Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 2;15(1):186.
doi: 10.1038/s41598-024-83984-2.

Impact of frailty and prevalent fractures on the long-term prognosis of patients with cirrhosis: a retrospective study

Takashi Niwa  1   2 , Chisato Saeki  3   4 , Mitsuru Saito  5 , Tsunekazu Oikawa  1 , Hiroshi Kamioka  1 , Tomoya Kanai  1   2 , Kaoru Ueda  1 , Masanori Nakano  1   2 , Yuichi Torisu  1   2 , Masayuki Saruta  1 , Akihito Tsubota  6
Affiliations

Impact of frailty and prevalent fractures on the long-term prognosis of patients with cirrhosis: a retrospective study

Takashi Niwa et al. Sci Rep. .

Abstract

Frailty and fractures are closely associated with adverse clinical outcomes. This retrospective study investigated the prognostic impact of frailty, prevalent fractures, and the coexistence of both in patients with cirrhosis. Frailty was defined according to the Fried frailty phenotype criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Prevalent fractures were assessed using questionnaires and lateral thoracolumbar spine radiographs. Cumulative survival rates were compared between the frailty and non-frailty groups, fracture and non-fracture groups, and all four groups stratified by the presence or absence of frailty and/or prevalent fractures. Among 189 patients with cirrhosis, 70 (37.0%) and 74 (39.2%) had frailty and prevalent fractures, respectively. The median observation period was 64.4 (38.6-71.7) months, during which 50 (26.5%) liver disease-related deaths occurred. Multivariate analysis identified frailty and prevalent fractures as significant independent prognostic factors in the overall cohort (p < 0.001 and p = 0.003, respectively). The cumulative survival rates were lower in the frailty or fracture groups than in the non-frailty or non-fracture groups, respectively, in the overall cohort and in patients with compensated and decompensated cirrhosis. Patients with both frailty and prevalent fractures showed the lowest cumulative survival rates, whereas those without these comorbidities showed the highest cumulative survival rates among the four stratified groups. Frailty and prevalent fractures were independently associated with mortality in patients with cirrhosis. Additionally, the coexistence of both comorbidities worsened the prognosis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prevalence of frailty and fracture. (A) The proportion of patients with prevalent fractures in the frailty and non-frailty groups. (B) The proportion of patients with frailty in the fracture and non-fracture groups.
Fig. 2
Fig. 2
Prognostic impact of frailty and fracture. (A) Comparison of cumulative survival rates between the frailty and non-frailty groups in all patients. (B) Comparison of cumulative survival rates between the fracture and non-fracture groups in all patients.
Fig. 3
Fig. 3
Prognostic impact of symptomatic and asymptomatic fractures. (A) Comparison of cumulative survival rates between the symptomatic or asymptomatic fracture and non-fracture groups in all patients.
Fig. 4
Fig. 4
Prognostic impact of frailty and fractures in patients with compensated and decompensated cirrhosis. Comparison of cumulative survival rates between the (A) frailty and non-frailty groups, and (B) fracture and non-fracture groups in patients with compensated cirrhosis. Comparison of cumulative survival rates between the (C) frailty and non-frailty groups, and (D) fracture and non-fracture groups in patients with decompensated cirrhosis.
Fig. 5
Fig. 5
Comparison of cumulative survival rates among the four groups stratified by the presence or absence of frailty and/or prevalent fractures.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Saeki, C. et al. Relationship between osteosarcopenia and frailty in patients with chronic liver disease. J. Clin. Med.9, 2381 (2020). - PMC - PubMed
    1. Laube, R. et al. Frailty in advanced liver disease. Liver Int.38, 2117–2128 (2018). - PubMed
    1. Tandon, P., Montano-Loza, A. J., Lai, J. C., Dasarathy, S. & Merli, M. Sarcopenia and frailty in decompensated cirrhosis. J. Hepatol.75(Suppl 1), S147–S162 (2021). - PMC - PubMed
    1. Lai, J. C. et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the american association for the study of liver diseases. Hepatology74(3), 1611–1644 (2021). - PMC - PubMed
    1. Nishikawa, H., Fukunishi, S., Asai, A., Nishiguchi, S. & Higuchi, K. Sarcopenia and frailty in liver cirrhosis. Life (Basel)11, 399 (2021). - PMC - PubMed

LinkOut - more resources