Cited by 556Liver Disease and TransplantationFrailty in Older AdultsLiver Disease Diagnosis and Treatment

The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index.

Development of a novel frailty index to predict mortality in patients with end‐stage liver disease

Open access

Lai, Jennifer C., Covinsky, Kenneth E., Dodge, Jennifer L., Boscardin, W. John, Segev, Dorry L., Roberts, John P., Feng, Sandy·2017·Hepatology

DOI 10.1002/hep.29219PMC PMC5519430

Open this paper in CoChat — free account Open PDF

Abstract

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).

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Integrity signals

Registry

Crossref · 10.1002/hep.29219

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Frailty in Older Adults: Evidence for a Phenotype
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., et al. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.3.m146 · Cited by 24,907 · cited 10×
“(1), good (2), fair (3), poor (4), or very poor (5).”
BackgroundMethodInfluential
Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living
Lawton, M. P., & Brody, E. M. (1969) · The Gerontologist · doi:10.1093/geront/9.3_part_1.179 · Cited by 18,540
A Proportional Hazards Model for the Subdistribution of a Competing Risk
Fine, J. P., & Gray, R. J. (1999) · Journal of the American Statistical Association · doi:10.1080/01621459.1999.10474144 · Cited by 14,290 · cited 2×
“not available for competing risk regression.((12)) However, in our cohort, the estimates of waitlist mortality, our primary outcome, were similar at 3, 6, and 12 months (Supporting Table S2).”
Result
A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission
Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., Scherr, P. A., & Wallace, R. B. (1994) · Journal of Gerontology · doi:10.1093/geronj/49.2.m85 · Cited by 9,792 · cited 3×
“Balance, seconds <30 seconds is impaired((16)) 30 (30-30) 0.”
Result
A Model to Predict Survival in Patients With End–Stage Liver Disease
Kamath, P. S., Wiesner, R. H., Malinchoc, M., Kremers, W. K., Therneau, T. M., Kosberg, C. L., D’Amico, G., Dickson, R. E., & Kim, W. R. (2001) · Hepatology · doi:10.1053/jhep.2001.22172 · Cited by 5,066 · cited 6×
“The MELD score has proven, time and time again, to predict mortality in patients with cirrhosis.((1,15)) However, clinicians have long recognized that, at a given MELD score, the clinical manifestations of patients with ESLD are highly heterogeneous.”
BackgroundMethodInfluential
Gait speed and survival in older adults.
Studenski, S. (2011) · JAMA · doi:10.1001/jama.2010.1923 · Cited by 4,558 · cited 3×
“Given the inherent sex differences in grip strength((8)) and walk speed((9)) norms, we converted grip strength and walk speed into sexspecific z-scores for use in the prediction modeling:”
MethodResult
Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability
Guralnik, J. M., Ferrucci, L., Simonsick, E. M., Salive, M. E., & Wallace, R. B. (1995) · New England Journal of Medicine · doi:10.1056/nejm199503023320902 · Cited by 4,083
Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): The TRIPOD statement
Collins, P. G. S., Reitsma, J. B., Altman, D. G., & Moons, K. G. M. (2015) · British Journal of Cancer · doi:10.1038/bjc.2014.639 · Cited by 3,319
Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): The TRIPOD Statement
Collins, G. S., Reitsma, J. B., Altman, D. G., & Moons, K. G. M. (2015) · Annals of Internal Medicine · doi:10.7326/m14-0697 · Cited by 3,267
Internal validation of predictive models
Steyerberg, E. W., Harrell, F. E., Borsboom, G. J. J. M., Eijkemans, M. J. C., Vergouwe, Y., & Habbema, J. D. F. (2001) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(01)00341-9 · Cited by 2,746 · cited 1×
“This was a deliberate choice, given that studies have demonstrated that this combination of selection methods is equivalent to cross-validation and bootstrapping and is preferred to internal validation.((10,25)) External validation, however, remains the gold standard to assess the true validity of this index when appl…”
Method

Show all 34 references

Research works printed but not linked: 1

2005, Model building in PROC PHREG with automatic variable selection and information criteria, Stat Data Anal, SUGI 30, 206

