Editorial: Advancing Adoption of Frailty to Improve the Care of Patients with Cirrhosis: Time for a Consensus on a Frailty Index

Lai, Jennifer C.

doi:10.1038/ajg.2016.485

Cited by 13 publications

(16 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of consensus for a feasible, reliable, and objective test of physical frailty for clinical use in liver transplantation has limited the application of the diagnosis of the frailty phenotype in clinical hepatology practice . We developed the LFI specifically for patients with cirrhosis using a parsimonious battery of tests that have been incorporated into composite frailty indices in the field of geriatrics for decades .…”

Section: Discussionmentioning

confidence: 99%

“…transplantation has limited the application of the diagnosis of the frailty phenotype in clinical hepatology practice. (10) We developed the LFI specifically for patients with cirrhosis using a parsimonious battery of tests that have been incorporated into composite frailty indices in the field of geriatrics for decades. (1,2) Thus far, we have demonstrated that the LFI improves risk prediction of wait-list mortality over the MELD-Na alone, (3) can enhance subjective clinician assessments of a patient's global health status, (6) and is strongly associated with robustness of physical function after liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Range and Reproducibility of the Liver Frailty Index

et al. 2019

View full text Add to dashboard Cite

The Liver Frailty Index (LFI), composed of 3 performance‐based tests (grip strength, chair stands, and balance), is a tool specifically developed in patients with cirrhosis to objectively measure physical function, a critical determinant of health outcomes. We aimed to (1) determine the range of LFI scores in adults with chronic liver disease but without cirrhosis, (2) determine the range of LFI scores in adults without known liver disease, and (3) evaluate reproducibility of the LFI in adults with cirrhosis listed for liver transplantation. Intraclass correlation coefficient (ICC) assessed interrater reliability of the LFI. Included were 91 adults with chronic liver disease, 109 adults without known liver disease, and 166 adults with cirrhosis with median Model for End‐Stage Liver Disease–sodium of 16. Median (interquartile range) LFI was 3.6 (3.1‐4.1) in adults with cirrhosis, 3.1 (2.5‐3.7) in adults with chronic liver disease but not cirrhosis, and 2.7 (2.2‐3.2) in adults without liver disease (P < 0.001). Using established LFI cutoffs for robust, prefrail, and frail categories, adults with cirrhosis or chronic liver disease were less likely to be robust (29% versus 53% versus 77%) and more likely to be prefrail (57% versus 42% versus 22%) or frail (14% versus 5% versus 1%) when compared with adults without liver disease (P < 0.001). The LFI had excellent reliability with ICC of 0.93 (95% confidence interval, 0.91‐0.95). In conclusion, the LFI has external validity in noncirrhotic populations and is highly reproducible among different raters. This objective assessment tool can be implemented in outpatient clinical practice or research to operationalize the concept of physical frailty.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Range and Reproducibility of the Liver Frailty Index

et al. 2019

View full text Add to dashboard Cite

show abstract

“…3 While several studies have investigated frailty 1,4 or aspects of frailty (eg, cardiopulmonary fitness, 5,6 disability, 7,8 ) in the pre–liver transplant setting, these tools have characteristics that have hampered efforts to fully understand if, how, and when frailty reverses after liver transplantation. For example, tools such as the Fried Frailty Index or Activities of Daily Living scale are subjective and scored on a noncontinuous scale, making them insensitive to subtle changes over time; cardiopulmonary exercise testing is technically challenging to administer, limiting the number of patients who are able to undergo repeat posttransplant testing.…”

