Frailty as a risk-stratification tool in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS)

Abstract

Objectives: The concept of frailty has gained importance, especially in patients with liver disease. Our study systematically investigated the effect of frailty on post-procedural outcomes in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). Methods: We used National Inpatient Sample(NIS) 2016-2019 data to identify patients who underwent TIPS. Hospital frailty risk score (HFRS) was used to classify patients as frail (HFRS>=5) and non-frail (HFRS<5). The relationship between frailty and outcomes such as death, post-procedural shock, non-home discharge, length of stay (LOS), post-procedural LOS, and total hospitalization charges (THC) was assessed. Results: A total of 13,700 patients underwent TIPS during 2016-2019. Of them, 5,995 (43.76%) patients were frail, while 7,705 (56.24%) were non-frail. There were no significant differences between the two groups based on age, gender, race, insurance, and income. Frail patients had higher mortality (15.18% vs. 2.07%, p<0.001), a higher incidence of non-home discharge (53.38% vs. 19.08%, p<0.001), a longer overall LOS (12.5 days vs. 3.35,p<0.001), longer post-procedural stay (8.2 days vs. 3.4 days, p<0.001), and higher THC ($240,746.7 vs. $121,763.1, p<0.001) compared to the non-frail patients. On multivariate analysis, frail patients had a statistically significant higher risk of mortality (aOR-3.22, 95% CI-1.98- 5.00, p<0.001). Conclusion: Frailty assessment can be beneficial in risk stratification in patients undergoing TIPS.

Frailty and transplant-free survival of patients with liver cirrhosis: A meta-analysis

“…Similarly, another study showed that frailty measured by gait speed was a strong risk factor for hospitalization for all cirrhosis complications, which also explained the association between frailty and poor prognosis of patients with cirrhosis [44]. In addition, a recent study showed that frailty might be a risk factor for in-hospital mortality of patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt [45]. These…”

“…Similarly, another study showed that frailty measured by gait speed was a strong risk factor for hospitalization for all cirrhosis complications, which also explained the association between frailty and poor prognosis of patients with cirrhosis [ 44 ]. In addition, a recent study showed that frailty might be a risk factor for in-hospital mortality of patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt [ 45 ]. These findings also suggested that cirrhotic patients with frailty may be at high risk for receiving invasive treatments, which may be another potential reason for the poor long-term clinical outcomes of these patients [ 45 ].…”

“…In addition, a recent study showed that frailty might be a risk factor for in-hospital mortality of patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt [ 45 ]. These findings also suggested that cirrhotic patients with frailty may be at high risk for receiving invasive treatments, which may be another potential reason for the poor long-term clinical outcomes of these patients [ 45 ]. Pathophysiologically, frailty has been related to upregulated inflammatory response, impaired systemic immune dysfunction, and gut microbiota disorder [ 46 – 48 ], which may also partly explain the association between frailty and poor TFS in patients with cirrhosis.…”

Frailty in end-stage liver disease: Understanding pathophysiology, tools for assessment, and strategies for management

“…Frailty has been observed to be a valuable predictor of outcomes both before and following therapeutic interventions. For instance, frailty has been associated with post-transjugular intrahepatic portosystemic shunt (TIPS) and post-liver transplant morbidity and mortality[ 143 , 144 ]. Additionally, early identification of frailty is also crucial as it is possible to reverse frailty to some extent, and identifying it early on enables healthcare providers to intervene more effectively to enhance the health outcomes of patients with frailty[ 145 ].…”

“…While several studies have shown promising results in terms of improving muscle mass and nutritional status, as well as reducing the risk of hepatic encephalopathy and mortality in sarcopenic patients[ 213 - 215 ], other studies have raised concerns about the use of TIPS as a therapy for sarcopenia and frailty, particularly in severe cases. These studies have demonstrated that these conditions are associated with a higher risk of post-TIPS complications, such as non-home discharge, prolonged hospital stay, hepatic encephalopathy, and even mortality[ 143 , 216 , 217 ].…”