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Hepatic encephalopathy impacts the predictive value of the Fried Frailty Index.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2018 Oct; Vol. 18 (10), pp. 2566-2570. Date of Electronic Publication: 2018 Aug 13. - Publication Year :
- 2018
-
Abstract
- Frailty is increasingly recognized as a predictor of poor outcomes in solid organ transplantation. The most widely utilized frailty tool, the Fried Frailty Index (FFI), includes patient-reported exhaustion, weight loss, and physical activity as well as measured walk speed and handgrip. Although hepatic encephalopathy (HE) is common among liver transplant candidates, data are lacking regarding its impact on the interpretation of frailty. We prospectively enrolled 685 patients with cirrhosis during their transplant evaluation, following them until death or transplantation. Our cohort was aged 54.5 ± 10.3 years, 60% male, with an average MELD score of 14.7 ± 6.3. A history of HE was present in 39%. Frailty was present in 41%, associated with higher MELD, low albumin, ascites, and HE. HE was associated with frail performance on three components of the FFI-grip (odds ratio 1.41 95% CI, 1.03-1.92), walk speed (1.56 95% CI, 1.14-2.15), and decreased energy (1.44 95% CI, 1.05-1.99). These three components were associated with transplant free survival in the whole cohort: energy (hazard ratio 1.67 95% CI, 1.25-2.28), grip (1.63 95% CI, 1.24-2.16), and walk speed (1.56 95% CI, 1.19-2.04). However, among patients with HE, the FFI was not associated with survival. HE plays a critical role in the frailty phenotype and the implications of frailty among patients with cirrhosis evaluated for liver transplantation.<br /> (© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Subjects :
- Adult
Female
Follow-Up Studies
Hand Strength
Hepatic Encephalopathy etiology
Humans
Liver Cirrhosis surgery
Liver Transplantation adverse effects
Male
Middle Aged
Prognosis
Prospective Studies
Survival Rate
Frailty physiopathology
Hepatic Encephalopathy mortality
Liver Cirrhosis mortality
Liver Transplantation mortality
Severity of Illness Index
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 18
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 30019835
- Full Text :
- https://doi.org/10.1111/ajt.15020