The Range and Reproducibility of the Liver Frailty Index

Abstract

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.

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

“…The Liver Frailty Index (LFI) is a simple and easily manageable vulnerability index that includes both lower limb strength and static balance. LFI consists of three performance‐based tests, such as grip strength, chair stand, and balance tests, and physical function is classified into robust, pre‐frail, or frail using LFI cut‐off values . LFI is useful for predicting mortality in patients with end‐stage liver disease .…”

“…LFI consists of three performance-based tests, such as grip strength, chair stand, and balance tests, 12 and physical function is classified into robust, pre-frail, or frail using LFI cut-off values. 13 LFI is useful for predicting mortality in patients with end-stage liver disease. 14 However, an association between LFI and muscle mass remains unclear in CLD patients with HCC.…”

Frailty and the Burden of Concurrent and Incident Disability in Patients With Cirrhosis: A Prospective Cohort Study

“…This is a particularly relevant barrier in the field of hepatology, in which many patients with end-stage liver disease may ultimately become candidates for liver transplantation, when objectivity of risk assessment is paramount. The LFI, a reliable, reproducible, performance-based metric that can be administered by medical assistants in approximately 90 seconds, (18) can help to identify patients with concurrent and future risk for subsequent ADL and IADL disability beyond what is routinely collected as part of today's standard clinical practice.…”

Irisin in Liver Cirrhosis

“…The Liver Frailty Index (LFI), which is composed of three performance-based tests (grip strength, chair stands, and balance), was used to objectively measure physical function, a critical determinant of health outcomes in patients with cirrhosis [ 23 ]. All participants underwent objective measurement of physical frailty using the following tests: Grip strength: measured in kilograms using a handheld dynamometer in the subject’s dominant hand.…”