Prognostic significance of frailty in liver cirrhosis patients

Introduction and Aim: Frailty is a clinical condition that has been shown to be effective in predicting unplanned hospitalization and mortality in liver cirrhosis patients. Although frailty has rarely been evaluated for its significance in predicting decompensation of cirrhosis, except a few studies examining its association with the development of hepatic encephalopathy. In our study, we examined the relationship between frailty and major complications of cirrhosis. In addition; we compared frailty with other prognostic scorings to assess its utility as a predictor of unplanned hospitalization and/or mortality in patients with cirrhosis in clinical practice. Methods: 134 patients, aged between 18-80 years, who applied to Bezmialem Vakıf University Gastroenterology Clinic and were diagnosed with K74 (Liver fibrosis and cirrhosis) according to ICD-10 criteria, were included in the prospective study design. After evaluating the patients with FFI (Fried Frailty Index) in terms of fragility, they were divided into 2 main groups. The first group consisted of frail (FFI ≥ 3) patients, and the second group consisted of prefrail (FFI: 1-2) and robust (FFI: 0) patients. In the first evaluation of the patients; age, gender, BMI (Body Mass Index), age at diagnosis, etiologies of cirrhosis, medications, history of ascites, CTP (Child-turcotte-pugh and MELD (model for end stage liver disease) scores were noted. All patients were prospectively evaluated for complications, unplanned hospitalization and mortality at each 3 month outpatient visit or phone call. One hundred of the patients were followed up for 12 months, twenty of them for 9 months and 14 of them for 6 months. Each complication and unplanned hospitalization developed during the follow-up period, were confirmed with electronic health records. At the end of the follow-up period, complications, unplanned hospitalizations and mortality compared in two main groups. Results: When the group consisting of frail patients (n=55) and the group consisting of non-frail patients (n=79) were compared in terms of basic characteristics; parameters such as gender, BMI, and etiology of cirrhosis were found to be similar (p>0.05). The frail patients were older than non-frail patients (p<0,001). Comorbidities such as diabetes, hypertension, CAD (coronary artery disease), CKD (chronic kidney disease) were more common in the frail group (p<0.05). When the two groups were compared, ascites, CTP and MELD scores were higher in the frail group (p<0.001). When the two groups were compared, varices and variceal bleeding history were found to be similar (p>0.05). At the end of the follow-up process; development of ascites, development of hepatic encephalopathy, HRS (hepatorenal syndrome), SBP (Spontaneous bacterial peritonitis), unplanned hospitalization and mortality were higher in the frail patient group (p<0.05). In terms of adverse outcome (complications, unplanned hospitalization, mortality); negative outcomes were found to be significantly higher in the frail patient group (p<0.001). When the two groups were compared, variceal bleeding was higher in the frail group, but it was not statistically significant (p>0.05). The development of HCC (Hepatcellular Carcinoma) was similar between the two groups (p>005). When the effectiveness of frailty to predict unplanned hospitalization and mortality was compared with CTP and MELD scores, no statistically significant difference was found (p>0,05). When the FFI criteria, were examined, each criterion was found to be associated with the development of ascites, hepatic encephalopathy, unplanned hospitalization, and mortality (p<0.05). Conclusion: Frailty in patients with cirrhosis is a clinical picture that both increases with complications and can be effective in predicting the development of complications. It is especially important to focus on the development of muscle strength and low physical activity, which are sub-parameters of frailty, in terms of the fact that these clinics can be corrected with interventions. Frailty in general, it can be associated with an unfavorable prognosis in cirrhosis. It would be beneficial to conduct studies with larger number of patients and longer follow-up periods in order examine if interventions on frailty may slow down or prevent this poor prognostic course. Key words: Liver cirrhosis, frailty, muscle strength, prognosis, hospitalization, mortality