., Kappus, M. R., Rahimi, R. S., Verna, E. C., Ruck, J. M., King, E. A., Ladner, D. P., Tevar, A. D., et al. (2024) · Liver Transplantation · doi:10.1097/lvt.0000000000000436 · Cited by 11
Self-citationRaveh, Y., Livingstone, J. J., Mahan, J., Tekin, A., Selvaggi, G., Bowdon‐Romero, M., & Nicolau‐Raducu, R. (2019) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1729 · Cited by 11
Top Ten Tips Palliative Care Clinicians Should Know About End-Stage Liver Disease
Waterman, B. L., Ramsey, S. U., Whitsett, M. P., Patel, A., Radcliff, J. A., Kotler, D. L., Winters, A. C., Woodrell, C. D., Ufere, N. N., Serper, M., et al. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0097 · Cited by 11
“1,56 The two most commonly used prognostic scoring systems are the Child/Turcotte/Pugh (CTP) classification and the Model for End-Stage Liver Disease (MELD).”
Singh, S., Taneja, S., Tandon, P., De, A., Verma, N., Premkumar, M., Duseja, A. K., Dhiman, R. K., & Singh, V. (2021) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2021.11.012 · Cited by 11
“It takes into account the handgrip strength, chair stand test, and balance testing(19).”
MethodKoons, B., Anderson, M. R., Smith, P. J., Greenland, J. R., & Singer, J. P. (2022) · Current Transplantation Reports · doi:10.1007/s40472-022-00365-2 · Cited by 11
“Refinements to frailty measures specific for lung transplantation may yield improvements in construct and predictive validity, as has been shown in liver transplantation [49].”
BackgroundMethodDeng, L. X., Kent, D. S., O’Riordan, D. L., Pantilat, S. Z., Lai, J. C., & Bischoff, K. E. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0219 · Cited by 11
Self-citationDeng, Y., Hui, Y., Cui, B., Xie, W., & Sun, C. (2023) · Liver International · doi:10.1111/liv.15639 · Cited by 11
“…toileting, dressing, bathing, transfers Predictive of 90- day mortality in liver cirrhosis, and discharge to rehabilitation facility LFI Lai et al (2017), USA5 Grip strength, chair stands, balance Add LFI to MELD- Na resulted in better prognosis prediction and risk stratification CFS…”
BackgroundAn open label feasibility study of a nutrition and exercise app-based solution in cirrhosis
Ismond, K. P., Cruz, C., Limón‐Miró, A. T., Low, G., Prado, C. M. M., Spence, J. C., Raman, M., McNeely, M. L., & Tandon, P. (2024) · Canadian Liver Journal · doi:10.3138/canlivj-2023-0011 · Cited by 10
Frailty and transplant-free survival of patients with liver cirrhosis: A meta-analysis
Yuan, C., Li, W., Liu, J., & Li, J. (2024) · PLoS ONE · doi:10.1371/journal.pone.0302836 · Cited by 10
Liver Transplantation: Protocol for Recipient Selection, Evaluation, and Assessment
Fatima, I., Jahagirdar, V., Kulkarni, A. V., Reddy, R., Sharma, M., Menon, B., Reddy, D. N., & Rao, P. N. (2023) · Journal of Clinical and Experimental Hepatology · doi:10.1016/j.jceh.2023.04.002 · Cited by 10
Systemic therapies in advanced hepatocellular carcinoma: How do older patients fare?
Kapacee, Z. A., McNamara, M. G., Carino, N. D. L., Lamarca, Á., Valle, J. W., & Hubner, R. A. (2020) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2020.03.210 · Cited by 10
Evaluation of liver transplant candidates with non-alcoholic steatohepatitis
Esteban, J. P., & Asgharpour, A. (2021) · Translational Gastroenterology and Hepatology · doi:10.21037/tgh.2020.03.04 · Cited by 9
“Recently, a Liver Frailty Index (LFI), composed of hand grip strength, chair stands and balance time, was developed specifically for LT candidates and has been shown to improve waitlist mortality prediction when combined with the MELD score (132).”
