Frailty in Children with Liver Disease: A Prospective Multicenter Study.

Autor: Lurz E; Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada., Quammie C; Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada., Englesbe M; Department of Transplantation Surgery, University of Michigan, Ann Arbor, MI, USA., Alonso EM; Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA., Lin HC; Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Hsu EK; Division of Gastroenterology, Hepatology and Nutrition, University of Washington-Seattle Children's Hospital, Seattle, WA, USA., Furuya KN; Division of Gastroenterology, Hepatology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, NC, USA; Division of Gastroenterology, Hepatology and Nutrition, Mayo clinic, Rochester, MN, USA., Gupta NA; Division of Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta Emory University School of Medicine, Atlanta, GA, USA., Venkat VL; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA., Daniel JF; Division of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA., Leonis MA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA., Miloh T; Division of Gastroenterology, Hepatology and Nutrition, Phoenix Children's Hospital, Phoenix, AZ, USA; Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, TX, USA., Telega GW; Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, WI, USA., Yap J; Division of Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital/Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada., Menendez J; Division of Pediatric Gastroenterology, Levine Children's Hospital Carolinas Health Care Center, Charlotte, NC, USA., Book LS; Division of Pediatric Gastroenterology, Primary Children's Hospital, Salt Lake, UT, USA., Himes RW; Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, TX, USA., Sundaram SS; Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA., Parekh R; Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada., Sonnenday C; Department of Transplantation Surgery, University of Michigan, Ann Arbor, MI, USA., Bucuvalas J; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA., Ng VL; Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada., Kamath BM; Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada. Electronic address: binita.kamath@sickkids.ca.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2018 Mar; Vol. 194, pp. 109-115.e4.
DOI: 10.1016/j.jpeds.2017.10.066
Abstrakt: Objective: To assess frailty, a measure of physiologic declines in multiple organ systems, in children with chronic liver disease using a novel pediatric frailty tool.
Study Design: We performed a prospective cross-sectional multicenter study at 17 liver transplantation (LT) centers. 71 children (5-17 years of age), 36 with compensated chronic liver disease (CCLD) and 35 with end-stage liver disease (ESLD) and listed for LT, were assessed for frailty using validated pediatric tools to assess the 5 classic Fried Frailty Criteria-slowness, weakness, exhaustion, diminished physical activity, and shrinkage. Test scores were translated to age- and sex-dependent z scores, generating a maximum frailty score of 10.
Results: The median frailty score of the cohort was 4 (IQR 3, 5). Subjects with ESLD had significantly higher frailty scores (median 5; IQR 4, 7) than subjects with CCLD (median 3; IQR 2, 4); (P <  .0001). Area under the curve receiver operating characteristic for frailty scores to discriminate between ESLD and CCLD was 0.83 (95% CI 0.73, 0.93). Forty-six percent of children with ESLD were frail and there was no correlation between pediatric frailty scores and physician's global assessments (r = -0.24, 95% CI -0.53, 0.10).
Conclusions: A novel frailty tool assessed additional dimensions of health, not captured by standard laboratory measures and identified the sickest individuals among a cohort of children with chronic liver disease. This tool may have applicability to other children with chronic disease.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: