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Frailty and cirrhosis

Soo Jin Na, Taek Kyu Park, Joo Myung Lee, Young Bin Song, Jin-Oh Choi, Joo-Yong Hahn, Jin-Ho Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh, Joong Hyun Ahn, Keumhee C Carriere, Jeong Hoon Yang
BACKGROUND: Data on the association between obesity and mortality in patients who require acute cardiac care are limited, so we investigated the effect of obesity on clinical outcomes in patients admitted to the cardiac intensive care unit (CICU). Methods and Results: We reviewed 2,429 eligible patients admitted to the CICU at Samsung Medical Center between January 2012 and December 2015. After excluding 197 patients with low body mass index (BMI) to adjust for the possibility of frailty, patients were divided into 3 categories: normal BMI (n=822), 18...
February 16, 2019: Circulation Journal: Official Journal of the Japanese Circulation Society
Jessica L Castilho, Maria M Escuder, Valdiléa Veloso, Jackeline O Gomes, Karu Jayathilake, Sayonara Ribeiro, Rosa A Souza, Maria L Ikeda, Paulo R de Alencastro, Unai Tupinanbas, Carlos Brites, Catherine C McGowan, Alexandre Grangeiro, Beatriz Grinsztejn
INTRODUCTION: People living with HIV (PLHIV) on antiretroviral therapy (ART) experience high rates of non-communicable diseases (NCDs). These co-morbidities often accumulate and older adults may suffer from multimorbidity. Multimorbidity has been associated with loss of quality of life, polypharmacy, and increased risk of frailty and mortality. Little is known of the trends or predictors NCD multimorbidity in PLHIV in low- and middle-income countries. METHODS: We examined NCD multimorbidity in adult PLHIV initiating ART between 2003 and 2014 using a multi-site, observational cohort in Brazil...
January 2019: Journal of the International AIDS Society
Jennifer C Lai, Robert Rahimi, Elizabeth C Verna, Matthew R Kappus, Michael A Dunn, Mara McAdams-DeMarco, Christine E Haugen, Michael L Volk, Andres Duarte-Rojo, Daniel R Ganger, Jacqueline G O'leary, Jennifer L Dodge, Daniela Ladner, Dorry Segev
BACKGROUND & AIMS: Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated liver frailty index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between LFI scores, ascites, and hepatic encephalopathy (HE) and mortality. METHODS: Adults without hepatocellular carcinoma who were on the liver transplant waitlist at 9 centers in the United States (n=1044) were evaluated using the LFI LFI scores of 4...
January 17, 2019: Gastroenterology
Elizabeth Buganza-Torio, Nicholas Mitchell, Juan G Abraldes, Lesley Thomas, Mang Ma, Robert J Bailey, Puneeta Tandon
BACKGROUND: Depression is associated with substantial morbidity and mortality in cirrhosis, but is underdiagnosed and undertreated. AIMS: Using the Mini International Neuropsychiatric Interview (MINI) as a gold-standard, to determine prevalence, predictors, and outcomes of depression, and to develop a screening nomogram for use in cirrhosis patients. METHODS: Cirrhotic outpatients 18-80 years of age, not on anti-depressants, were consecutively recruited from liver clinics at three tertiary care hospitals...
November 28, 2018: Alimentary Pharmacology & Therapeutics
Maryam Ebadi, Aldo J Montano-Loza
Sarcopenia and frailty are among the most common features of cirrhosis that contribute significantly to morbidity and mortality; however, sarcopenia is not identical to frailty. Sarcopenia is a critical reduction in skeletal muscle mass associated with poor outcomes. The main components of frailty are sarcopenia and physical impairment, which result in a cumulative decline in physiologic reserve (1, 2). This article is protected by copyright. All rights reserved.
November 25, 2018: Liver Transplantation
Elliot B Tapper, Jad Baki, Neehar D Parikh, Anna S Lok
Cirrhosis is associated with disabling symptoms and diminished health-related quality of life (HRQOL). However, for patients with compensated disease, data are limited regarding associations with poor patient-reported outcomes (PROs). We prospectively enrolled 300 patients with cirrhosis and portal hypertension without a history of hepatic encephalopathy and reviewed medical and pharmacy records. We characterized determinants of PROs using the SF-8 scale (0-100) and sleep quality using the Pittsburgh Sleep Quality Index (poor sleep >5)...
