Frailty Increases Hospitalization Rates in an Ambulatory Cohort of Patients With Cirrhosis: The North American Consortium for the Study of End-Stage Liver Disease 3 Prospective Cohort.

BACKGROUND & AIMS: Frailty predicts mortality in liver transplant candidates, but its impact on hospitalizations in general hepatology outpatients-and whether related components such as functional capacity provide additional prognostic value- remains unclear.

METHODS

We analyzed data from the North American Consortium for the Study of End-Stage Liver Disease (NACSELD), a multicenter prospective ambulatory cirrhosis cohort. Frailty was assessed using the Liver Frailty Index, categorized as robust (≤3.2), prefrail (3.2-4.4), and frail (≥4.4), and the Duke Activity Status Index. The primary outcome was hospitalization at 6 months.

RESULTS

Among 1007 patients, at enrollment, 12.9% were robust, 70.6% were prefrail, and 16.5% were frail. Twenty-four percent of the cohort was hospitalized within 6 months, and hospitalization rates increased with frailty at 3 months (5%, 12%, and 21%, respectively; P = .001) and almost doubled by 6 months (11%, 21%, and 31%, respectively; P = .002). In multivariable modeling, the Liver Frailty Index (odds ratio, 1.6; P = .03) or the Duke Activity Status Index (odds ratio, 0.99; P = .04), after controlling for Model for End-stage Liver Disease 3.0, Charlson Comorbidity Index, cirrhosis etiology, diabetes, prior cirrhosis complications, admission medications, and Child-Turcotte-Pugh score remained independently associated with 6-month hospitalization risk. The Liver Frailty Index and the Duke Activity Status Index were inversely correlated (Pearson -0.37; P < .001); with every 0.1 unit increase in the Liver Frailty Index, the Duke Activity Status Index decreased by 0.95 units. Low 6-month mortality underpowered the association of the Liver Frailty Index with mortality.

CONCLUSION

Measures of frailty (by Liver Frailty Index) and functional capacity (by Duke Activity Status Index) independently predict 6-month hospitalization in ambulatory patients with cirrhosis. One-third of frail patients and almost one-quarter of prefrail patients with a median Model for End-stage Liver Disease 3.0 of 11 required hospitalization by 6 months. Routine assessment with the Liver Frailty Index may improve risk stratification and guide interventions to reduce health care utilization.