Impact of age on frailty in liver cirrhosis: a prospective cohort study

Abstract

Frailty is an emerging predictor of adverse outcomes in liver cirrhosis, yet the interplay between aging and liver disease severity in driving frailty remains insufficiently understood. To evaluate the impact of age on the prevalence, severity, and predictors of frailty in patients with liver cirrhosis. In this prospective observational study, 460 adults with liver cirrhosis were assessed for frailty using the CFS (Clinical Frailty Scale) (CFS). Patients were classified as frail (CFS > 4) (210 cases), or non-frail (CFS ≤ 4) (250 cases). Demographic, clinical, and biochemical data of frail cases were collected. Multivariate and logistic regression analyses were performed to identify independent predictors of frailty. Frailty prevalence increased markedly with age-from 42% in patients aged 50-59 to over 90% in those aged ≥ 70. Age was moderately correlated with frailty (r = 0.40, p < 0.001). In multivariate analysis, both age (β = 0.0636, p < 0.001) and Child-Pugh score (β = 0.7874, p < 0.001) were independent predictors of frailty. Logistic regression (including interaction terms where appropriate) confirmed that each additional year of age increased frailty risk (OR = 1.13; 95% CI: 1.09-1.17, p < 0.001). Frailty in cirrhosis is strongly age-associated but also driven by hepatic dysfunction. These findings highlight the inadequacy of MELD-Na scores alone in capturing patient vulnerability, particularly in older adults. Future longitudinal studies and targeted prehabilitation strategies are warranted to mitigate frailty and improve outcomes in this vulnerable population.

Keywords: Aging; Child–Pugh score; Frailty; Liver cirrhosis; Sarcopenia.

Fig. 1

Age distribution in patients with liver cirrhosis

Fig. 2

Frailty scores across age groups

Fig. 3

Logistic regression (including interaction terms where appropriate) probability plot (Age vs. frailty risk)