Surender Singh1, Sunil Taneja1, Puneeta Tandon2, Akash Bansal3, Ujjwal Gorsi3, Akash Roy1, Arka De1, Nipun Verma1, Madhumita Premkumar1, Ajay Duseja1, R. K. Dhiman1, Virendra Singh1

1Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India, 2Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada, 3Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education & Research, Chandigarh, India.

Background/Aims: There is no “gold standard” tool for the assessment of physical frailty in cirrhosis. This study compares Liver Frailty Index (LFI), Short Performance Physical Battery (SPPB), Fried Frailty Criteria (FFC), and Clinical Frailty Scale (CFS) for frailty assessment and ascertains its impact on predicting mortality and hospitalizations in a cohort of outpatients with cirrhosis.

Methods: 150 outpatients with cirrhosis were screened, out of which 34 patients were excluded. 116 patients were prospectively enrolled in this cross-sectional study. Frailty assessment was done using LFI, SPPB, FFC, and CFS. All patients were followed up for 6 months. The primary outcome was the first of either all-cause unplanned hospitalization or all-cause mortality occurring within 6 months of the study period.

Results: A total of 116 patients predominantly males (86.2%), mean age 50.2 (48.4-51.9) years were included. The most common cause of cirrhosis was alcoholic liver disease (47.4%) followed by hepatitis C (12.9%) and NASH (10.3%). There was no significant difference in the prevalence of frailty based on LFI (43.1%), FFC (36.2%), CFS (44%), and SPPB (47.4%) (p>0.05). The mean overall survival was 360.2 (296.9-423.4) days in the Frail group and 540.3 (526.9-553.7) days in the Not frail group (p=0.01). Frailty, Child Turcotte Pugh, and Chronic liver disease questionnaire scores emerged as independent predictors of hospitalization and deaths (Table 1).

Conclusion: LFI, SPPB, FFC, and CFS are comparable in physical frailty assessment in patients with cirrhosis. The presence of frailty is a robust predictor of hospitalizations and mortality in outpatients with cirrhosis.

Keywords: Frailty, Cirrhosis, Mortality, Hospitalization