Sorted by citations

Items 401–500 of 554

Nutrition and Liver Disease
Franz, A. A., Shay, H., Kirpich, I., & McClain, C. J. (2025) · Seminars in Liver Disease · doi:10.1055/a-2725-5313 · Cited by 1
Optimizing Perioperative Outcomes in Liver Transplantation: The Role of Inpatient Rehabilitation
Malmut, L., Eickmeyer, S. M., Neal, J., Barker, K., Lanphere, J. A., & Rydberg, L. (2026) · Clinical Transplantation · doi:10.1111/ctr.70432 · Cited by 1
Frailty in Hepatocellular Carcinoma: An Unsettled Clinical Challenge
Bonato, A., Guerra, P., Vitale, A., & Martini, A. (2026) · Current Oncology · doi:10.3390/curroncol33010058 · Cited by 1
“…is associated with increased mortality, higher rates of decompensation and hospitalization among individuals on the liver transplant wait-list [22,23], increased mortality and hospitalization also among those with non-advanced cirrhosis [24–28] and increased mortality for inpatients admitted for…”
Influential
Letter on: ‘Impact of Frailty on the Prognosis of Patients With Liver Cirrhosis Undergoing Insertion of a TIPS ’
Kuchana, S. K., Vuppalanchi, R., & Desai, A. P. (2026) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70545 · Cited by 1
EASL position paper on palliative care in advanced chronic liver disease
Verma, S., Pinter, M., Macken, L., Künzler‐Heule, P., Gluud, L. L., Takkenberg, R. B., Nunes, R., Gheorghe, L., Prentice, W. M., & Hudson, B. (2026) · JHEP Reports · doi:10.1016/j.jhepr.2025.101686 · Cited by 1
CAQ Corner: Surgical evaluation for liver transplantation
Misra, A. C., & Emamaullee, J. A. (2022) · Liver Transplantation · doi:10.1002/lt.26505 · Cited by 1
“Measures and definitions of frailty specific to patients with cirrhosis are being developed, which may be more widely adopted and employed in the future.[10,11] Patients who are prohibitively frail often require nutritional optimization, such as supplemental enteral feeds, and aggressive physical and occupational ther…”
Background
Prognostic Nomograms for Hospital Survival and Transplant-Free Survival of Patients with Hepatorenal Syndrome: A Retrospective Cohort Study
Song, Y., Wang, Y., Zang, C., Yang, X., Li, Z., Wu, L., & Li, K. (2022) · Diagnostics · doi:10.3390/diagnostics12061417 · Cited by 1
“Moreover, it has now been widely validated as a prognosis predictor of survival in patients with liver diseases [29].”
Background
Frailty and Sarcopenia in Cirrhosis
Siddiqui, O., Olson, S. L., Thuluvath, A. J., & Ladner, D. P. (2022) · In clinical practice · doi:10.1007/978-3-031-10012-3_6 · Cited by 1
Navigating Hepatocellular Carcinoma Treatment in the Context of Frailty
Rabei, R., & Fidelman, N. A. (2023) · Medical Research Archives · doi:10.18103/mra.v11i10.4493 · Cited by 1
Integration: A Unified Frailty Framework
Azzolino, D., & Cesari, M. (2024) · Springer eBooks · doi:10.1007/978-3-031-57361-3_4 · Cited by 1
Untangling frailty, sarcopenia, and physical fitness in cirrhosis
Duarte‐Rojo, A., Bux, R., & Sliwa, J. A. (2024) · Clinical Liver Disease · doi:10.1097/cld.0000000000000213 · Cited by 2
“…and broadly contributed to the field, special mention deserves the Functional Assessment in Liver Transplantation consortium led by Dr. Lai et al, [5] which recognized the importance of physical performance versus self-reported (subjective) assessment and catapulted the liver frailty index (LFI)…”
Effects of l‐c arnitine on frailty status in patients with liver cirrhosis: A randomized‐controlled trial
Motazedian, N., Ashari, A., Ebrahimi, N. D., Sayadi, M., Pourjafar, S., Motazedian, N., Khademi, V., Shamsaeefar, A., & Eshraghian, A. (2024) · Health Science Reports · doi:10.1002/hsr2.70148 · Cited by 1
Initial participant perspectives about participating in an online, semi‐supervised, cirrhosis‐specific nutrition and exercise intervention
