Patient Frailty Is Independently Associated With the Risk of Hospitalization for Acute-on-Chronic Liver Failure.
Patient Frailty Is Independently Associated With the Risk of Hospitalization for Acute-on-Chronic Liver Failure.
复制标题
DOI：
10.1002/lt.25896
复制
发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Mahmud N
中科院分区：
文献类型：
--
作者：
Shah S;Goldberg DS;Kaplan DE;Sundaram V;Taddei TH;Mahmud N
There is significant interest in identifying risk factors associated with acute on chronic liver failure (ACLF). In transplant candidates, frailty predicts waitlist mortality and post-transplant outcomes. However, the impact of frailty on ACLF development and mortality is unknown. This was a retrospective study of U.S. Veterans with cirrhosis identified between 2008 to 2016. First hospitalizations were characterized as ACLF or non-ACLF admissions. Pre-hospitalization patient frailty was ascertained using a validated score based on administrative coding data. We used logistic regression to investigate the impact of 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 long-term survival from hospitalization. We identified 16,561 cirrhosis hospitalizations over median follow-up 4.19 years (interquartile range 2.47–6.34). In adjusted models, increasing frailty score was associated with significantly increased odds of ACLF hospitalization versus non-ACLF hospitalization (odds ratio [OR] 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 adjusted Cox analysis of all hospitalizations, increasing frailty scores were associated with poorer long-term survival from the time of hospitalization (HR 1.02 per 5 points, 95% CI 1.01–1.04, p=0.004). Frailty increases the likelihood of ACLF hospitalization among patients with cirrhosis, but 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.
登录
查看更多内容
2001-2013 年美国退伍军人肝硬化和肝细胞癌负担趋势（按肝脏疾病分类
影响因子：
29.4
作者：
Beste, Lauren A.;Leipertz, Steven L.;Ioannou, George N.
通讯作者：
Ioannou, George N.
影响因子：
5.4
作者：
McAlister, Finlay;van Walraven, Carl
通讯作者：
van Walraven, Carl
影响因子：
2.6
作者：
McAlister, Finlay A.;Lin, Mu;Bakal, Jeffrey A.
通讯作者：
Bakal, Jeffrey A.
DOI：
10.1002/hep.28316
发表时间：
2016-02
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Lai JC;Dodge JL;Sen S;Covinsky K;Feng S
通讯作者：
Feng S
DOI：
10.1038/s41569-018-0064-2
发表时间：
2018-09
期刊：
Nature reviews. Cardiology
影响因子：
--
作者：
Ferrucci L;Fabbri E
通讯作者：
Fabbri E