BackgroundSarcopenia and Frailty in Chronic Liver Damage: Common and Different Points
Nishikawa, H., Yoh, K., Enomoto, H., Iwata, Y., Sakai, Y., Kishino, K., Shimono, Y., Ikeda, N., Takashima, T., Aizawa, N., et al. (2020) · In Vivo · doi:10.21873/invivo.12072 · Cited by 10
Recommendations and Guidance on Nutritional Supplementation in the Liver Transplant Setting
Campos‐Varela, I., Gómez‐Gavara, C., & Augustín, S. (2021) · Transplantation · doi:10.1097/tp.0000000000003736 · Cited by 12
“The LFI correlates well with waitlist mortality, and mortality after LT, cellular rejection after LT, and to date has been validated only in the outpatient setting.(25,26,31,36) When possible, LFI should be the preferred frailty measurement.”
BackgroundMethodGoh, M. J., Kim, J., Chang, W. H., Sinn, D. H., Gwak, G., Paik, Y., Choi, M. S., Lee, J. H., Koh, K. C., Paik, S. W., et al. (2023) · Gut and Liver · doi:10.5009/gnl220337 · Cited by 10
Constitutional Challenges to Liver Transplant Policy
Tapper, E. B., Wexler, R., Goldman, E. B., & Volk, M. L. (2019) · Transplantation · doi:10.1097/tp.0000000000002703 · Cited by 10
“Frailty assessments range from the subjective “eye-ball” test or Karnofsky index to objective indices (eg, hand-grip strength, walkspeed).(8) Subjective assessments are highly variable between centers.”
BackgroundLoschi, T. M., Baccan, M. D. T. A., Guardia, B. D., Martins, P. N. A., Boteon, A. P. C. D. S., & BOTEON, Y. L. (2023) · World Journal of Hepatology · doi:10.4254/wjh.v15.i10.1153 · Cited by 9
“Instruments that take objective measures, such as the LFI[13], the Short Physical Performance Battery[43], the Gait Speed test and the 6MWT[44], evaluate the strength and resistance of the lower limbs, the strength of the upper limbs, and balance.”
Perioperative Considerations in Older Kidney and Liver Transplant Recipients: A Review
Chanan, E. L., Wagener, G., Whitlock, E. L., Berger, J. C., McAdams‐DeMarco, M., Yeh, J. S., & Nunnally, M. (2024) · Transplantation · doi:10.1097/tp.0000000000005000 · Cited by 11
Giri, P., Taneja, S., Sahni, N., Bhujade, H., Padhi, B. K., Karki, T., Garg, P., Rathi, S., De, A., Verma, N., et al. (2024) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2024.09.021 · Cited by 9
The impact of sarcopenia and frailty on decompensation in compensated cirrhosis: A systematic review
Becchetti, C., Dajti, E., Su, G. L., Labenz, C., Colecchia, A., Siramolpiwat, S., Ishizu, Y., Ismond, K. P., Beer, L., Paternostro, R., et al. (2025) · Hepatology Communications · doi:10.1097/hc9.0000000000000811 · Cited by 9
“[9] While data regarding the prognostic role of frailty and sarcopenia in decompensated disease are well-established, [4,25 – 27] data on compensated diseases are scant and pose additional questions about the cause-and-effect relationship between sarcopenia and the natural history of compensated…”
Malnutrition Impacts Health‐Related Quality of Life in Cirrhosis: A Cross‐Sectional Study
Chiu, E., Marr, K. J., Taylor, L., Lam, L., Stapleton, M. P., Tandon, P., & Raman, M. (2019) · Nutrition in Clinical Practice · doi:10.1002/ncp.10265 · Cited by 9
Prevalence and Nonpharmacological Interventions for Sarcopenia among Cirrhotic Patients
Abdelbasset, W. K., Nambi, G. S., ELSAYED, S. H., Moawd, S. A. A., Ibrahim, A. A., Verma, A., Tantawy, S. A., Kamel, D. M., Saleh, A. K., Aldhafian, O. R., et al. (2021) · Disease Markers · doi:10.1155/2021/8866093 · Cited by 9
“Recently, the liver frailty index in combination with handgrip strength, balance, and chair standing has been used to predict the mortality rate in cirrhotics [28].”
BackgroundNUTRITIONAL MANAGEMENT OF LIVER CIRRHOSIS AND ITS COMPLICATIONS IN HOSPITALIZED PATIENTS
Javaid, N., IQBAL, A. Z., & Hameeda, M. (2021) · Arquivos de Gastroenterologia · doi:10.1590/s0004-2803.202100000-43 · Cited by 9
Serum and plasma protein biomarkers associated with frailty in patients with cirrhosis
Ha, N. B., Seetharaman, S., Kent, D. S., Yao, F., Shui, A. M., Huang, C., Walston, J. D., & Lai, J. C. (2023) · Liver Transplantation · doi:10.1097/lvt.0000000000000128 · Cited by 9
“[4] Patients in the FrAILT Study enrolled at the University of California, San Francisco (UCSF) undergo biospecimen collection at the time of enrollment and clinical frailty assessment.”
