Frailty in outpatients with cirrhosis: A prospective observational study

Background and Aim Frailty is increasingly recognized as a major prognostic factor in cirrhosis in addition to conventional liver insufficiency scores. The aim was to compare the prevalence and characteristics of frailty between patients with cirrhosis and controls, and to analyse its prognostic val...

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Veröffentlicht in:Liver international 2021-02, Vol.41 (2), p.357-368
Hauptverfasser: Román, Eva, Parramón, Marc, Flavià, Montserrat, Gely, Cristina, Poca, Maria, Gallego, Adolfo, Santesmases, Rosalia, Hernández, Elvira, Nieto, Juan C., Urgell, Eulàlia, Alvarado‐Tapias, Edilmar, Vidal, Silvia, Ferrero‐Gregori, Andreu, Vargas, Víctor, Guarner, Carlos, Soriano, German
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container_end_page 368
container_issue 2
container_start_page 357
container_title Liver international
container_volume 41
creator Román, Eva
Parramón, Marc
Flavià, Montserrat
Gely, Cristina
Poca, Maria
Gallego, Adolfo
Santesmases, Rosalia
Hernández, Elvira
Nieto, Juan C.
Urgell, Eulàlia
Alvarado‐Tapias, Edilmar
Vidal, Silvia
Ferrero‐Gregori, Andreu
Vargas, Víctor
Guarner, Carlos
Soriano, German
description Background and Aim Frailty is increasingly recognized as a major prognostic factor in cirrhosis in addition to conventional liver insufficiency scores. The aim was to compare the prevalence and characteristics of frailty between patients with cirrhosis and controls, and to analyse its prognostic value. Methods We included outpatients with cirrhosis and age‐ and gender‐matched non‐cirrhotic controls. Frailty was defined according to the Fried frailty criteria. In patients with cirrhosis, we analysed the ability of the degree of frailty to predict a composite endpoint, consisting of hospitalization, admission to a long‐term care centre, falls or death. Results We included 135 patients with cirrhosis and 135 controls. The prevalence of frailty was higher among patients with cirrhosis: 35 (25.9%) frail, 74 (54.8%) pre‐frail and 26 (19.2%) robust vs 14 (10.4%) frail, 67 (49.6%) pre‐frail and 54 (40%) robust (P 
doi_str_mv 10.1111/liv.14694
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The aim was to compare the prevalence and characteristics of frailty between patients with cirrhosis and controls, and to analyse its prognostic value. Methods We included outpatients with cirrhosis and age‐ and gender‐matched non‐cirrhotic controls. Frailty was defined according to the Fried frailty criteria. In patients with cirrhosis, we analysed the ability of the degree of frailty to predict a composite endpoint, consisting of hospitalization, admission to a long‐term care centre, falls or death. Results We included 135 patients with cirrhosis and 135 controls. The prevalence of frailty was higher among patients with cirrhosis: 35 (25.9%) frail, 74 (54.8%) pre‐frail and 26 (19.2%) robust vs 14 (10.4%) frail, 67 (49.6%) pre‐frail and 54 (40%) robust (P &lt; .001) in controls. This difference was mainly as a result of decreased muscle strength in patients with cirrhosis. During follow‐up, frail patients with cirrhosis showed a higher probability of composite endpoint, hospitalization and falls than pre‐frail and robust cirrhotic patients but mortality was similar. MELD‐Na score and frailty were independent predictive factors for hospitalization, frailty for falls, and MELD‐Na score and albumin for survival. Vitamin D deficiency and increased cystatin C were associated with frailty. Conclusions Frailty was more frequent in outpatients with cirrhosis than in controls, mainly because of a decrease in muscle strength, and it could be a predictive factor for hospitalization and falls in these patients.</description><identifier>ISSN: 1478-3223</identifier><identifier>EISSN: 1478-3231</identifier><identifier>DOI: 10.1111/liv.14694</identifier><identifier>PMID: 33030788</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Albumins ; Cirrhosis ; Cystatin C ; falls ; Frailty ; fried frailty criteria ; Hospitalization ; Liver cirrhosis ; Muscle strength ; Observational studies ; Robust control ; Vitamin D ; Vitamin deficiency</subject><ispartof>Liver international, 2021-02, Vol.41 (2), p.357-368</ispartof><rights>2020 John Wiley &amp; Sons A/S. Published by John Wiley &amp; Sons Ltd</rights><rights>2020 John Wiley &amp; Sons A/S. Published by John Wiley &amp; Sons Ltd.