Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study

Jennifer C. Lai*, Robert S. Rahimi, Elizabeth C. Verna, Matthew R. Kappus, Michael A. Dunn, Mara McAdams-DeMarco, Christine E. Haugen, Michael L. Volk, Andres Duarte-Rojo, Daniel R Ganger, Jacqueline G. O'Leary, Jennifer L. Dodge, Daniela P Ladner, Dorry L. Segev

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background & Aims: Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated Liver Frailty Index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between LFI scores, ascites, and hepatic encephalopathy (HE) and mortality. Methods: Adults without hepatocellular carcinoma who were on the liver transplantation waitlist at 9 centers in the United States (N = 1044) were evaluated using the LFI; LFI scores of at least 4.5 indicated that patients were frail. We performed logistic regression analyses to assess associations between frailty and ascites or HE and competing risk regression analyses (with liver transplantation as the competing risk) to estimate sub-hazard ratios (sHRs) of waitlist mortality (death or removal from the waitlist). Results: Of study subjects, 36% had ascites, 41% had HE, and 25% were frail. The odds of frailty were higher for patients with ascites (adjusted odd ratio 1.56, 95% confidence interval [CI] 1.15–2.14) or HE (odd ratio 2.45, 95% CI 1.80–3.33) than for those without these features. Larger proportions of frail patients with ascites (29%) or HE (30%) died while on the waitlist compared with patients who were not frail (17% of patients with ascites and 20% with HE). In univariable analysis, ascites (sHR 1.52, 95% CI 1.14–2.05), HE (sHR 1.84, 95% CI 1.38–2.45), and frailty (sHR 2.38, 95% CI 1.77–3.20) were associated with waitlist mortality. In adjusted models, only frailty remained significantly associated with waitlist mortality (sHR 1.82, 95% CI 1.31–2.52); ascites and HE were not. Conclusions: Frailty is a prevalent complication of cirrhosis that is observed more frequently in patients with ascites or HE and independently associated with waitlist mortality. LFI scores can be used to objectively quantify risk of death related to frailty—in excess of liver disease severity—in patients with cirrhosis.

Original languageEnglish (US)
Pages (from-to)1675-1682
Number of pages8
JournalGastroenterology
Volume156
Issue number6
DOIs
StatePublished - May 1 2019

Fingerprint

Hepatic Encephalopathy
Ascites
Multicenter Studies
Mortality
Confidence Intervals
Liver
Fibrosis
Liver Transplantation
Odds Ratio
Regression Analysis
Liver Diseases
Hepatocellular Carcinoma
Logistic Models

Keywords

  • End-Stage Liver Disease
  • Malnutrition
  • Portal Hypertension
  • Risk Factor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Lai, J. C., Rahimi, R. S., Verna, E. C., Kappus, M. R., Dunn, M. A., McAdams-DeMarco, M., ... Segev, D. L. (2019). Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study. Gastroenterology, 156(6), 1675-1682. https://doi.org/10.1053/j.gastro.2019.01.028
Lai, Jennifer C. ; Rahimi, Robert S. ; Verna, Elizabeth C. ; Kappus, Matthew R. ; Dunn, Michael A. ; McAdams-DeMarco, Mara ; Haugen, Christine E. ; Volk, Michael L. ; Duarte-Rojo, Andres ; Ganger, Daniel R ; O'Leary, Jacqueline G. ; Dodge, Jennifer L. ; Ladner, Daniela P ; Segev, Dorry L. / Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study. In: Gastroenterology. 2019 ; Vol. 156, No. 6. pp. 1675-1682.
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title = "Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study",
abstract = "Background & Aims: Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated Liver Frailty Index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between LFI scores, ascites, and hepatic encephalopathy (HE) and mortality. Methods: Adults without hepatocellular carcinoma who were on the liver transplantation waitlist at 9 centers in the United States (N = 1044) were evaluated using the LFI; LFI scores of at least 4.5 indicated that patients were frail. We performed logistic regression analyses to assess associations between frailty and ascites or HE and competing risk regression analyses (with liver transplantation as the competing risk) to estimate sub-hazard ratios (sHRs) of waitlist mortality (death or removal from the waitlist). Results: Of study subjects, 36{\%} had ascites, 41{\%} had HE, and 25{\%} were frail. The odds of frailty were higher for patients with ascites (adjusted odd ratio 1.56, 95{\%} confidence interval [CI] 1.15–2.14) or HE (odd ratio 2.45, 95{\%} CI 1.80–3.33) than for those without these features. Larger proportions of frail patients with ascites (29{\%}) or HE (30{\%}) died while on the waitlist compared with patients who were not frail (17{\%} of patients with ascites and 20{\%} with HE). In univariable analysis, ascites (sHR 1.52, 95{\%} CI 1.14–2.05), HE (sHR 1.84, 95{\%} CI 1.38–2.45), and frailty (sHR 2.38, 95{\%} CI 1.77–3.20) were associated with waitlist mortality. In adjusted models, only frailty remained significantly associated with waitlist mortality (sHR 1.82, 95{\%} CI 1.31–2.52); ascites and HE were not. Conclusions: Frailty is a prevalent complication of cirrhosis that is observed more frequently in patients with ascites or HE and independently associated with waitlist mortality. LFI scores can be used to objectively quantify risk of death related to frailty—in excess of liver disease severity—in patients with cirrhosis.",
keywords = "End-Stage Liver Disease, Malnutrition, Portal Hypertension, Risk Factor",
author = "Lai, {Jennifer C.} and Rahimi, {Robert S.} and Verna, {Elizabeth C.} and Kappus, {Matthew R.} and Dunn, {Michael A.} and Mara McAdams-DeMarco and Haugen, {Christine E.} and Volk, {Michael L.} and Andres Duarte-Rojo and Ganger, {Daniel R} and O'Leary, {Jacqueline G.} and Dodge, {Jennifer L.} and Ladner, {Daniela P} and Segev, {Dorry L.}",
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Lai, JC, Rahimi, RS, Verna, EC, Kappus, MR, Dunn, MA, McAdams-DeMarco, M, Haugen, CE, Volk, ML, Duarte-Rojo, A, Ganger, DR, O'Leary, JG, Dodge, JL, Ladner, DP & Segev, DL 2019, 'Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study', Gastroenterology, vol. 156, no. 6, pp. 1675-1682. https://doi.org/10.1053/j.gastro.2019.01.028

Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study. / Lai, Jennifer C.; Rahimi, Robert S.; Verna, Elizabeth C.; Kappus, Matthew R.; Dunn, Michael A.; McAdams-DeMarco, Mara; Haugen, Christine E.; Volk, Michael L.; Duarte-Rojo, Andres; Ganger, Daniel R; O'Leary, Jacqueline G.; Dodge, Jennifer L.; Ladner, Daniela P; Segev, Dorry L.

In: Gastroenterology, Vol. 156, No. 6, 01.05.2019, p. 1675-1682.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study

AU - Lai, Jennifer C.

AU - Rahimi, Robert S.

AU - Verna, Elizabeth C.

AU - Kappus, Matthew R.

AU - Dunn, Michael A.

AU - McAdams-DeMarco, Mara

AU - Haugen, Christine E.

AU - Volk, Michael L.

AU - Duarte-Rojo, Andres

AU - Ganger, Daniel R

AU - O'Leary, Jacqueline G.

AU - Dodge, Jennifer L.

AU - Ladner, Daniela P

AU - Segev, Dorry L.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background & Aims: Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated Liver Frailty Index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between LFI scores, ascites, and hepatic encephalopathy (HE) and mortality. Methods: Adults without hepatocellular carcinoma who were on the liver transplantation waitlist at 9 centers in the United States (N = 1044) were evaluated using the LFI; LFI scores of at least 4.5 indicated that patients were frail. We performed logistic regression analyses to assess associations between frailty and ascites or HE and competing risk regression analyses (with liver transplantation as the competing risk) to estimate sub-hazard ratios (sHRs) of waitlist mortality (death or removal from the waitlist). Results: Of study subjects, 36% had ascites, 41% had HE, and 25% were frail. The odds of frailty were higher for patients with ascites (adjusted odd ratio 1.56, 95% confidence interval [CI] 1.15–2.14) or HE (odd ratio 2.45, 95% CI 1.80–3.33) than for those without these features. Larger proportions of frail patients with ascites (29%) or HE (30%) died while on the waitlist compared with patients who were not frail (17% of patients with ascites and 20% with HE). In univariable analysis, ascites (sHR 1.52, 95% CI 1.14–2.05), HE (sHR 1.84, 95% CI 1.38–2.45), and frailty (sHR 2.38, 95% CI 1.77–3.20) were associated with waitlist mortality. In adjusted models, only frailty remained significantly associated with waitlist mortality (sHR 1.82, 95% CI 1.31–2.52); ascites and HE were not. Conclusions: Frailty is a prevalent complication of cirrhosis that is observed more frequently in patients with ascites or HE and independently associated with waitlist mortality. LFI scores can be used to objectively quantify risk of death related to frailty—in excess of liver disease severity—in patients with cirrhosis.

AB - Background & Aims: Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated Liver Frailty Index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between LFI scores, ascites, and hepatic encephalopathy (HE) and mortality. Methods: Adults without hepatocellular carcinoma who were on the liver transplantation waitlist at 9 centers in the United States (N = 1044) were evaluated using the LFI; LFI scores of at least 4.5 indicated that patients were frail. We performed logistic regression analyses to assess associations between frailty and ascites or HE and competing risk regression analyses (with liver transplantation as the competing risk) to estimate sub-hazard ratios (sHRs) of waitlist mortality (death or removal from the waitlist). Results: Of study subjects, 36% had ascites, 41% had HE, and 25% were frail. The odds of frailty were higher for patients with ascites (adjusted odd ratio 1.56, 95% confidence interval [CI] 1.15–2.14) or HE (odd ratio 2.45, 95% CI 1.80–3.33) than for those without these features. Larger proportions of frail patients with ascites (29%) or HE (30%) died while on the waitlist compared with patients who were not frail (17% of patients with ascites and 20% with HE). In univariable analysis, ascites (sHR 1.52, 95% CI 1.14–2.05), HE (sHR 1.84, 95% CI 1.38–2.45), and frailty (sHR 2.38, 95% CI 1.77–3.20) were associated with waitlist mortality. In adjusted models, only frailty remained significantly associated with waitlist mortality (sHR 1.82, 95% CI 1.31–2.52); ascites and HE were not. Conclusions: Frailty is a prevalent complication of cirrhosis that is observed more frequently in patients with ascites or HE and independently associated with waitlist mortality. LFI scores can be used to objectively quantify risk of death related to frailty—in excess of liver disease severity—in patients with cirrhosis.

KW - End-Stage Liver Disease

KW - Malnutrition

KW - Portal Hypertension

KW - Risk Factor

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