Ismond, K. P., McNeely, M. L., Spence, J. C., Spiers, J. A., & Tandon, P. (2024) · British Journal of Health Psychology · doi:10.1111/bjhp.12769 · Cited by 2
Prevalence of Osteosarcopenia and Frailty in Patients with Chronic Liver Disease
Abbas, Z., Nazir, S., Amjad, S., Altaf, A., Qadeer, M. A., Maqbool, S., Siyal, M., & Kumar, M. (2024) · Euroasian Journal of Hepato-Gastroenterology · doi:10.5005/jp-journals-10018-1442 · Cited by 1
“7 However, the relationship between osteosarcopenia and the LFI remains inadequately elucidated.”
A Comparative Study of Dietary Intake, Nutritional Status, and Frailty in Outpatients and Inpatients with Liver Cirrhosis
Khan, S., Sansoni, S., Cola, S. D., Lapenna, L., & Merli, M. (2025) · Nutrients · doi:10.3390/nu17030580 · Cited by 1
Latin American association for the study of the liver (ALEH) guidance on preoperative care in liver transplantation: referral criteria, patient assessment, and waiting list management
Mainardi, V., Pagés, J., Menéndez, J., Zapata, R., Díaz, L. A., Marciano, S., Cairo, F. M., Padilla, M., Tenorio, L., Urzua, A. M., et al. (2025) · Annals of Hepatology · doi:10.1016/j.aohep.2025.101939 · Cited by 2
The Definition and Diagnosis of Frailty in the Research and Clinical Settings
Chen, H., & Duarte‐Rojo, A. (2019) · Springer eBooks · doi:10.1007/978-3-030-26226-6_2 · Cited by 1
The Role of Cardiopulmonary Exercise Testing (CPET) in the Preoperative Assessment of Patients for Hepatico-Pancreatic-Biliary (HPB) Surgery and Liver Transplantation (LT)
Loughnan, A., Nair, S., & James, S. (2020) · Springer eBooks · doi:10.1007/978-3-030-51331-3_7 · Cited by 1
Personality Traits in Patients With Cirrhosis Are Different From Those of the General Population and Impact Likelihood of Liver Transplantation
Thuluvath, A., Siddiqui, O., Lai, J., Peipert, J., Levitsky, J., Daud, A., Mazumder, N., Flores, A.-M., Borja-Cacho, D., Caicedo, J., et al. (2022) · Transplantation · doi:10.1097/tp.0000000000004304 · Cited by 1
Self-citation
Frailty after liver transplantation: The strong survive but may not prosper
Maddur, H., & Levitsky, J. (2018) · American Journal of Transplantation · doi:10.1111/ajt.14750 · Cited by 1
Changes in Frailty Status: Some Better, Some Worse
Montgomery, J. R., & Englesbe, M. J. (2018) · Transplantation · doi:10.1097/tp.0000000000002564 · Cited by 1
“The Fried score is too complex and timeconsuming for generalized use in the field of transplantation, and there is evidence that simplified scores can be developed (eg, Liver Frailty Index for the cirrhotic population).(8,9) The authors should lead the kidney transplant community in these efforts.”
Background
Editorial: moving towards a robust definition of sarcopenia in cirrhosis
Sinha, R. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15070 · Cited by 1
“Conceivably, sarcopenia may play a greater role in physical frailty in a patient with end‐stage liver disease compared to an older adult—where the term “frailty” is described as a distinct biological condition.(4) Incorporating sarcopenia with MELD has shown conflicting prognosticating potential, not least influenced…”
Background
Editorial: effect of exercise on physical frailty in patients with chronic liver disease
karnam, R. S., & Bhat, M. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15534 · Cited by 1
Assessment and prognostic importance of nutritional status and body composition in liver transplantation
Lindqvist, C. (2020) · Figshare · Cited by 1
Frailty index–predicted mortality is moderated by health-related behaviors: a 4-year community-based longitudinal-cohort studyPreprint
Huang, L., Chen, H., Ye, B., Qi, S., Ruan, Y., Chen, X., Ding, G., Fei, J., Shen, Y., Gao, J., et al. (2020) · doi:10.21203/rs.2.21751/v1 · Cited by 1