InfluentialSelf-citationChen, H. W., Ferrando, A. A., Dunn, M. A., Kim, W. R., & Duarte‐Rojo, A. (2020) · Liver Transplantation · doi:10.1002/lt.25745 · Cited by 9
“Sarcopenia, physical deconditioning, and frailty in ESLD are known to increase adverse outcomes,(1,5) and exercise is recommended to improve these conditions.”
BackgroundOral Health‐Related Quality of Life in Chronic Liver Failure Patients Measured by OHIP‐14 and GOHAI
Zahed, M., Ranjbar, M. A., & Azad, A. (2020) · BioMed Research International · doi:10.1155/2020/8835824 · Cited by 9
“The only treatment at this stage remains to be liver transplantation surgery [1].”
BackgroundVogliotti, E., Ceolin, C., Valenti, M., Vanin, J., Campodall’Orto, C., Tonon, M., Zanforlini, B. M., Curreri, C., Devita, M., RUI, M. D., et al. (2023) · European Geriatric Medicine · doi:10.1007/s41999-023-00826-6 · Cited by 9
Ferreira, S. C., Cardoso, A. D. S. R., Machado, A. D. A. S., & Anastácio, L. R. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.03.023 · Cited by 8
Marcantei, C., Couret, A., King, J. A., Mazeaud, S., Abergel, A., & Ennequin, G. (2024) · Digestive Diseases and Sciences · doi:10.1007/s10620-024-08441-6 · Cited by 8
“They used the liver frailty index [31] to evaluate this outcome.”
D’Arcangelo, F., Zanetto, A., Ferrarese, A., Gambato, M., Lanari, J., Piano, S. S., Germani, G., Senzolo, M., Russo, F. P., Angeli, P., et al. (2024) · Updates in Surgery · doi:10.1007/s13304-024-01962-9 · Cited by 8
“5; (3) Frail: LFI ≥ 4.5 [3, 33].”
InfluentialGeladari, E. V., Alexopoulos, T., Vasilieva, L., Τέντα, Ρ., Mani, I., Sevastianos, V., & Alexopoulou, A. A. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175169 · Cited by 8
“Consistent with prior research [13–15], we observed that frail individuals had more severe liver disease (as assessed by MELD and hepatic encephalopathy) and comorbidities such as renal impairment.”
BackgroundMethodResultInfluentialSogbe, M., Wong, R. J., Bloomer, P. M., Steinberg, A. S., Rahimi, R. S., Lai, J. C., & Duarte‐Rojo, A. (2025) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003583 · Cited by 8
Self-citationAssessing nutrition status, sarcopenia, and frailty in adult transplant recipients
Ruiz‐Margáin, A., Macías‐Rodríguez, R. U., Flores-García, N. C., Román-Calleja, B. M., Fierro-Angulo, O. M., & González-Regueiro, J. A. (2023) · Nutrition in Clinical Practice · doi:10.1002/ncp.11107 · Cited by 8
LaHue, S. C., Fuentealba, M., Diaz, S. R., Seetharaman, S., Garcia, T. Y., Furman, D., Lai, J. C., & Newman, J. C. (2024) · GeroScience · doi:10.1007/s11357-024-01076-5 · Cited by 8
“As part of the FrAILT Study protocol, all participants undergo in-person testing of physical frailty in the pre-transplant ambulatory setting using the Liver Frailty Index, calculated from grip strength, timed chair stands, and balance [23].”
Self-citationWang, M., Shui, A. M., Ruck, J. M., Huang, C., Verna, E. C., King, E. A., Ladner, D. P., Ganger, D. R., Kappus, M. R., Rahimi, R. S., et al. (2024) · Liver Transplantation · doi:10.1097/lvt.0000000000000418 · Cited by 8
“[12,14,19] Exclusion criteria include severe HE, which may affect the ability to provide informed consent and complete physical frailty testing.”
