The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study

Chelsea Q. Xu, Yara Mohamad, Matthew R. Kappus, Brian Boyarsky, Daniel R. Ganger, Michael L. Volk, Robert S. Rahimi, Andres Duarte-Rojo, Mara McAdams-DeMarco, Dorry L. Segev, Daniela P. Ladner, Elizabeth C. Verna, Joshua Grab, Monica Tincopa, Michael A. Dunn, Jennifer C. Lai*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background & Aims: Cirrhosis leads to malnutrition and muscle wasting that manifests as frailty, which may be influenced by cirrhosis aetiology. We aimed to characterize the relationship between frailty and cirrhosis aetiology. Methods: Included were adults with cirrhosis listed for liver transplantation (LT) at 10 US centrer who underwent ambulatory testing with the Liver Frailty Index (LFI; ‘frail’ = LFI ≥ 4.4). We used logistic regression to associate aetiologies and frailty, and competing risk regression (LT as the competing risk) to determine associations with waitlist mortality (death/delisting for sickness). Results: Of 1,623 patients, rates of frailty differed by aetiology: 22% in chronic hepatitis C, 31% in alcohol-associated liver disease (ALD), 32% in non-alcoholic fatty liver disease (NAFLD), 21% in autoimmune/cholestatic and 31% in ‘other’ (P <.001). In univariable logistic regression, ALD (OR 1.53, 95% CI 1.12-2.09), NAFLD (OR 1.64, 95% CI 1.18-2.29) and ‘other’ (OR 1.58, 95% CI 1.06-2.36) were associated with frailty. In multivariable logistic regression, only ALD (OR 1.40; 95% 1.01-1.94) and ‘other’ (OR 1.59; 95% 1.05-2.40) remained associated with frailty. A total of 281 (17%) patients died/were delisted for sickness. In multivariable competing risk regression, LFI was associated with waitlist mortality (sHR 1.05, 95% CI 1.03-1.06), but aetiology was not (P >.05 for each). No interaction between frailty and aetiology on the association with waitlist mortality was found (P >.05 for each interaction term). Conclusions: Frailty is more common in patients with ALD, NAFLD and ‘other’ aetiologies. However, frailty was associated with waitlist mortality independent of cirrhosis aetiology, supporting the applicability of frailty across all cirrhosis aetiologies.

Original languageEnglish (US)
Pages (from-to)2467-2473
Number of pages7
JournalLiver International
Issue number10
StatePublished - Oct 2021


  • frailty
  • malnutrition
  • non-alcoholic fatty liver disease
  • physical function
  • sarcopenia

ASJC Scopus subject areas

  • Hepatology


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