“Over the past 5 years, the number of studies on the FI’s validity for predicting mortality has grown, but the majority of subjects were hospitalized with various chronic diseases such as end-stage liver disease[15], HIV-related diseases[16], or Alzheimer disease[17]; or”
Background
Letter: patients who have both sarcopenia and frailty have similar prognosis to those with either condition separately—authors’ reply
Bunchorntavakul, C., & Reddy, K. R. (2021) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16581 · Cited by 1
Table of contents
(2017) · Hepatology · doi:10.1002/hep.29280 · Cited by 1
Pre-transplant Biomarkers of Immune Dysfunction Improve Risk Assessment of Post-transplant Mortality Compared With Conventional Clinical Risk ScoresPreprint
Medina-Morales, J. E., Panayotova, G. G., Nguyen, D. T., Graviss, E. A., Prakash, G. S., Marsh, J. A., Simonishvili, S., Shah, Y. M., Ayorinde, T., Qin, Y., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2548184/v1 · Cited by 1
The Critical Evolution of the Concept of Frailty in Surgery
Tsoulfas, G. (2023) · Annals of Surgical Oncology · doi:10.1245/s10434-023-14529-6 · Cited by 1
Nutritional Status In Frail Cirrhotic Patients Undergoing Liver Transplantation
Azzolino, D., Damanti, S., & Cesari, M. (2018) · The Journal of Frailty & Aging · doi:10.14283/jfa.2018.14
Identifying Novel Biomarkers of Frailty in Cirrhosis: Results from an Unbiased Proteomics Search from the Functional Assessment in Liver Transplantation (FrAILT) Study
Huppert, L. A., Sinclair, M. J., & Lai, J. C. (2018) · OBM Transplantation · doi:10.21926/obm.transplant.1804028 · Cited by 1
Self-citation
Metrics of Aging in Transplantation
Johansen, K. L. (2019) · Current Transplantation Reports · doi:10.1007/s40472-019-0229-x
Obesity and the Critically Ill Cirrhotic Patient
Wu, T., & Sundaram, V. (2019) · Springer eBooks · doi:10.1007/978-3-030-24490-3_8
A Research Wish List to Understand, Diagnose, and Manage Frailty and Sarcopenia
Dunn, M. A. (2019) · Springer eBooks · doi:10.1007/978-3-030-26226-6_18
Nutritional Therapy in the Management of Physical Frailty and Sarcopenia
Merli, M., Lattanzi, B., D’Ambrosio, D., Fabrini, N., & Liguori, A. (2019) · Springer eBooks · doi:10.1007/978-3-030-26226-6_6
Exercise Training in Patients with Cirrhosis
Purdy, G. M., Riess, K. J., Ismond, K. P., & Tandon, P. (2019) · Springer eBooks · doi:10.1007/978-3-030-26226-6_7
Muscle Mass Versus Muscle Strength and Performance: Is Muscle Mass Measurement Alone Enough?
Kappus, M. R., & Barman, P. M. (2019) · Springer eBooks · doi:10.1007/978-3-030-26226-6_9
Physical Frailty and Sarcopenia in End-Stage Liver Disease: Do They Improve After Liver Transplantation?
Bhanji, R. A., & Carey, E. J. (2019) · Springer eBooks · doi:10.1007/978-3-030-26226-6_13
Prognostic Implications of Physical Frailty and Sarcopenia Pre and Post Transplantation
Buettner, S., IJzermans, J. N. M., & van Vugt, J. L. A. (2019) · Springer eBooks · doi:10.1007/978-3-030-26226-6_5
Prognose bei Leberzirrhose
Labenz, C. (2019) · Gastro-News · doi:10.1007/s15036-019-0686-1
Editorial: current challenges in predicting mortality in patients with cirrhosis and refractory ascites
Mahgoub, S., Armstrong, M. J., & Ferguson, J. (2020) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15982
Evaluation and Management of Nutrition in Chronic Liver Disease
Rogers, M. (2020) · Academic Journal of Gastroenterology & Hepatology · doi:10.33552/ajgh.2020.01.000520
“[27] modified this concept to create a liver-specific frailty score that emphasized physical frailty and this included HGS, time to do 5 chair stands, and time to hold difference positions of balance [25,26].”
Background
11教-2P-K34 体育授業における「楽しさ」の再検討 : 多様異質性を越えて"とリこにさせる"場に着目して(11.体育科教育学,一般研究発表抄録)
高橋, 美., & 細江, 文. (2010) · 日本体育学会大会予稿集第61回（2010） · doi:10.20693/jspehss.61.265_1
Sarcopenia; An Endemic in the Times of Pandemic in Liver Transplantation
