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Patient Frailty Is Independently Associated With the Risk of Hospitalization for Acute‐on‐Chronic Liver Failure
Author(s) -
Shah Shivani,
Goldberg David S.,
Kaplan David E.,
Sundaram Vinay,
Taddei Tamar H.,
Mahmud Nadim
Publication year - 2021
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25896
Subject(s) - medicine , interquartile range , hazard ratio , confidence interval , odds ratio , proportional hazards model , logistic regression , cirrhosis , liver transplantation , retrospective cohort study , transplantation
There is significant interest in identifying risk factors associated with acute‐on‐chronic liver failure (ACLF). In transplant candidates, frailty predicts wait‐list mortality and posttransplant outcomes. However, the impact of frailty on ACLF development and mortality is unknown. This was a retrospective study of US veterans with cirrhosis identified between 2008 and 2016. First hospitalizations were characterized as ACLF or non‐ACLF admissions. Prehospitalization patient frailty was ascertained using a validated score based on administrative coding data. We used logistic regression to investigate the impact of an increasing frailty score on the odds of ACLF hospitalization and short‐term ACLF mortality. Cox regression was used to analyze the association between frailty and longterm survival from hospitalization. We identified 16,561 cirrhosis hospitalizations over a median follow‐up of 4.19 years (interquartile range, 2.47‐6.34 years). In adjusted models, increasing frailty score was associated with significantly increased odds of ACLF hospitalization versus non‐ACLF hospitalization (odds ratio, 1.03 per point; 95% CI 1.02‐1.03; P < 0.001). By contrast, frailty score was not associated with ACLF 28‐ or 90‐day mortality ( P = 0.13 and P = 0.33, respectively). In an adjusted Cox analysis of all hospitalizations, increasing frailty scores were associated with poorer longterm survival from the time of hospitalization (hazard ratio, 1.02 per 5 points; 95% confidence interval, 1.01‐1.03; P = 0.004). Frailty increases the likelihood of ACLF hospitalization among patients with cirrhosis, but it does not impact short‐term ACLF mortality. These findings have implications for clinicians caring for frail outpatients with cirrhosis, including tailored follow‐up, risk mitigation strategies, and possible expedited transplant evaluation.