Frailty in Nonalcoholic Fatty Liver Cirrhosis: A Comparison with Alcoholic Cirrhosis, Risk Patterns, and Impact on Prognosis

Abstract

Background. Physical frailty increases susceptibility to stressors and predicts adverse outcomes of cirrhosis. Data on disease course in different etiologies are scarce, so we aimed to compare the prevalence and risk factors of frailty and its impact on prognosis in nonalcoholic fatty liver (NAFLD) and alcoholic (ALD) cirrhosis. Patients and Methods. Cirrhosis registry RH7 operates since 2014 and includes hospitalized patients with decompensated cirrhosis, pre-LT evaluation, or curable hepatocellular carcinoma (HCC). From the RH7, we identified 280 ALD and 105 NAFLD patients with at least 6 months of follow-up. Results. Patients with NAFLD compared with ALD were older and had a higher proportion of females, higher body mass index (BMI) and mid-arm circumference (MAC), lower MELD score, CRP, and lower proportion of refractory ascites. The liver frailty index did not differ, and the prevalence of HCC was higher (17.1 vs. 6.8%, p = 0.002 ). Age, sex, serum albumin, and C-reactive protein (CRP) were independent predictors of frailty. In NAFLD, frailty was also associated with BMI and MAC and in ALD, with the MELD score. The Cox model adjusted for age, sex, MELD, CRP, HCC, and LFI showed that NAFLD patients had higher all-cause mortality (HR = 1.88 95% CI 1.32–2.67, p < 0.001 ) and were more sensitive to the increase in LFI (HR = 1.51, 95% CI 1.05–2.2). Conclusion. Patients with NAFLD cirrhosis had a comparable prevalence of frailty compared to ALD. Although prognostic indices showed less advanced disease, NAFLD patients were more sensitive to frailty, which reflected their higher overall disease burden and led to higher all-cause mortality.

Frailty in metabolic syndrome, focusing on nonalcoholic fatty liver disease

“…Notably, Skladany et al , based on a registry of hospitalized patients with decompensated cirrhosis or curable HCC since 2014, evaluated 280 ALD and 105 NAFLD patients with at least 6 months of follow up. Although the prevalence of frailty as assessed by the LFI was similar among the 2 groups, NAFLD patients had a higher risk for death or LT and displayed higher all-cause mortality (HR 1.88, 95%CI 1.32-2.67) compared to their ALD counterparts [ 42 ].…”

“…Concerning NAFLD, we can assume that, since frailty is thought to represent the overall end-manifestation of deficits and comorbidities a patient may acquire, NAFLD patients who display a high prevalence of comorbidities such as T2DM, CVD, arterial hypertension or CKD should have a higher rate of frailty. Moreover, the higher prevalence of frailty among cirrhotic NAFLD compared to non-NAFLD cirrhotic patients could be attributed to the typically greater age of the former, as the physiologic reserve declines with age [ 36 , 42 ]. Insulin resistance and high BMI may be additional potentially burdening factors associated with the increased prevalence of frailty among NAFLD patients.…”

Establishing a HOPE Program in a Real-life Setting: A Brazilian Case Series

“…34 This condition is frequently associated with renal dysfunction, regular paracentesis, frequent albumin infusions, sarcopenia, and frailty. [34][35][36] Despite the severity of the disease when there is a disproportionally high prevalence of complications from cirrhosis related to portal hypertension without liver dysfunction, the MELD and their priority for transplantation remains low. 37 The option for a perfused ECD DBD organ may be of interest.…”

Difference in alcohol consumption in central and eastern Slovakia during a coronavirus pandemic (COVID-19)

“…Several governments introduced various restrictions on social life and contacts, resulting in quarantine, to slow the spread of the COVID-19 pandemic (7,8). These restrictions included the closure of schools, kindergartens, and other facilities such as restaurants, cafes, and hairdressers, travel bans and border closures, the abolition of sporting and cultural events, even guidelines for social contacts (9,10). Several restrictions caused millions of people to be isolated for long periods of time, increasing feelings of anxiety and depression in the general population (11)(12)(13).…”