Ullah, H., Iqbal, S., Lizaola‐Mayo, B., & Carey, E. J. (2021) · OBM Transplantation · doi:10.21926/obm.transplant.2103149
“Lai et al coined Liver Frailty Index (LFI) in 2017 [33] from a cohort of 536 patients with ESLD this was based on Fried Frailty Index [34] and Short physical performance battery (SPPB) [35].”
Method
The feasibility and Acceptability of a Home-Based, Virtual Exercise Intervention for Older Patients with Hepatocellular Carcinoma: Protocol for a Non-Randomised Feasibility Study (TELEX-Liver Cancer)Preprint
Orange, S. T., Hallsworth, K., Brown, M. C., & Reeves, H. L. (2021) · Research Square · doi:10.21203/rs.3.rs-966837/v1
ANALISIS MANFAAT SUMBER DAYA HUTAN DAN EKOSISTEMNYASEBAGAI PENGATUR TATA AIR (FUNGSI HIDROLOGIS)PADA KAWASAN LINDUNG DAERAH ALIRAN SUNGAI (DAS) SAMINDI KABUPATEN KARANGANYAR
Adiwidanto, N. (2004)
Survival of the less‐fit
Carey, E. J. (2021) · Hepatology · doi:10.1002/hep.32300
“These data come from the original Functional Assessment in Liver Transplantation (FrAILT) Study from which the Liver Frailty Index (LFI) was derived.[1] Patients in the original FrAILT cohort were followed for a median of 36 months after transplantation.”
Method
Reply
Lai, J. C., Covinsky, K. E., Dodge, J. L., Boscardin, W. J., Segev, D. L., Roberts, J. P., & Feng, S. (2018) · Hepatology · doi:10.1002/hep.29817
“,((1)) in which the authors aimed to develop a frailty index to capture the extrahepatic complications of cirrhosis and enhance mortality prediction in patients who have cirrhosis.”
BackgroundSelf-citation
Health System Requirements for Pediatric Liver Transplantation
Wadhwani, S. I., & Bucuvalas, J. C. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-63671-1.00003-3
Measurements matter: Assessing outcomes in “lean” patients with nonalcoholic fatty liver disease awaiting liver transplantation
Barritt, A. S. (2022) · Liver Transplantation · doi:10.1002/lt.26579
Evaluation of the Role of Sarcopenia in the Definition of Decompensation of the Compensated Patient
Rodrigues, S. G., & Becchetti, C. (2022) · Springer eBooks · doi:10.1007/978-3-031-08552-9_33
Valoración preanestésica para trasplante hepático ortotópico.
Medicine, C. C. &. E., Martínez, D. E., Antolinez-Motta, J., Escorza-Molina, C. A., Gutiérrez, M. A. G., Baro, R. A. J., Díaz-Martínez, M. A., Candelaria, R., Pérez, G. A. S., & Fernández-Bravo, M. (2023) · doi:10.58281/ccem22111905
Assessment Techniques of Sarcopenia in Chronic Liver Disease
(2023) · doi:10.55162/mcms.04.101
Identification and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Mortality Following Liver Transplantation: The Liver Immune Frailty IndexPreprint
Panayotova, G. G., Simonishvili, S., Nguyen, D. T., Graviss, E. A., Aware, N., Manner, C. J., Minze, L. J., Ayorinde, T., Qin, Y., Jin, L., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2134172/v2
Pre-transplant Biomarkers of Immune Dysfunction Improve Risk Assessment of Post-transplant Mortality Compared to Conventional Clinical Risk ScoresPreprint
Medina-Morales, J. E., Panayotova, G. G., Nguyen, D. T., Graviss, E. A., Prakash, G. S., Marsh, J. A., Simonishvili, S., Shah, Y., Ayorinde, T., Qin, Y., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2548184/v2
The next step in frailty assessment: Biomarker development
Saiman, Y. (2023) · Liver Transplantation · doi:10.1097/lvt.0000000000000176
Sarkopenie bei Lebertransplantation
Schäfer, D. (2023) · PRO CARE · doi:10.1007/s00735-023-1725-x
Development and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Post-Liver Transplant MortalityPreprint
Panayotova, G. G., Simonishvili, S., Nguyen, D. T., Graviss, E. A., Aware, N., Manner, C. J., Minze, L. J., Ayorinde, T., Qin, Y., Jin, L., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-2134172/v3
Clinical guidance for polycystic liver disease
Barten, T. R. M. (2023) · Radboud University Press eBooks · doi:10.54195/9789493296275