</rights><rights>2021 John Wiley &amp; Sons A/S</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3534-88fd35bfda685b6dec35b6105ba0e2fb387679796e0ba9bf93fd9cac2dae6cd03</citedby><cites>FETCH-LOGICAL-c3534-88fd35bfda685b6dec35b6105ba0e2fb387679796e0ba9bf93fd9cac2dae6cd03</cites><orcidid>0000-0002-3909-6682 ; 0000-0002-0235-1395 ; 0000-0001-9084-8555 ; 0000-0002-9267-6811 ; 0000-0003-2036-6133 ; 0000-0002-7190-6948</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fliv.14694$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fliv.14694$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33030788$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Román, Eva</creatorcontrib><creatorcontrib>Parramón, Marc</creatorcontrib><creatorcontrib>Flavià, Montserrat</creatorcontrib><creatorcontrib>Gely, Cristina</creatorcontrib><creatorcontrib>Poca, Maria</creatorcontrib><creatorcontrib>Gallego, Adolfo</creatorcontrib><creatorcontrib>Santesmases, Rosalia</creatorcontrib><creatorcontrib>Hernández, Elvira</creatorcontrib><creatorcontrib>Nieto, Juan C.</creatorcontrib><creatorcontrib>Urgell, Eulàlia</creatorcontrib><creatorcontrib>Alvarado‐Tapias, Edilmar</creatorcontrib><creatorcontrib>Vidal, Silvia</creatorcontrib><creatorcontrib>Ferrero‐Gregori, Andreu</creatorcontrib><creatorcontrib>Vargas, Víctor</creatorcontrib><creatorcontrib>Guarner, Carlos</creatorcontrib><creatorcontrib>Soriano, German</creatorcontrib><title>Frailty in outpatients with cirrhosis: A prospective observational study</title><title>Liver international</title><addtitle>Liver Int</addtitle><description>Background and Aim Frailty is increasingly recognized as a major prognostic factor in cirrhosis in addition to conventional liver insufficiency scores. The aim was to compare the prevalence and characteristics of frailty between patients with cirrhosis and controls, and to analyse its prognostic value. Methods We included outpatients with cirrhosis and age‐ and gender‐matched non‐cirrhotic controls. Frailty was defined according to the Fried frailty criteria. In patients with cirrhosis, we analysed the ability of the degree of frailty to predict a composite endpoint, consisting of hospitalization, admission to a long‐term care centre, falls or death. Results We included 135 patients with cirrhosis and 135 controls. The prevalence of frailty was higher among patients with cirrhosis: 35 (25.9%) frail, 74 (54.8%) pre‐frail and 26 (19.2%) robust vs 14 (10.4%) frail, 67 (49.6%) pre‐frail and 54 (40%) robust (P &lt; .001) in controls. This difference was mainly as a result of decreased muscle strength in patients with cirrhosis. During follow‐up, frail patients with cirrhosis showed a higher probability of composite endpoint, hospitalization and falls than pre‐frail and robust cirrhotic patients but mortality was similar. MELD‐Na score and frailty were independent predictive factors for hospitalization, frailty for falls, and MELD‐Na score and albumin for survival. Vitamin D deficiency and increased cystatin C were associated with frailty. 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Parramón, Marc ; Flavià, Montserrat ; Gely, Cristina ; Poca, Maria ; Gallego, Adolfo ; Santesmases, Rosalia ; Hernández, Elvira ; Nieto, Juan C. ; Urgell, Eulàlia ; Alvarado‐Tapias, Edilmar ; Vidal, Silvia ; Ferrero‐Gregori, Andreu ; Vargas, Víctor ; Guarner, Carlos ; Soriano, German</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3534-88fd35bfda685b6dec35b6105ba0e2fb387679796e0ba9bf93fd9cac2dae6cd03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Albumins</topic><topic>Cirrhosis</topic><topic>Cystatin C</topic><topic>falls</topic><topic>Frailty</topic><topic>fried frailty criteria</topic><topic>Hospitalization</topic><topic>Liver cirrhosis</topic><topic>Muscle strength</topic><topic>Observational studies</topic><topic>Robust control</topic><topic>Vitamin D</topic><topic>Vitamin deficiency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Román, Eva</creatorcontrib><creatorcontrib>Parramón, Marc</creatorcontrib><creatorcontrib>Flavià, Montserrat</creatorcontrib><creatorcontrib>Gely, Cristina</creatorcontrib><creatorcontrib>Poca, Maria</creatorcontrib><creatorcontrib>Gallego, Adolfo</creatorcontrib><creatorcontrib>Santesmases, Rosalia</creatorcontrib><creatorcontrib>Hernández, Elvira</creatorcontrib><creatorcontrib>Nieto, Juan C.