Incorporation of frailty estimated by gait speed within MELD-Na and the predictive potential for mortality in cirrhosis

Abstract

Background: The 5 m gait speed (5MGS), a simple and reliable performance metric and surrogate indicator of frailty, consistently predicts adverse events in elders. Additionally, MELD-Na (model for end-stage liver disease-sodium) scores fail to capture nutritional and functional decline of cirrhotic patients that may confer excess mortality. We hypothesized that 5MGS might be associated with all-cause mortality, and that inclusion of frailty assessment within MELD-Na could improve the prediction of mortality in cirrhosis. Methods: 5MGS was measured at baseline in 113 hospitalized cirrhotic patients. Survival status over 2 years and cirrhosis-related complications were recorded. We evaluated the prognostic value of 5MGS (as a continuous variable and as a dichotomous variable). The definition of slow versus preserved 5MGS was 0.8 ms−1 based on previous publication. Using Cox proportional hazards regression, a novel MELDNa-5MGS score was derived. Receiver operating characteristics (ROC) curves estimated discrimination between the new score model and established prognostic indices. Results: The continuous 5MGS and slow 5MGS were independent predictors of all-cause mortality [5MGS: hazard ratio (HR) 0.133 (0.047–0.347), p < 0.001; slow 5MGS: HR 4.805 (1.536–15.026), p < 0.007]. The equation derived from Cox regression analysis was as follows: MELDNa-5MGS: MELD-Na score + 11 × slow 5MGS. The 2-year mortality in patients with high MELDNa-5MGS score was significantly higher ( p < 0.001). Discriminatory power was significantly better for MELDNa-5MGS than MELD-Na score (AUC: 0.802 versus 0.724, p = 0.014 for 1 year; 0.773 versus 0.709, p = 0.044 for 2 years). Conclusion: In cirrhotic patients, 5GMS is an independent risk factor of mortality. Modification of MELD-Na to include frailty estimated by low 5GMS is related to improved prognostication of mortality.

Definition of Sarcopenia in Chronic Liver Disease

“…GS is the most frequently used tool for the assessment of physical performance. GS was found to be associated with the development of cirrhotic complications, waitlist mortality, and post-LT complications in patients with cirrhosis [114][115][116][117]. In the consensus definition for community-dwelling elderly people, the recommended cutoff value for the diagnosis of low physical performance was 0.8 m/s regardless of sex [1,2].…”

Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!

“…Deng et al 35 The prognostic value of FFP was also verified. Incorporation of frailty assessed by FFP facilitated organ allocation for patients with cirrhosis on waitlist, as a result, those with low MELD can experience more accurate evaluation and suitable prehabilitation program.…”

“…Deng et al 35 argued that 5MGS as a surrogate indicator of physical frailty and determined its prognostic role in both continuous and dichotomous manners. Their findings implicated that respective slow 5MGS and continuous 5MGS are independently associated with 2‐year all‐cause mortality in hospitalized cirrhotics, and modification of MELD‐Na to include 5MGS‐defined frailty enhanced the prognosticating performance.…”

Relationship between sarcopenia/myosteatosis and frailty in hospitalized patients with cirrhosis: a sex-stratified analysis

“…Frailty and sarcopenia are prevalent in patients with cirrhosis, and both have been proved to negatively impact morbidity and mortality. 1–4 Although accumulating evidence indicates that sarcopenia might serve as a component of frailty, frailty itself is more multi-faceted than sarcopenia alone. 5 Tapper et al .…”

“…Frailty and sarcopenia are prevalent in patients with cirrhosis, and both have been proved to negatively impact morbidity and mortality. [1][2][3][4] Although accumulating evidence indicates that sarcopenia might serve as a component of frailty, frailty itself is more multi-faceted than sarcopenia alone. 5 Tapper et al 6 found bedside measures of frailty (handgrip strength and number of chair stands), cognitive function, and computed tomography (CT)-based indices of sarcopenia exhibit sex-dependent correlations.…”