Two-Step Sequential Screening for Frailty in Patients With Chronic Liver Disease: A Triage Efficiency Study of Liver Frailty Index Components.

AIM: To develop and validate a nurse-administered two-step sequential screening pathway based on single Liver Frailty Index components for identifying frailty in people with chronic liver disease.

DESIGN

A single-centre cross-sectional diagnostic accuracy study.

METHODS

Overall, 606 hospitalised patients with chronic liver disease were enrolled between August 2021 and August 2025. Timed chair-stands and grip strength served as step-one index tests against frailty defined by the Liver Frailty Index (score of 4.5 or higher); bedridden patients were counted as screen-positive. Cutoffs were derived with the Youden index and stress-tested with bootstrap resampling and split-sample validation.

RESULTS

Frailty prevalence was 18.6%. The either-positive rule (chair stands of 16.55 s or longer, or grip strength of 23.42 kg or lower) achieved 100% sensitivity and a negative predictive value of 1.000, missing zero frail patients, while sparing 62.3% of patients from the complete index assessment. Zero missed cases were reproduced in five split-sample analyses.

CONCLUSION

In this cohort, nearly two-thirds of full assessments could have been avoided without missing LFI-defined frailty cases. Prospective multicentre external validation of the frozen cutoffs is required before routine implementation.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The pathway may reduce the burden of complete frailty assessment in inpatient hepatology nursing practice, pending external validation.

IMPACT: Universal frailty screening in chronic liver disease is hindered by the burden of completing the full index. In this cohort, the first step identified all LFI-defined frailty cases while avoiding nearly two-thirds of complete assessments. These findings matter to hepatology nurses and inpatient hepatology services seeking feasible, guideline-concordant universal screening.

REPORTING METHOD: This study adhered to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guideline.

NO PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.