Cognitive Impairment and Physical Frailty in Patients With Cirrhosis.
Cognitive Impairment and Physical Frailty in Patients With Cirrhosis.
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DOI：
10.1002/hep4.1796
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发表时间：
2022-01
影响因子：
5.1
通讯作者：
from the Multi-Center Functional Assessment in Liver Transplantation (FrAILT) Study
中科院分区：
文献类型：
--
作者：
Berry K;Duarte-Rojo A;Grab JD;Dunn MA;Boyarsky BJ;Verna EC;Kappus MR;Volk ML;McAdams-DeMarco M;Segev DL;Ganger DR;Ladner DP;Shui A;Tincopa MA;Rahimi RS;Lai JC;from the Multi-Center Functional Assessment in Liver Transplantation (FrAILT) Study
在肝硬化患者中，身体脆弱和认知受损是常见的。肝硬化用肝脏脆弱指数评估（LFI；“脆弱”，LFI≥4.4）。秒表示对描述性统计的认知受损，“认知受损”是NCT≥45秒等待名单死亡率的估计值（即死亡/疾病的死亡）为41秒。 。 0.07-0.10）。脆弱但不损害的认知与等待名单死亡率显着相关（SHR，1.55; 95％CI，1.33-1.79）。 2.0％-16.4％）脆弱对1年等待名单死亡率的总影响：肝硬化患者的认知率较高，表现出更高的身体脆弱性，但与候补的死亡率相关，而认知却具有损害我们的数据不是。
Physical frailty and impaired cognition are common in patients with cirrhosis. Physical frailty can be assessed using performance‐based tests, but the extent to which impaired cognition may impact performance is not well characterized. We assessed the relationship between impaired cognition and physical frailty in patients with cirrhosis. We enrolled 1,623 ambulatory adult patients with cirrhosis waiting for liver transplantation at 10 sites. Frailty was assessed with the liver frailty index (LFI; “frail,” LFI ≥ 4.4). Cognition was assessed at the same visit with the number connection test (NCT); continuous “impaired cognition” was examined in primary analysis, with longer NCT (more seconds) indicating worse impaired cognition. For descriptive statistics, “impaired cognition” was NCT ≥ 45 seconds. Linear regression associated frailty and impaired cognition; competing risk regression estimated subhazard ratios (sHRs) of wait‐list mortality (i.e., death/delisting for sickness). Median NCT was 41 seconds, and 42% had impaired cognition. Median LFI (4.2 vs. 3.8) and rates of frailty (38% vs. 20%) differed between those with and without impaired cognition. In adjusted analysis, every 10‐second NCT increase associated with a 0.08‐LFI increase (95% confidence interval [CI], 0.07‐0.10). In univariable analysis, both frailty (sHR, 1.63; 95% CI, 1.43‐1.87) and impaired cognition (sHR, 1.07; 95% CI, 1.04‐1.10) associated with wait‐list mortality. After adjustment, frailty but not impaired cognition remained significantly associated with wait‐list mortality (sHR, 1.55; 95% CI, 1.33‐1.79). Impaired cognition mediated 7.4% (95% CI, 2.0%‐16.4%) of the total effect of frailty on 1‐year wait‐list mortality. Conclusion: Patients with cirrhosis with higher impaired cognition displayed higher rates of physical frailty, yet frailty independently associated with wait‐list mortality while impaired cognition did not. Our data provide evidence for using the LFI to understand mortality risk in patients with cirrhosis, even when concurrent impaired cognition varies.
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