Aplicabilidad del índice de fragilidad hepática en pacientes cirróticos evaluados para trasplante
García-Caraballo, M., Hughes-López, M. G., Giorgi, T. I.-D., Ksiazenicki-Ruiz, M., Lafourcade-Luna, G., Osores-Masanttes, A. B., Elizondo, M., Sosa-Rodríguez, R., Valverde, M., & Gerona-Sangiovanni, S. (2024) · Hepatología · doi:10.59093/27112330.93
Nonmechanical preservation and allocation of liver grafts
Braat, A. E. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99655-6.00011-7
Liver procurement: DBD, DCD, and living donation
Eker, H. H., & Berrevoet, F. C. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99655-6.00003-8
Rehabilitácia Pri Cirhóze Pečene
Sekereš, M. (2023) · časopis REHABILITÁCIA · doi:10.61983/lcrh.v60i3.5
Die Rolle des Anästhesisten bei Lebertransplantationen – präoperative Evaluation
Müller, M., & Grasshoff, C. (2024) · AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie · doi:10.1055/a-2152-7350
Frailty Measure Development, Selection, and Implications
Bandeen‐Roche, K. (2024) · Springer eBooks · doi:10.1007/978-3-031-57361-3_17
Deciphering an expanding array of clinical and research frailty measures
Thuluvath, A. J., & Verna, E. C. (2024) · Clinical Liver Disease · doi:10.1097/cld.0000000000000180
New Scanographic Index for the Detection of Frailty in Patients with Cirrhosis with a Prognostic Impact
Khoueiry, C. E., Slim, R., Rida, M., Khoury, B., Honein, K., Smayra, T., & Yaghi, C. (2024) · Middle East Journal of Digestive Diseases · doi:10.34172/mejdd.2024.376
Clinical/Functional Assessment and Staging
(2021) · doi:10.1093/med/9780197534052.005.0002
Predicting 90-day mortality in patients with HBV-ACLF using machine learning toolsPreprint
Liu, J., Zhu, W., Deng, T., Zhu, Y., Xu, Q., Shi, P., Liang, A., Wang, Y., Fu, J., & Wu, X. (2024) · Research Square · doi:10.21203/rs.3.rs-5289373/v1
Improvement of Frailty with Rehabilitation therapy in a patient with alcohol-related decompensated liver cirrhosis
Koya, S., Nakano, D., Hattori, Y., Nagamatsu, A., Bekki, S., Sano, T., Amano, K., Kawaguchi, M., Sonoda, R., Okada, T., et al. (2024) · Kanzo · doi:10.2957/kanzo.65.559
Abdominale Organtransplantation beim multimorbiden Patienten
Bauschke, A., Deeb, A. A., Dondorf, F., Rauchfuß, F., Rohland, O., & Settmacher, U. (2024) · Die Chirurgie · doi:10.1007/s00104-024-02201-y
Liver Transplantation in Well‐Selected Class III Obese Recipients Yields Good Outcomes
Yi, K., Avery, V. M., McCall, J. L., Giles, H., Lindsay, H. A., Gane, E. J., Orr, D. W., & Barbier, L. A. (2025) · Clinical Transplantation · doi:10.1111/ctr.70060
“More recently, in 2018, the Liver Frailty Index was introduced as part of the assessment, including functional parameters such as dominant hand grip strength, balance testing, and timed sit-to-stand [22].”
Mechanisms and Intervention Strategies for Frailty in Cirrhotic Patients
涂, 积. (2025) · Advances in Clinical Medicine · doi:10.12677/acm.2025.154955
Multidisciplinary approach to malnutrition and physical frailty in patients with decompensated cirrhosis
Armstrong, M. J., Hopkins, L., Towey, J., Williams, F. R., & Johnson, J. L. (2025) · Frontline Gastroenterology · doi:10.1136/flgastro-2024-102926
Liver frailty and impact of liver transplants on transplanted patients’ health
Fernández‐Alonso, V., Hernández-Matías, A. M., Pérez-Gómez, M., Rodríguez-Leal, L., & Moro‐Tejedor, M. N. (2025) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.7330.4563
Predicting Short-Term Mortality in Severe Cirrhosis: An Interpretable Machine Learning Model Integrating Routine Clinical IndicatorsPreprint
Zhang, S., Liu, R., Li, Z., Pan, T., & Wen, X. (2025) · medRxiv · doi:10.1101/2025.07.11.25331343
Current Focus and Innovation in Liver Transplantation
Laohapand, C., Tiwari, A., & Reddy, K. R. (2025) · Clinics in Liver Disease · doi:10.1016/j.cld.2025.06.011
