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Comprehensive Frailty Severity Index for End‐Stage Liver Disease Predicts Early Outcomes After Liver Transplantation
Author(s) -
Raveh Yehuda,
Livingstone Joshua,
Mahan Jared,
Tekin Akin,
Selvaggi Gennaro,
BowdonRomero Molly,
NicolauRaducu Ramona
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1729
Subject(s) - medicine , liver disease , sarcopenia , liver transplantation , parenteral nutrition , model for end stage liver disease , enteral administration , body mass index , transplantation , physical therapy , intensive care medicine
Background Frailty is rampant in candidates of liver transplantation (LT); however, its impact on posttransplant survival is inconclusive. Most studies have used a single measure of frailty; however, a comprehensive frailty severity index (FSI) has not been developed. The objectives of this study were to (1) evaluate frailty utilizing several metrics, (2) develop an FSI for end‐stage liver disease (ESLD), and (3) determine its predictive abilities for outcomes after LT. Methods Frailty metrics included (1) modified nutrition assessment of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition that includes height‐adjusted third lumbar vertebra psoas mass index, (2) physical performance assessment combining Karnofsky Performance Status and pressure injury scale, and (3) Controlling Nutritional Status as a measure of severity of liver disease and inflammation. Results Moderate to severe frailty was reported in 52%–97% of recipients depending on the metric. A statistically significant threshold FSI value was identified for each adverse outcome studied. FSI ≥ 14 was associated with decreased survival (88% vs 97% for FSI < 14). Conclusions The proposed FSI for ESLD is predictive of poorer outcomes after LT.