Prognostic value of the liver fragility index to predict hospitalization and mortality in outpatients with cirrhosis.

OBJECTIVE

To evaluate the association between LFI and the risk of hospitalization and mortality in outpatients with liver cirrhosis.

PATIENTS AND

METHODS

Prospective observational study of ambulatory patients with cirrhosis. After removal of duplicate records, 118 unique patients were analyzed. LFI was measured at baseline and categorized as robust, pre-frail, or frail. Time to first hospitalization and mortality were assessed using Cox proportional hazards models. Multivariable models were fitted, and the prognostic performance of Child-Pugh versus Child-Pugh + LFI was compared using Harrell's C-index and likelihood-ratio testing.

RESULTS

Mean age was 65.5 ± 11.0 years and 61.0% were women. Overall, 56.8% were pre-frail and 20.3% were frail. During follow-up, 29 patients (24.6%) were hospitalized and 13 (11.0%) died. Continuous LFI was associated with hospitalization (HR 1.72; 95% CI 1.10-2.68; p=0.016) and mortality (HR 2.67; 95% CI 1.30-5.51; p=0.008) in univariable Cox models, but it did not remain statistically significant in the broader multivariable models. Adding LFI to Child-Pugh class increased the C-index from 0.665 to 0.719 for hospitalization (likelihood-ratio p=0.046) and from 0.765 to 0.859 for mortality (p=0.025).

CONCLUSION

LFI was associated with hospitalization and mortality in ambulatory patients with cirrhosis. Although independent prognostic value was not demonstrated in the broader multivariable models, adding LFI to Child-Pugh class improved model fit and numerically increased discrimination. These findings support further evaluation of LFI as a complementary risk-stratification tool in larger cohorts.