Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study
Open accessAbstract
Background & aims Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated Liver Frailty Index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between LFI scores, ascites, and hepatic encephalopathy (HE) and mortality. Methods Adults without hepatocellular carcinoma who were on the liver transplantation waitlist at 9 centers in the United States (N = 1044) were evaluated using the LFI; LFI scores of at least 4.5 indicated that patients were frail. We performed logistic regression analyses to assess associations between frailty and ascites or HE and competing risk regression analyses (with liver transplantation as the competing risk) to estimate sub-hazard ratios (sHRs) of waitlist mortality (death or removal from the waitlist). Results Of study subjects, 36% had ascites, 41% had HE, and 25% were frail. The odds of frailty were higher for patients with ascites (adjusted odd ratio 1.56, 95% confidence interval [CI] 1.15-2.14) or HE (odd ratio 2.45, 95% CI 1.80-3.33) than for those without these features. Larger proportions of frail patients with ascites (29%) or HE (30%) died while on the waitlist compared with patients who were not frail (17% of patients with ascites and 20% with HE). In univariable analysis, ascites (sHR 1.52, 95% CI 1.14-2.05), HE (sHR 1.84, 95% CI 1.38-2.45), and frailty (sHR 2.38, 95% CI 1.77-3.20) were associated with waitlist mortality. In adjusted models, only frailty remained significantly associated with waitlist mortality (sHR 1.82, 95% CI 1.31-2.52); ascites and HE were not. Conclusions Frailty is a prevalent complication of cirrhosis that is observed more frequently in patients with ascites or HE and independently associated with waitlist mortality. LFI scores can be used to objectively quantify risk of death related to frailty-in excess of liver disease severity-in patients with cirrhosis.
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Malnutrition, frailty, and especially sarcopenia have become increasingly important in patients with advanced chronic liver disease.
“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 [107]
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Lai, J. C., Tandon, P., Bernal, W., Tapper, E. B., Ekong, U., Dasarathy, S., & Carey, E. J. (2021) · Hepatology · doi:10.1002/hep.32049 · Cited by 742 · see citing works
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- Authors
- Lai, J. C., Rahimi, R. S., Verna, E. C., Kappus, M. R., Dunn, M. A., McAdams-DeMarco, M., Haugen, C. E., Volk, M. L., Duarte-Rojo, A., Ganger, D. R., O’Leary, J. G., Dodge, J. L., Ladner, D., & Segev, D. L.
- Affiliations
- University of California, San Francisco (US)
- Baylor University Medical Center (US)
- Columbia University Irving Medical Center (US)
- Duke University (US)
- University of Pittsburgh (US)
- Johns Hopkins University (US)
- Loma Linda University Medical Center (US)
- Northwestern University (US)
- Dallas VA Medical Center (US)
- Corresponding author
- Lai, Jennifer C.
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2019-05
- Volume
- 156
- Issue
- 6
- Pages
- 1675-1682
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC6475483
- OpenAlex
- W2910818863
- Cited by
- 229
- References
- 4
- Citations by year
- 2026: 27 · 2025: 30 · 2024: 25 · 2023: 30 · 2022: 32 · 2021: 39 · 2020: 34 · 2019: 12
- FWCI
- 18.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (K23AG048337, R01AG059183, K24DK101828, F32AG053025, P30DK026743)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- frailty, Liver Frailty Index, liver cirrhosis, liver transplant waiting list, waitlist mortality, ascites, hepatic encephalopathy, frailty assessment, mortality risk stratification, competing risk analysis, liver transplant candidates
- MeSH terms
- Frailty, Ascites, Female, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Male, Middle Aged, Severity of Illness Index, United States, Waiting Lists, Liver Transplantation
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