Predictors of Frailty in Patients with Liver Cirrhosis in 2023-24!

Introduction

Frailty is common in patients with advanced liver disease (cirrhosis). It leads to more frequent hospitalizations, longer stays, and even removal from transplant lists. This study aims to identify factors that predict frailty in these patients.

Methods

Study Details

• Location: Sindh Institute of Urology and Transplantation, Karachi, Pakistan
• Duration: March 1, 2022, to August 31, 2022
• Participants: 132 patients diagnosed with liver cirrhosis, aged 18-70 years

Exclusions

• Patients with conditions that overestimate frailty (e.g., cardiopulmonary diseases, hepatocellular carcinoma)

Measurement

• Liver Frailty Index (LFI): Assessed using hand grip strength, timed chair stands, and balance testing
• Frailty Criteria: LFI > 4.5

Data Analysis

• Software: IBM SPSS Statistics for Windows, Version 22.0
• Tests: Student t-test for continuous variables, chi-square test for categorical variables, multivariate analysis for independent predictors
• Significance: p-value < 0.05

Results

Participant Overview

• Total Patients: 132
• Gender: 67.4% male, 32.6% female
• Mean Age: 47 ± 12.3 years

Health Conditions

• Hepatitis C: 52.3%
• Hepatitis B: 33.5%
• Autoimmune Hepatitis: 5.3%
• Non-alcoholic Fatty Liver Disease: 3%
• Hepatic Encephalopathy History: 15.9%
• Secondary Bacterial Peritonitis History: 6.1%
• Esophageal Varices History: 40.9%
• Variceal Band Ligation History: 12%
• Hepato-renal Syndrome History: 9%

Frailty Assessment

• Frail Patients: 38.6%
• Hospital Admissions: 42.4% due to liver-related complications

Univariate Analysis

Factors associated with frailty:

• Female gender
• Advanced age
• Raised total leukocyte count
• Increased percentage of neutrophils on peripheral smear
• Raised serum creatinine
• Raised total bilirubin
• Raised prothrombin time
• High Child Turcotte Pugh (CTP) score
• High model for end-stage liver disease (MELD) score
• Low hemoglobin
• Low serum albumin

Multivariate Analysis

Independent predictors of frailty:

• Female gender
• Age > 40 years
• CTP score > B7
• Hemoglobin < 10 g/dl
• Neutrophils > 60% on peripheral smear

Conclusion

Female gender, advanced age, increased neutrophils on peripheral smear, decreased hemoglobin, and severe liver dysfunction are independent predictors of frailty in patients with liver cirrhosis.

Background Information

Cirrhosis Overview

Cirrhosis results from prolonged liver damage due to:

• Viral infections
• Autoimmune disorders
• Metabolic diseases
• Alcoholic and non-alcoholic steatohepatitis
• Cholestasis

Characterized by fibrous bands and nodules, cirrhosis can lead to complications like ascites, portosystemic encephalopathy, variceal bleeding, and hepatocellular carcinoma.

Frailty in Cirrhotic Patients

Frailty means reduced physical strength and a higher risk of adverse outcomes due to stressors like infections. It’s seen in 17-43% of cirrhotic patients and measured by various indices, including the Liver Frailty Index (LFI).

Impact of Frailty

Frailty in cirrhotic patients leads to:

• Increased risks of decompensation and hospitalization
• Higher mortality rates
• More post-transplant complications

Improving frailty can enhance survival and quality of life.

Need for the Study

Limited data exists on the predictors of frailty in cirrhotic patients. Identifying these predictors can help manage frailty and improve the quality of life for these patients.

Study Presentation

This study was presented as a poster at the 2023 Asian Pacific Digestive Week Federation (APDWF) annual meeting on December 9, 2023.

Materials & Methods

Study Approval

Approved by the Ethical Review Committee of SIUT (approval number: 412).

Participant Criteria

• Inclusion: Patients diagnosed with liver cirrhosis, aged 18-70 years
• Exclusion: Patients with pulmonary or cardiovascular diseases, joint movement disorders, impaired mentation, or a history of malignancy

Frailty Assessment

• Method: Hand grip strength, timed chair stands, balance testing
• Frailty Definition: LFI > 4.5

Data Analysis

• Software: IBM SPSS Statistics for Windows, Version 22.0
• Statistical Methods: Student t-test, chi-square test, multivariate Cox-regression analysis
• Significance Level: p-value < 0.05

Results

Patient Characteristics

• Total Patients: 132
• Mean Age: 47 ± 12.3 years
• Gender: 67.4% male, 32.6% female

Health Conditions

• Common Causes: Hepatitis C (52.3%), Hepatitis B (33.5%)
• Other Conditions: Autoimmune hepatitis, non-alcoholic fatty liver disease, hepatic encephalopathy, secondary bacterial peritonitis, esophageal varices, variceal band ligation, hepato-renal syndrome

Frailty and Hospitalization

• Frail Patients: 38.6%
• Hospital Admissions: 42.4%

Significant Factors on Univariate Analysis

• Female gender
• Advanced age
• Raised total leukocyte count
• Increased neutrophils on peripheral smear
• Raised serum creatinine, total bilirubin, prothrombin time
• High CTP and MELD scores
• Low hemoglobin and serum albumin

Independent Predictors on Multivariate Analysis

• Female gender
• Age > 40 years
• CTP score > B7
• Hemoglobin < 10 g/dl
• Neutrophils > 60% on peripheral smear

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