Self-citationKim, D. H. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.19151 · Cited by 8
Beta-blockers and physical frailty in patients with end-stage liver disease
Kuo, S. Z., Lizaola‐Mayo, B., Hayssen, H., & Lai, J. C. (2018) · World Journal of Gastroenterology · doi:10.3748/wjg.v24.i33.3770 · Cited by 8
Self-citationJohnston, H. E., de Crom, T. O. E., Hargrave, C., Adhyaru, P., Woodward, A. J., Pang, S., Ali, A., Coombes, J. S., Keating, S. E., McLean, K., et al. (2020) · Clinical Transplantation · doi:10.1111/ctr.14185 · Cited by 8
“Liver Transplantation 2019;25(10):1480-1487.”
Duarte‐Rojo, A., Brown, R., Bloomer, P. M., Duarte, M. N., Grubbs, R. K., & Hernáez, R. (2022) · Transplantation Direct · doi:10.1097/txd.0000000000001347 · Cited by 8
Sugiyama, Y., Ishizu, Y., Ando, Y., Yokoyama, S., Yamamoto, K., Ito, T., Imai, N., Nakamura, M., Honda, T., Kawashima, H., et al. (2022) · Hepatology Research · doi:10.1111/hepr.13820 · Cited by 8
“Regarding grip strength, the original study used the average value of grip strength measured three times.(16) However, in the present study, since grip strength was measured only twice, the average value of the grip strength measured twice was used.”
MethodEffects of an active lifestyle on the physical frailty of liver transplant candidates
Oikonomou, I. M., Sinakos, E., Antoniadis, N., Goulis, I., Γιουλεμέ, Ό., Anifanti, M., Katsanos, G., Karakasi, K.-E., Tsoulfas, G., & Kouidi, E. J. (2022) · World Journal of Transplantation · doi:10.5500/wjt.v12.i11.365 · Cited by 8
Normative cutoffs of muscle mass, muscle strength, and frailty for healthy Indian population
Singh, S. A., Madan, K., Prabhudesai, A. A., Agarwal, A. R., Rastogi, R., Bhargava, R., Kriplani, P., Pampaniya, H., Gupta, S. C., & Indrayan, A. (2022) · Indian Journal of Gastroenterology · doi:10.1007/s12664-022-01295-8 · Cited by 8
“The measure of upper limb muscle strength, HGS, is measured using hand grip dynamometry [13, 14] and has been independently associated with higher mortality in cirrhotics.”
BackgroundMethodCurrent opinions in organ allocation
(2018) · American Journal of Transplantation · doi:10.1111/ajt.15094 · Cited by 8
Waller, K. M. J., Prince, D. S., Lai, E. H. Y., Levy, M. T., Strasser, S. I., McCaughan, G. W., Teng, M. L. P., Huang, D. Q., & Liu, K. (2024) · ESMO Gastrointestinal Oncology · doi:10.1016/j.esmogo.2024.100043 · Cited by 7
Cullaro, G., Chiou, S. H., Fenton, C. L., Ge, J., McCulloch, C. E., Rubin, J., Shui, A. M., Yao, F., & Lai, J. C. (2024) · Liver Transplantation · doi:10.1097/lvt.0000000000000359 · Cited by 7
“[4] Briefly, the FrAILT Study prospectively enrolled patients who are 18 years old or above with a diagnosis of cirrhosis, are actively listed for liver transplantation, and are seen in the ambulatory setting.”
Self-citationStøy, S. H., Eriksen, L. L., Lauszus, J. S., Damsholt, S., Baunwall, S. M. D., Erikstrup, C., Vilstrup, H., Jepsen, P., Hvas, C. L., & Thomsen, K. L. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-091078 · Cited by 7
Adamantou, M., Pergantina, E., Kamiliou, A., Rachiotis, N., Lekakis, V., Chrysavgis, L., Papatheodoridis, G., Angelousi, A. G., & Cholongitas, Ε. (2025) · Liver International · doi:10.1111/liv.70384 · Cited by 7
“Finally, patients' frailty status was assessed and categorised according to the Liver Frailty Index (LFI) [27].”
