Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2017; 23(5): 899-905
Published online Feb 7, 2017. doi: 10.3748/wjg.v23.i5.899
Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist
Marie Sinclair, Eduard Poltavskiy, Jennifer L Dodge, Jennifer C Lai
Marie Sinclair, Eduard Poltavskiy, Jennifer L Dodge, Jennifer C Lai, Gastroenterology and Hepatology, University of California, San Francisco, CA 94143, United States
Author contributions: Sinclair M formulated the research plan, collected data, and drafted the manuscript; Poltavskiy E and Dodge JL provide statistical support and reviewed the manuscript; Lai JC formulated the research plan and drafted the manuscript.
Supported by UCSF Liver Center, No. P30 DK026743.
Institutional review board statement: This study was reviewed and approved by medical department IRB of the University of California, San Francisco (UCSF-138344 -M_MED-EDUC-CORE).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrolment.
Conflict-of-interest statement: There are no conflicts of interest to report for the production of this manuscript.
Data sharing statement: All data has been stored in a password protected file on a password protected server at UCSF. No identified information is accessible.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jennifer C Lai, Assistant Professor, Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA 94143, United States. jennifer.lai@ucsf.edu
Telephone: +1-415-4766422 Fax: +1-415-3532407
Received: November 7, 2016
Peer-review started: November 7, 2016
First decision: December 19, 2016
Revised: December 21, 2016
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: February 7, 2017
Processing time: 76 Days and 2.5 Hours
Abstract
AIM

To investigate the impact of physical frailty on risk of hospitalisation in cirrhotic patients on the liver transplant waitlist.

METHODS

Cirrhotics listed for liver transplantation at a single centre underwent frailty assessments using the Fried Frailty Index, consisting of grip strength, gait speed, exhaustion, weight loss, and physical activity. Clinical and biochemical data including MELD score as collected at the time of assessment. The primary outcome was number of hospitalised days per year; secondary outcomes included incidence of infection. Univariable and multivariable analysis was performed using negative binomial regression to associate baseline parameters including frailty with clinical outcomes and estimated incidence rate ratios (IRR).

RESULTS

Of 587 cirrhotics, 64% were male, median age (interquartile range) was 60 (53-64) years and MELD score was 15 (12-18). Median Fried Frailty Index was 2 (1-3); 31.6% were classified as frail (fried frailty ≥ 3). During 12 mo of follow-up, 43% required at least 1 hospitalisation; 38% of which involved major infection. 107/184 (58%) frail and 142/399 (36%) non-frail patients were hospitalised at least once (P < 0.001). In univariable analysis, Fried Frailty Index was associated with total hospitalisation days per year (IRR = 1.51, 95%CI: 1.28-1.77; P ≤ 0.001), which remained significant on multivariable analysis after adjustment for MELD, albumin, and gender (IRR for frailty of 1.21, 95%CI: 1.02-1.44; P = 0.03). Incidence of infection was not influenced by frailty.

CONCLUSION

In cirrhotics on the liver transplant waitlist, physical frailty is a significant predictor of hospitalisation and total hospitalised days per year, independent of liver disease severity.

Keywords: Hospitalisation; Infection; Cirrhosis; Frailty; Transplantation

Core tip: This study demonstrates a significant independent link between bedside measures of physical frailty and risk for hospitalisation in cirrhotic patients on the liver transplant waitlist. This adds to previous data showing a link between frailty and mortality in cirrhosis, and therefore allows us to better select at-risk cirrhotic patients who are most in need of more intense chronic disease management programs.