Section: | Introductionmentioning

confidence: 99%

“…Such information is crucial to informing discussions with patients and caregivers about what to expect after liver transplantation and guiding prognosis regarding quality of life.One of the major barriers to investigating recovery from physical frailty after liver transplantation has been the frailty measurement tools themselves. 3 While several studies have investigated frailty 1,4 or aspects of frailty (eg, cardiopulmonary fitness, 5,6 disability, 7,8 ) in the pre-liver transplant setting, these tools have characteristics that have hampered efforts to fully understand if, how, and when frailty reverses after liver transplantation. For example, tools such as the Fried Frailty Index or Activities of Daily Living scale are subjective and scored on a noncontinuous scale, making them insensitive to Frailty is prevalent in liver transplant candidates, but little is known of what happens to frailty after liver transplantation.…”

mentioning

confidence: 99%

Physical frailty after liver transplantation

Lai

Segev²,

McCulloch

et al. 2018

American Journal of Transplantation

127

122

View full text Add to dashboard Cite

Frailty is prevalent in liver transplant candidates, but little is known of what happens to frailty after liver transplantation. We analyzed data for 214 adult liver transplant recipients who had ≥1 frailty assessment using the Liver Frailty Index (LFI) at 3- (n = 178), 6- (n = 139), or 12- (n = 107) months posttransplant (higher values=more frail). "Frail" and "robust" were defined as LFI ≥4.5 and <3.2. Median pre-liver transplant LFI was 3.7, and was worse at 3 months (3.9; P = .02), similar at 6 months (3.7; P = .07), and improved at 12 months (3.4; P < .001). The percentage who were robust pre- and 3-, 6-, and 12-months posttransplant were 25%, 14%, 28%, and 37%; the percentage frail were 21%, 21%, 10%, and 7%. In univariable analysis, each 0.1 pretransplant LFI point more frail was associated with a decreased odds of being robust at 3- (odds ratio [OR] 0.75), 6- (OR 0.77), and 12-months (OR 0.90) posttransplant (P ≤ .001), which did not change substantially with multivariable adjustment. In conclusion, frailty worsens 3 months posttransplant and improves modestly by 12 months, but fewer than 2 of 5 patients achieve robustness. Pretransplant LFI was a potent predictor of posttransplant robustness. Aggressive interventions aimed at preventing frailty pretransplant are urgently needed to maximize physical health after liver transplantation.

show abstract

“…23 The biologic construction of physical frailty, originally developed in the field of geriatrics, has been shown to capture the effects of end-stage liver failure in adults ("relative chronologic youth") and predict post-transplant outcomes and morbidity. [24][25][26] The concept of frailty has been extended to children, with a recent study demonstrating feasibility of testing for the five domains of the Fried Frailty Phenotype in a multicenter cohort of children between the ages of 5 and 18 years with chronic liver disease, with 46% meeting the criteria for frailty at a single baseline assessment. 27 However, the majority of wait listed children are under the age of 5 years, and thereby too young to undergo functional or performance-based (frailty) testing before time of LT.…”

Section: Enhancing Risk Stratification Of Patients On the Wait Listmentioning

confidence: 99%

Barriers to ideal outcomes after pediatric liver transplantation

Mazariegos

Kelly

et al. 2019

Pediatric Transplantation

View full text Add to dashboard Cite

Long‐term survival for children who undergo LT is now the rule rather than the exception. However, a focus on the outcome of patient or graft survival rates alone provides an incomplete and limited view of life for patients who undergo LT as an infant, child, or teen. The paradigm has now appropriately shifted to opportunities focused on our overarching goals of “surviving and thriving” with long‐term allograft health, freedom of complications from long‐term immunosuppression, self‐reported well‐being, and global functional health. Experts within the liver transplant community highlight clinical gaps and potential barriers at each of the pretransplant, intra‐operative, early‐, medium‐, and long‐term post‐transplant stages toward these broader mandates. Strategies including clinical research, innovation, and quality improvement targeting both traditional as well as PRO are outlined and, if successfully leveraged and conducted, would improve outcomes for recipients of pediatric LT.

show abstract

Editorial: Advancing Adoption of Frailty to Improve the Care of Patients with Cirrhosis: Time for a Consensus on a Frailty Index

Cited by 13 publications

References 9 publications

The Range and Reproducibility of the Liver Frailty Index

The Range and Reproducibility of the Liver Frailty Index

Physical frailty after liver transplantation

Barriers to ideal outcomes after pediatric liver transplantation

Contact Info

Product

Resources

About