Hepatic encephalopathy impacts the predictive value of the Fried Frailty Index
| Autor: | Monica A. Konerman, Christopher J. Sonnenday, Susan A. Murphy, Elliot B. Tapper |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Cirrhosis medicine.medical_treatment 030230 surgery Liver transplantation Severity of Illness Index Article 03 medical and health sciences 0302 clinical medicine Weight loss Internal medicine medicine Humans Immunology and Allergy Pharmacology (medical) Prospective Studies Hepatic encephalopathy Transplantation Frailty Hand Strength business.industry Hazard ratio Odds ratio Middle Aged Prognosis medicine.disease Liver Transplantation Survival Rate Hepatic Encephalopathy Cohort Female 030211 gastroenterology & hepatology medicine.symptom business Follow-Up Studies |
| Zdroj: | American Journal of Transplantation. 18:2566-2570 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.15020 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text