Sarcopenia in liver cirrhosis
Ali, S. H., Mazzawi, T. R. E., Sneineh, A. T. A., & Marji, F. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-21938-2.00018-7
Cognitive Impairment in Liver Transplant Recipients
Berry, K., Barry, F., Tsoy, E., Haswell, C. C., Petty, C., Rodriguez, A. M., Ellingson, T. N., Chan, B., Wong, R. J., Seetharaman, S., et al. (2025) · Neurology Open Access · doi:10.1212/wn9.0000000000000023
Self-citation
Fragilidad y calidad del consumo alimentario en pacientes con infección crónica de virus de hepatitis C (VHC) con y sin cirrosis
Vázquez-Rodríguez, D., Rodríguez-Echevarría, R., la Mora, D. A. L.-D., Lazcano-Becerra, M., Velasco, J. A. V.-R., & Aldana-Ledesma, J. M. (2025) · Revista de Gastroenterología de México · doi:10.1016/j.rgmx.2025.06.013
Fragilidade hepática e o impacto do transplante de fígado na saúde dos pacientes com transplante hepático
Fernández‐Alonso, V., Hernández-Matías, A. M., Pérez-Gómez, M., Rodríguez-Leal, L., & Moro‐Tejedor, M. N. (2025) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.7330.4564
Fragilidad hepática e impacto del trasplante hepático en la salud de pacientes trasplantados hepáticos
Fernández‐Alonso, V., Hernández-Matías, A. M., Pérez-Gómez, M., Rodríguez-Leal, L., & Moro‐Tejedor, M. N. (2025) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.7330.4562
Beyond Identification: Operationalizing Frailty and Sarcopenia Assessment for Pre-transplant Optimization
Hu, J., Zhang, X., & Pei, W. (2025) · Digestive Diseases and Sciences · doi:10.1007/s10620-025-09357-5
“For instance, Lai et al. developed the Frailty Index, a validated tool for prognostication in cirrhosis using direct performance-based tests [2].”
Capturing frailty in cirrhosis: Bridging disciplinary gaps, clinical decision-making, and research
Tanaka, T., & Axelrod, D. (2025) · Liver Transplantation · doi:10.1097/lvt.0000000000000738
Motor performance as a predictor of blood levels of ammonia and inflammatory biomarkers in patients with liver cirrhosis
Valenzuela, C. S. M., Gallego, J., Urios, A., Correa‐Ghisays, P., Tabarés‐Seisdedos, R., & Montoliú, C. (2025) · PLoS ONE · doi:10.1371/journal.pone.0333029
“[56] developed a liver-specific frailty index in patients with liver disease, which include three performance-based tests of physical frailty: grip strength, chair stands, and balance testing.”
Association of Frailty With Waitlist and Post-Transplant Outcomes in Patients With Hepatopulmonary Syndrome and Portopulmonary Hypertension
Sharma, A. N., Usman, L., Lai, J. C., & Jutras, G. (2026) · Transplantation Proceedings · doi:10.1016/j.transproceed.2026.05.023
Self-citation
Frailty in early HCC transplant candidates: It’s not only about the tumor
Mauro, E. (2025) · Liver Transplantation · doi:10.1097/lvt.0000000000000771
Additional file 1 of The feasibility and acceptability of a home-based, virtual exercise intervention for older patients with hepatocellular carcinoma: protocol for a non-randomised feasibility study (TELEX-Liver Cancer)
Orange, S. T., Hallsworth, K., Brown, M. C., & Reeves, H. L. (2022) · Figshare · doi:10.6084/m9.figshare.19914843
Additional file 2 of The feasibility and acceptability of a home-based, virtual exercise intervention for older patients with hepatocellular carcinoma: protocol for a non-randomised feasibility study (TELEX-Liver Cancer)
Orange, S. T., Hallsworth, K., Brown, M. C., & Reeves, H. L. (2022) · Figshare · doi:10.6084/m9.figshare.19914846
Additional file 3 of The feasibility and acceptability of a home-based, virtual exercise intervention for older patients with hepatocellular carcinoma: protocol for a non-randomised feasibility study (TELEX-Liver Cancer)
Orange, S. T., Hallsworth, K., Brown, M. C., & Reeves, H. L. (2022) · Figshare · doi:10.6084/m9.figshare.19914849
2025: The Current State of Functional Assessment in Patients Undergoing Liver Transplantation
Bernstein, D. A., & Kappus, M. R. (2025) · Current Transplantation Reports · doi:10.1007/s40472-025-00493-5
“…and after transplant, of grip strength (an average of three measurements using a hand dynamometer), timed chair stands (number of seconds to complete five chair stands), and balance testing (number of seconds a patient can remain balanced in side-to-side, semi-tandem, and tandem positions) [68].”
The Effects of Flaxseed Consumption on Frailty and Sarcopenia in Patients With Liver Cirrhosis: An Open‐Labeled Randomized Controlled Clinical Trial
Pashayee-Khamene, F., Hekmatdoost, A., Haidari, F., Anushiravani, A., Hatami, B., Sadeghi, A., Engali, K. A., & Helli, B. (2025) · Food Science & Nutrition · doi:10.1002/fsn3.71397
“Given that the LFI was specifically designed for cirrhotic patients, it was used as the reference tool for diagnosing frailty (Lai et al. 2017).”
Candidate Evaluation for Liver Transplantation
Aceituno, L., Seetahal, V., & Tsien, C. D. (2025) · Springer eBooks · doi:10.1007/978-3-032-07072-2_3
Frailty and food intake quality in patients with chronic hepatitis C virus (HCV) infection with or without cirrhosis
Vázquez-Rodríguez, D., Rodríguez-Echevarría, R., la Mora, D. A. L.-D., Lazcano-Becerra, M., Velasco, J. V.-R., & Aldana-Ledesma, J. M. (2026) · Revista de Gastroenterología de México (English Edition) · doi:10.1016/j.rgmxen.2025.12.009
Thigh ultrasound is a valid measurement for sarcopenia and fat mass analysis in patients with cirrhosis
Saeidi, R., Gettigan, N. M., Hanley, M., Morrin, M. M., Ryan, J. D., & Boland, K. (2026) · Clinical Nutrition Open Science · doi:10.1016/j.nutos.2026.100628
Evaluation and management of primary sclerosing cholangitis patients awaiting liver transplantation
Frolkis, A. D., Nayagam, J. S., Parente, A., Seager, M. J., Sadler, M. D., Montaño‐Loza, A. J., & Joshi, D. (2026) · JHEP Reports · doi:10.1016/j.jhepr.2026.101748
Association of dietary energy and protein intake with frailty among patients with cirrhosis and implications for nursing practice
Li, G., Wang, Y., Wang, K., & Wang, K. (2026) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2026.02.001
“Our results are consistent with a survey by Lai et al., which found a 25 % prevalence of frailty among 1,044 patients with cirrhosis [36].”
Influential
Hemoglobin, phase angle, and clinical and nutritional characteristics in patients with advanced chronic liver disease: An exploratory study
Silva, D. E. S., Boulhosa, R. S. S. B., Arruda, M. R., Batista, A. C. V., LYRA, A. C., de Oliveira, L. P. M., & de Jesus, R. P. (2026) · Nutrition · doi:10.1016/j.nut.2026.113143
The Risk of Risk Stratification in Liver Transplant
Wall, A. E., & Testa, G. (2026) · JAMA Surgery · doi:10.1001/jamasurg.2025.6548
Prognostic Significance of Frailty in Liver Cirrhosis Patients: A Prospective Single-Center Study
Mıldanoğlu, M. M., Akpınar, A., Koçhan, K., Bilici, A. E., Keskin, E. B., & Şentürk, H. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15051943

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: Lai, Jennifer C.
Covinsky, Kenneth E.
Dodge, Jennifer L.
Boscardin, W. John
Segev, Dorry L.
Roberts, John P.
Feng, Sandy
Venue: Hepatology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2017-06-28
Volume: 66
Issue: 2
Pages: 564-574
ISSN: 0270-9139 (ISSN-L)
1527-3350
DOI: 10.1002/hep.29219
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: doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
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

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Development of a novel frailty index to predict mortality in patients with end‐stage liver disease

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Self-check

Citations

Cites

Cited by

Related

Metadata

Record

About these checks