The tele-liver frailty index (TeLeFI): development of a novel frailty tool in patients with cirrhosis via telemedicine

Melinda Wang, Amy M. Shui, Fawzy Barry, Elizabeth Verna, Dorothea Kent, Frederick Yao, Srilakshmi Seetharaman, Kacey Berry, Rachel K. Grubbs, Geena George, Chiung Yu Huang, Andres Duarte-Rojo, Jennifer C. Lai*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Frailty is a critical determinant of outcomes in cirrhosis patients. The increasing use of telemedicine has created an unmet need for virtual frailty assessment. We aimed to develop a telemedicine-enabled frailty tool (tele-liver frailty index). Adults with cirrhosis in the liver transplant setting underwent ambulatory frailty testing with the liver frailty index (LFI) in-person, then virtual administration of (1) validated surveys (eg, SARC-F and Duke Activity Status Index [DASI]), (2) chair stands, and (3) balance. Two models were selected and internally validated for predicting LFI ≥4.4 using: (1) Bayesian information criterion (BIC), (2) C-statistics, and (3) ease of use. Of 145 patients, the median (interquartile range) LFI was 3.7 (3.3-4.2); 15% were frail. Frail (vs not frail) patients reported significantly greater impairment on all virtually assessed instruments. We selected 2 parsimonious models: (1) DASI + chair/bed transfer (SARC-F) (BIC 255, C-statistics 0.78), and (2) DASI + chair/bed transfer (SARC-F) + virtually assessed chair stands (BIC 244, C-statistics 0.79). Both models had high C-statistics (0.76-0.78) for predicting frailty. In conclusion, the tele-liver frailty index is a novel tool to screen frailty in liver transplant patients via telemedicine pragmatically and may be used to identify patients who require in-person frailty assessment, more frequent follow-up, or frailty intervention.

Original languageEnglish (US)
Pages (from-to)966-975
Number of pages10
JournalAmerican Journal of Transplantation
Issue number7
StatePublished - Jul 2023


  • LFI
  • cirrhosis
  • frailty
  • survey
  • telehealth
  • virtual

ASJC Scopus subject areas

  • Transplantation
  • Pharmacology (medical)
  • Immunology and Allergy


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