</creatorcontrib><creatorcontrib>Urgell, Eulàlia</creatorcontrib><creatorcontrib>Alvarado‐Tapias, Edilmar</creatorcontrib><creatorcontrib>Vidal, Silvia</creatorcontrib><creatorcontrib>Ferrero‐Gregori, Andreu</creatorcontrib><creatorcontrib>Vargas, Víctor</creatorcontrib><creatorcontrib>Guarner, Carlos</creatorcontrib><creatorcontrib>Soriano, German</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Liver international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Román, Eva</au><au>Parramón, Marc</au><au>Flavià, Montserrat</au><au>Gely, Cristina</au><au>Poca, Maria</au><au>Gallego, Adolfo</au><au>Santesmases, Rosalia</au><au>Hernández, Elvira</au><au>Nieto, Juan C.</au><au>Urgell, Eulàlia</au><au>Alvarado‐Tapias, Edilmar</au><au>Vidal, Silvia</au><au>Ferrero‐Gregori, Andreu</au><au>Vargas, Víctor</au><au>Guarner, Carlos</au><au>Soriano, German</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Frailty in outpatients with cirrhosis: A prospective observational study</atitle><jtitle>Liver international</jtitle><addtitle>Liver Int</addtitle><date>2021-02</date><risdate>2021</risdate><volume>41</volume><issue>2</issue><spage>357</spage><epage>368</epage><pages>357-368</pages><issn>1478-3223</issn><eissn>1478-3231</eissn><abstract>Background and Aim Frailty is increasingly recognized as a major prognostic factor in cirrhosis in addition to conventional liver insufficiency scores. The aim was to compare the prevalence and characteristics of frailty between patients with cirrhosis and controls, and to analyse its prognostic value. Methods We included outpatients with cirrhosis and age‐ and gender‐matched non‐cirrhotic controls. Frailty was defined according to the Fried frailty criteria. In patients with cirrhosis, we analysed the ability of the degree of frailty to predict a composite endpoint, consisting of hospitalization, admission to a long‐term care centre, falls or death. Results We included 135 patients with cirrhosis and 135 controls. The prevalence of frailty was higher among patients with cirrhosis: 35 (25.9%) frail, 74 (54.8%) pre‐frail and 26 (19.2%) robust vs 14 (10.4%) frail, 67 (49.6%) pre‐frail and 54 (40%) robust (P &lt; .001) in controls. This difference was mainly as a result of decreased muscle strength in patients with cirrhosis. During follow‐up, frail patients with cirrhosis showed a higher probability of composite endpoint, hospitalization and falls than pre‐frail and robust cirrhotic patients but mortality was similar. MELD‐Na score and frailty were independent predictive factors for hospitalization, frailty for falls, and MELD‐Na score and albumin for survival. Vitamin D deficiency and increased cystatin C were associated with frailty. Conclusions Frailty was more frequent in outpatients with cirrhosis than in controls, mainly because of a decrease in muscle strength, and it could be a predictive factor for hospitalization and falls in these patients.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33030788</pmid><doi>10.1111/liv.14694</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-3909-6682</orcidid><orcidid>https://orcid.org/0000-0002-0235-1395</orcidid><orcidid>https://orcid.org/0000-0001-9084-8555</orcidid><orcidid>https://orcid.org/0000-0002-9267-6811</orcidid><orcidid>https://orcid.org/0000-0003-2036-6133</orcidid><orcidid>https://orcid.org/0000-0002-7190-6948</orcidid></addata></record>
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subjects Albumins
Cirrhosis
Cystatin C
falls
Frailty
fried frailty criteria
Hospitalization
Liver cirrhosis
Muscle strength
Observational studies
Robust control
Vitamin D
Vitamin deficiency
title Frailty in outpatients with cirrhosis: A prospective observational study
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