A self-reported Frailty Index predicts long-term mortality in hospitalized patients with cirrhosis

You Deng; Lin Lin; Lijun Hou; Xiaofei Fan; Tianming Zhao; Lihong Mao; Xiaoyu Wang; Bangmao Wang; Yingli Ma; Chao Sun

doi:10.21037/atm-20-943

A self-reported Frailty Index predicts long-term mortality in hospitalized patients with cirrhosis

Ann Transl Med. 2020 Oct;8(19):1217. doi: 10.21037/atm-20-943.

Authors

You Deng^{1

2}, Lin Lin³, Lijun Hou^{1

2}, Xiaofei Fan^{1

2}, Tianming Zhao^{1

2}, Lihong Mao^{1

2}, Xiaoyu Wang^{1

2}, Bangmao Wang^{1

2}, Yingli Ma^{1

2}, Chao Sun^{1

2

3}

Affiliations

¹ Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.
² Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China.
³ Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China.

Abstract

Background: Frailty is a syndrome that diminishes the potential for functional recovery in liver cirrhosis (LC). However, its utility is limited due to sole reliance on physical performance, especially in hospitalized patients. We investigate the predictive value of a modified self-reported Frailty Index in cirrhotics, and identify which health deficits play more important roles.

Methods: Consecutive LC patients were assessed by our frailty scale. Outcomes of interest were mortality for 90-day, 1-year and 2-year. Independent predictors were identified by multivariate Cox regression. Receiver operating characteristic curve (ROC) was performed to evaluate discriminative ability. We used a combination of stepwise selection, best subset selection, and Akaike information criteria (AIC) to identify pivotal frailty components.

Results: The study cohort consisted of 158 patients, in which 37 expired during follow-up. Compared with non-frail groups, the frail group had higher 1- and 2-year mortality. The area under ROC of the Child-Turcotte-Pugh classification (CTP) and Frailty Index were 0.66 and 0.68, while 0.72 for CTP + Frailty Index (P=0.034), respectively. The optimal predictors comprised instrumental activities of daily living (IADL) limitation, falls and loss of weight (AIC =170, C-statistic =0.67).

Conclusions: It is plausible for incorporating Frailty Index to improve prognostication in cirrhotics. IADL limitation, falls and loss of weight play more crucial roles on mortality determination.

Keywords: Frailty Index; best subset selection; cirrhosis; mortality.