The definition and diagnosis of frailty in the research and clinical settings

Frailty is characterized by reduced physiological reserve and increased vulnerability to health stressors, and it is prevalent among patients with cirrhosis and particularly in those listed for liver transplantation. It is recommended to base frailty diagnosis on physical function or performance-based testing. Pending the development of consensus documents and clinical practice guidelines, multiple tools can be used to objectively assess frailty in patients with cirrhosis, including the Liver Frailty Index, gait speed testing, and the 6-minute walk test. In research settings, cardiopulmonary exercise testing is expected to provide additional information on exercise physiology. Regardless of the used tool, there is almost universal agreement on the association of frailty with worse clinical outcomes. Given the evidence linking frailty to increased healthcare costs, it is of the utmost importance to develop a model of care that includes baseline evaluation and frailty monitoring as part of the routine care of patients with cirrhosis.