The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study

Chelsea Q Xu¹, Yara Mohamad¹, Matthew R Kappus², Brian Boyarsky³, Daniel R Ganger⁴, Michael L Volk⁵, Robert S Rahimi⁶, Andres Duarte-Rojo⁷, Mara McAdams-DeMarco^{3

8}, Dorry L Segev^{3

8}, Daniela P Ladner^{9

10}, Elizabeth C Verna¹¹, Joshua Grab¹², Monica Tincopa¹³, Michael A Dunn⁷, Jennifer C Lai¹

Affiliations

¹ Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
² Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
³ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL, USA.
⁵ Division of Gastroenterology & Hepatology, and Transplantation Institute, Loma Linda University Health, Loma Linda, CA, USA.
⁶ Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White, Dallas, TX, USA.
⁷ Center for Liver Diseases, Thomas A. Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA.
⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁹ Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, IL, USA.
¹⁰ Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
¹¹ Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY, USA.
¹² Department of Surgery, University of California-San Francisco, San Francisco, CA, USA.
¹³ Division of Gastroenterology and Hepatology, University of Michigan Medical School, Ann Arbor, MI, USA.

PMID: 34219362
PMCID: PMC8522207
DOI: 10.1111/liv.15006

The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study

Chelsea Q Xu et al. Liver Int. 2021 Oct.

. 2021 Oct;41(10):2467-2473.

doi: 10.1111/liv.15006. Epub 2021 Jul 14.

Authors

Affiliations

¹ Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
² Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
³ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Chicago, IL, USA.
⁵ Division of Gastroenterology & Hepatology, and Transplantation Institute, Loma Linda University Health, Loma Linda, CA, USA.
⁶ Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White, Dallas, TX, USA.
⁷ Center for Liver Diseases, Thomas A. Starzl Transplantation Institute, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA.
⁸ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁹ Division of Transplantation, Department of Surgery, Northwestern Medicine, Chicago, IL, USA.
¹⁰ Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
¹¹ Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY, USA.
¹² Department of Surgery, University of California-San Francisco, San Francisco, CA, USA.
¹³ Division of Gastroenterology and Hepatology, University of Michigan Medical School, Ann Arbor, MI, USA.

PMID: 34219362
PMCID: PMC8522207
DOI: 10.1111/liv.15006

Abstract

Background & aims: Cirrhosis leads to malnutrition and muscle wasting that manifests as frailty, which may be influenced by cirrhosis aetiology. We aimed to characterize the relationship between frailty and cirrhosis aetiology.

Methods: Included were adults with cirrhosis listed for liver transplantation (LT) at 10 US centrer who underwent ambulatory testing with the Liver Frailty Index (LFI; 'frail' = LFI ≥ 4.4). We used logistic regression to associate aetiologies and frailty, and competing risk regression (LT as the competing risk) to determine associations with waitlist mortality (death/delisting for sickness).

Results: Of 1,623 patients, rates of frailty differed by aetiology: 22% in chronic hepatitis C, 31% in alcohol-associated liver disease (ALD), 32% in non-alcoholic fatty liver disease (NAFLD), 21% in autoimmune/cholestatic and 31% in 'other' (P < .001). In univariable logistic regression, ALD (OR 1.53, 95% CI 1.12-2.09), NAFLD (OR 1.64, 95% CI 1.18-2.29) and 'other' (OR 1.58, 95% CI 1.06-2.36) were associated with frailty. In multivariable logistic regression, only ALD (OR 1.40; 95% 1.01-1.94) and 'other' (OR 1.59; 95% 1.05-2.40) remained associated with frailty. A total of 281 (17%) patients died/were delisted for sickness. In multivariable competing risk regression, LFI was associated with waitlist mortality (sHR 1.05, 95% CI 1.03-1.06), but aetiology was not (P > .05 for each). No interaction between frailty and aetiology on the association with waitlist mortality was found (P > .05 for each interaction term).

Conclusions: Frailty is more common in patients with ALD, NAFLD and 'other' aetiologies. However, frailty was associated with waitlist mortality independent of cirrhosis aetiology, supporting the applicability of frailty across all cirrhosis aetiologies.

Keywords: NAFLD; frailty; malnutrition; non-alcoholic fatty liver disease; physical function; sarcopenia.

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Conflict of interest statement

DISCLOSURES

The authors of this manuscript have no conflicts of interest to disclose.

References

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The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study

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The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study

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Abstract

Conflict of interest statement

References

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