Ability of the Short Physical Performance Battery Frailty Index to Predict Mortality and Hospital Readmission in Patients with Liver Cirrhosis

Abstract

Background/Aims. Unplanned hospitalisation is a marker of poor prognosis and a major financial burden in patients with cirrhosis. Frailty-screening tools could determine the risk for unplanned hospital admissions and death. The study aims to evaluate the bedside frailty-screening tool (Short Physical Performance Battery (SPPB)) in prediction of mortality in patients with liver cirrhosis. Methods. One hundred forty-five patients with liver cirrhosis were recruited from Cairo University Hospital. Clinical assessment and routine laboratory tests were performed, and the SPPB frailty index, Child score, and model for end-stage liver disease (MELD) score were calculated on admission. These metrics were compared to assess mortality outcomes over the course of 90 days. Results. The mean age of the patients was 60 ± 7 years, and frailty index score (SD) was 6 ± 3. The overall 90-day readmission rate was 43.4%, while the overall 90-day mortality rate was 18.6%. SPPB scores differed significantly between survivors (4.1 ± 1.4) and nonsurvivors (6.47 ± 2.8) (P value ≤ 0.001) as well as between readmitted patients (7.5 ± 2.9) and patients who were not readmitted (4.5 ± 1.9) (P value ≤ 0.001), while the Child and MELD scores showed no associations with patient outcomes. SPPB performed better with a specificity of 72.3% and a sensitivity of 72.2% for predicting mortality. Conclusions. SPPB could be a screening tool used to detect frailty and excelled over traditional scores as a predictor of death. A low SPPB frailty score among hospitalised patients with cirrhosis is associated with poor outcomes.

Clinical utility of the Liver Frailty Index for predicting muscle atrophy in chronic liver disease patients with hepatocellular carcinoma

“…used another physical function test, the Short Physical Performance Battery (SPPB), and reported that the SPPB is not associated with the muscle mass of patients with CLD . SPPB consists of walking speed, standing balance, and timed chair stands . It remains unclear as to why no association was seen between SPPB and muscle mass, a possible reason is that walking speed, but not grip strength, is used as an assessment item in SPPB.…”

APTA Cross Sections and Academies Recommendations for COVID-19 Core Outcome Measures

“…Moreover, the SPPB has high clinical utility in a diverse range of clinical populations. 22 – 26 The 2-minute step test was selected for endurance because of its utility in acutely ill and active populations and because the testing conditions, like step height, could be varied and exercise capacity and metabolic equivalent of task level performance could be calculated to illustrate progress, as functional capacity improved. 20…”

Systematic review: the role of frailty in advanced chronic liver disease

“…The studies that were assessed were exclusively observational or cohort studies, with no defined interventions in any of the studies. Using the suitable quality assessment tool, 31 only one of these studies 32 was highlighted as poor quality.…”

“…It has previously been shown to be predictive of both frailty and waitlist mortality in patients awaiting a liver transplant 37 . Four of the included 12 studies prospectively utilised SPPB in their assessment and demonstrated that it could predict mortality 32,34,35,38 . Essam Behiry et al 32 demonstrated through ROC curve analyses of mortality based on frailty as per SPPB, handgrip, MELD and Childs‐Pugh that only SPPB had a significant AUC (0.743; p = 0.013).…”

“…Four of the included 12 studies prospectively utilised SPPB in their assessment and demonstrated that it could predict mortality 32,34,35,38 . Essam Behiry et al 32 demonstrated through ROC curve analyses of mortality based on frailty as per SPPB, handgrip, MELD and Childs‐Pugh that only SPPB had a significant AUC (0.743; p = 0.013). In an evaluation of SPPB compared to CFS, Tandon et al 38 found CFS to be superior at predicting 6‐month mortality (odds ratio = 5 for CFS vs OR = 3.4 for SPPB) and commented that CFS was more user‐friendly and less time‐consuming.…”