Siripen, N., Chonprasertsuk, S., Aumpan, N., & Siramolpiwat, S. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.11.018 · Cited by 7
Lepour, M., Delorme, A., Goffaux, A., Tréfois, P., Dubois, E., Catoul, C., Braem, F., Azevedo, D. D., Collard, A., Lanthier, N., et al. (2025) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2025.102743 · Cited by 7
Li, C., Zhao, C., Yu, Z., Yang, W., Sun, M., Li, Y., Guo, G., Hui, Y., Wang, X., Fan, X., et al. (2022) · Postgraduate Medicine · doi:10.1080/00325481.2022.2063487 · Cited by 7
Yoshioka, Y., Oshima, Y., Hata, K., Satô, S., Hamada, R., Sato, T., Kaido, T., Munekage, F., Ito, T., Ikeguchi, R., et al. (2022) · Clinical Transplantation · doi:10.1111/ctr.14800 · Cited by 7
Panezai, M. Q., Yaseen, R. T., Lail, G., Khalid, M. A., Ismail, H. M., Majid, Z., Kumar, D., Shahzad, S., Laeeq, S. M., & Luck, N. H. (2023) · Cureus · doi:10.7759/cureus.40574 · Cited by 7
“LFI [8] will be measured by putting the following values into the equation: LFI [8] = (-0.”
BackgroundMethodResultInfluentialMartinez-Perez, S., McCluskey, S. A., Davierwala, P. M., Kalra, S., Nguyen, E. T., Bhat, M., Borosz, C., Luzzi, C. A., Jaeckel, E., & Neethling, E. (2023) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2023.11.039 · Cited by 7
Moosavi, S. A., Mashhadiagha, A., Taherifard, E., Fallahzadeh, M. A., Motazedian, N., Sayadi, M., Azarpira, N., & Rahimi, R. S. (2023) · Gastroenterology and hepatology from bed to bench. · doi:10.22037/ghfbb.v16i4.2795 · Cited by 7
Jutras, G., & Lai, J. C. (2024) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000001157 · Cited by 7
Self-citationOlson, S. L., Polineni, P., Schwartz, W. A. H., Thuluvath, A. J., Duarte‐Rojo, A., & Ladner, D. P. (2024) · Clinical Transplantation · doi:10.1111/ctr.15412 · Cited by 7
“Significantly, LFI predicts waitlist mortality [22, 24–26] across ESLD etiologies [27].”
InfluentialDallio, M., Romeo, M., Nardo, F. D., Napolitano, C., Vaia, P., Iadanza, G., Olivieri, S., Coppola, A., Niosi, M., & Federico, A. (2025) · Nutrition Journal · doi:10.1186/s12937-025-01074-z · Cited by 7
Nutritional Evaluation and Treatment of the Cirrhotic Patient
Zelber‐Sagi, S., Wajcman, D. I., Rabinowich, L., Bentov, I., & Deutsch, L. (2021) · Clinics in Liver Disease · doi:10.1016/j.cld.2021.01.007 · Cited by 7
Frailty in Liver Transplantation: A Comprehensive Review
Liapakis, A., Morris, E., & Emre, S. (2021) · Hepatology forum/Hepatology forum (Online) · doi:10.14744/hf.2021.2021.0023 · Cited by 7
“[14] The LFI measures handgrip strength, chair stands, and balance.”
BackgroundMethodWang, S., Limón‐Miró, A. T., Cruz, C., & Tandon, P. (2022) · Liver Transplantation · doi:10.1002/lt.26491 · Cited by 7
“2 as frail, prefail, and robust, respectively.[1] Although these tools can all be implemented in the ambulatory setting, the prognostic value of several of these tools has also been established in the inpatient population, including ADL and the KPS.”
BackgroundLi, S., Yuan, Y., An, R., & Li, M. (2022) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002502 · Cited by 7
Campos‐Varela, I., Castells, L., Quiroga, S., Vargas, V., & Simón‐Talero, M. (2024) · Annals of Hepatology · doi:10.1016/j.aohep.2024.101515 · Cited by 12
Cullaro, G., Allegretti, A. S., Patidar, K. R., Verna, E. C., & Lai, J. C. (2024) · Liver Transplantation · doi:10.1097/lvt.0000000000000439 · Cited by 7
“[27,28] Since 2017, the FrAILT study has included a biorepository of biospecimens (eg, serum and urine) measured at the participant ’ s ambulatory liver transplant evaluation.”
InfluentialSelf-citationAssessment and Management of Nutrition Status in the Hospitalized Patient With Cirrhosis
Moore, C., & Stein, A. C. (2018) · Clinical Liver Disease · doi:10.1002/cld.758 · Cited by 7
Incorporating Frailty in the Treatment Program of Elderly Patients with Gastrointestinal Disease
Thompson, C., & Taleban, S. (2020) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-020-00310-1 · Cited by 7
“While the Modified Frailty Index appears to be the most widely used Frailty Index in multiple surgery specialties, a recent study reported that the Enhanced Modified Frailty Index (EMFI) is a better predictor of post-operative complications and mortality after Whipple procedures [106].”
