Clinically relevant cut-points for changes in the Liver Frailty Index are associated with waitlist mortality in patients with cirrhosis.

Autor:	Wang M; Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA., Shui AM; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA., Ruck J; Department of Surgery, John Hopkins University School of Medicine, Baltimore, Maryland, USA., Huang CY; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA., Verna EC; Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA., King EA; Department of Surgery, John Hopkins University School of Medicine, Baltimore, Maryland, USA., Ladner DP; Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA., Ganger D; Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA., Kappus M; Division of Gastroenterology and Hepatology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA., Rahimi R; Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas, USA., Tevar AD; Department of Surgery and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Duarte-Rojo A; Northwestern University Transplant Outcomes Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA., Lai JC; Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Jazyk:	angličtina
Zdroj:	Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2024 Oct 01; Vol. 30 (10), pp. 991-1001. Date of Electronic Publication: 2024 Jun 21.
DOI:	10.1097/LVT.0000000000000418
Abstrakt:	Physical frailty is a critical determinant of mortality in patients with cirrhosis and can be objectively measured using the Liver Frailty Index (LFI), which is potentially modifiable. We aimed to identify LFI cut-points associated with waitlist mortality. Ambulatory adults with cirrhosis without HCC awaiting liver transplantation from 9 centers from 2012 to 2021 for ≥3 months with ≥2 pre-liver transplantation LFI assessments were included. The primary explanatory variable was the change in LFI from first to second assessments per 3 months (∆LFI); we evaluated clinically relevant ∆LFI cut-points at 0.1, 0.2, 0.3, and 0.5. The primary outcome was waitlist mortality (death or delisting for being too sick), with transplant considered as a competing event. Among 1029 patients, the median (IQR) age was 58 (51-63) years; 42% were female; and the median lab Model for End-Stage Liver Disease-Sodium at first assessment was 18 (15-22). For each 0.1 improvement in ∆LFI, the risk of overall mortality decreased by 6% (cause-specific hazard ratio: 0.94, 95% CI: 0.92-0.97, p < 0.001). ∆LFI was associated with waitlist mortality at cut-points as low as 0.1 (cause-specific hazard ratio: 0.63, 95% CI: 0.46-0.87) and 0.2 (HR: 0.61, 95% CI: 0.42-0.87). An improvement in LFI per 3 months as small as 0.1 in the pre-liver transplantation period is associated with a clinically meaningful reduction in waitlist mortality. These data provide estimates of the reduction in mortality risk associated with improvements in LFI that can be used to assess the effectiveness of interventions targeting physical frailty in patients with cirrhosis. (Copyright © 2024 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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