BackgroundInfluentialExercise Only Works If You Do It! The Holy Grail of Adherence
Kok, B., McNeely, M. L., Watt, M., & Tandon, P. (2021) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001198 · Cited by 7
Prevalence of cognitive impairment in liver transplant recipients
Berry, K., Ruck, J. M., Barry, F., Shui, A. M., Cortella, A., Kent, D., Seetharaman, S., Wong, R., VandeVrede, L., & Lai, J. C. (2024) · Clinical Transplantation · doi:10.1111/ctr.15229 · Cited by 6
Self-citationJohnston, H. E., Andelkovic, M., Mayr, H. L., Chen, Y., Thrift, A. P., Macdonald, G. A., & Hickman, I. J. (2024) · Clinical Transplantation · doi:10.1111/ctr.70034 · Cited by 6
“The liver frailty index (LFI) [27] was measured as part of routine care at the initial QLTS dietitian consultation.”
Tang, W.-Z., Zhu, S.-R., Mo, S.-T., Xie, Y., Tan, Z.-K.-K., Teng, Y., & Jia, K. (2025) · JMIR Medical Informatics · doi:10.2196/60683 · Cited by 6
“For example, several researchers have demonstrated that frailty serves as a prognostic indicator for mortality in individuals with cirrhosis [17,18], but conflicting findings have been reported in another investigation [16].”
Lai, J. C., Shui, A. M., Molinari, M., Rahimi, R. S., Ladner, D. P., Ganger, D. R., Kappus, M. R., King, E., Tevar, A. D., Volk, M. L., et al. (2025) · Hepatology · doi:10.1097/hep.0000000000001320 · Cited by 6
Self-citationImpact of Frailty on the Prognosis of Patients With Liver Cirrhosis Undergoing Insertion of a TIPS
Kabelitz, M. A., Gairing, S. J., Tiede, A., Schleicher, E. M., Ahl, L. G., Wagner, L., Zucker‐Reimann, F., Rieland, H., Mauz, J. B., Weinmann‐Menke, J., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70315 · Cited by 6
Nguyen, V. V., Wang, S., Whitlock, R. H., Xu, C. Q., Taneja, S., Singh, S., Abraldeṣ, J. G., Burak, K. W., Bailey, R. J., Grab, J. D., et al. (2022) · Canadian Liver Journal · doi:10.3138/canlivj-2022-0021 · Cited by 6
Self-citationManzia, T. M., Sensi, B., Gentileschi, P., Quaranta, C., Toti, L., Baiocchi, L., Dauri, M., Angelico, R., & Tisone, G. (2024) · Liver Transplantation · doi:10.1097/lvt.0000000000000522 · Cited by 7
Laghi, L., Ortiz, M. A., Rossi, G., Román, E. M., Mengucci, C., Cantó, E., Biagini, L., Sánchez, E., Mulet, M., García‐Osuna, Á., et al. (2024) · Biomolecules · doi:10.3390/biom14111410 · Cited by 6
Koutoukidis, D. A., Jebb, S. A., Tomlinson, J., Mózes, F. E., Pavlides, M., Lacharie, M., Saffioti, F., Aveyard, P. N., & Cobbold, J. (2025) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13783 · Cited by 8
“[16] and liver frailty index [17] and c. anthropometric: weight and fat-free mass.”
Wiering, L., Öllinger, R., Kruppa, J., Schoeneberg, U., Dziodzio, T., Jara, M., Biebl, M., Dargie, R., Raschzok, N., Schöning, W., et al. (2020) · Liver Transplantation · doi:10.1002/lt.25748 · Cited by 6
“Laboratory MELD 23 (17-32) 23 (17-32) 29 (20.”
BackgroundCognitive dysfunction, psychiatric distress, and functional decline after liver transplantation
Ruck, J. M., Murriel, E. C., Fortune, N., Jefferis, A. A., McAdams‐DeMarco, M., Vannorsdall, T. D., Segev, D. L., King, E. A., & Oh, E. S. (2025) · Liver Transplantation · doi:10.1097/lvt.0000000000000569 · Cited by 5
Self-citation
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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