November 1, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Michael Ney, Navdeep Tangri, Bonnie Dobbs, Jasmohan Bajaj, Darryl Rolfson, Mang Ma, Thomas Ferguson, Param Bhardwaj, Robert J Bailey, Juan Abraldes, Puneeta Tandon
INTRODUCTION: Hepatic encephalopathy (HE) is the most common potentially modifiable reason for admission in patients with cirrhosis. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for HE. We aimed to assess the utility of a composite score (MoCA-CFS) developed using the Montreal Cognitive Assessment (MoCA) and the Clinical Frailty Scale (CFS) for predicting HE admissions within 6 months. METHODS: Consecutive adult patients with cirrhosis were followed for 6 months or until death/transplant...
October 2018: American Journal of Gastroenterology
Selena Z Kuo, Blanca Lizaola, Hilary Hayssen, Jennifer C Lai
AIM: To investigate beta-blocker (BB) use in patients with cirrhosis and determine their effects on physical frailty and overall survival. METHODS: Adult outpatients with cirrhosis listed for liver transplantation underwent testing of physical frailty using the performance-based Liver Frailty Index, comprised of chair stands, grip strength, and balance testing, as well as self-reported assessments of exhaustion and physical activity. BB use was assessed from medical chart review...
September 7, 2018: World Journal of Gastroenterology: WJG
Elliot B Tapper, Monica Konerman, Susan Murphy, Christopher J Sonnenday
Frailty is increasingly recognized as a predictor of poor outcomes in solid organ transplantation. The most widely utilized frailty tool, the Fried Frailty Index (FFI), includes patient-reported exhaustion, weight loss, and physical activity as well as measured walk speed and handgrip. Although hepatic encephalopathy (HE) is common among liver transplant candidates, data are lacking regarding its impact on the interpretation of frailty. We prospectively enrolled 685 patients with cirrhosis during their transplant evaluation, following them until death or transplantation...
October 2018: American Journal of Transplantation
Patrick McCabe, Robert J Wong
The impact of functional status on liver transplant (LT) waitlist outcomes is not well studied. Early evidence suggests frailty portends increased mortality. We aim to evaluate the association of functional status with LT waitlist survival and the probability of receiving LT among adults with cirrhosis. Using 2005-2016 United Network for Organ Sharing (UNOS) data, we retrospectively assessed the association of functional status, as determined by Karnofsky Performance Status Score (KPSS) with LT waitlist survival and the probability of receiving LT using Kaplan-Meier and multivariate Cox proportional hazard models...
September 2018: Clinical Transplantation
Puneeta Tandon, Kathleen Patricia Ismond, Kenneth Riess, Andres Duarte-Rojo, Bandar Al-Judaibi, Michael Andrew Dunn, Jennifer Holman, Nancy Howes, Mark Joseph Franklin Haykowsky, Deborah Ann Josbeno, Margaret McNeely
Physical inactivity, sarcopenia, and frailty are highly prevalent, independent predictors of morbidity and mortality in patients with cirrhosis. Across a range of chronic diseases, exercise training is a key recommendation supported by guidelines and, for some conditions, even by governmental funding of exercise programmes. Consistent with the broader chronic disease literature, the evidence for a benefit of exercise in cirrhosis is promising. Several small trials have reported significant improvements in muscle health (mass, strength, functional capacity), quality of life, fatigue, and reductions in the hepatic venous pressure gradient, without adverse events...
June 30, 2018: Journal of Hepatology
Robyn Laube, Hogan Wang, Laura Park, Joanne K Heyman, Helen Vidot, Avik Majumdar, Simone I Strasser, Geoffrey W McCaughan, Ken Liu
Prognostication of patients with cirrhosis is complex, depending on more than just the severity of liver disease. Scores such as the model for end-stage liver disease (MELD) and Child Pugh can assist with prognostication, yet by focusing on physiological parameters they fail to completely capture the elements contributing to a patient's clinical status. Evidence is increasing to support an important role for physical functioning in patient outcomes. Frailty has been increasingly recognised in medical literature over recent years, including in hepatology where it is identified in nearly half of cirrhosis patients...
June 23, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Jasmohan S Bajaj, Richard Moreau, Patrick S Kamath, Hugo E Vargas, Vicente Arroyo, K Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C Lai, Florence Wong
Acute on chronic liver failure (ACLF) is the culmination of chronic liver disease and extrahepatic organ failures, which is associated with a high short-term mortality and immense health care expenditure. There are varying definitions for organ failures and ACLF in Europe, North America, and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multifactorial and related to interactions between the immunoinflammatory system, microbiota, and the various precipitating factors...
October 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Beverley Kok, Puneeta Tandon
PURPOSE OF REVIEW: This review gives an overview of the evolving concept of physical frailty in patients with cirrhosis. As well as summarizing the available metrics that have been used to diagnose it, this review also examines the major recent trials that have investigated frailty in patients with cirrhosis. The complex relationship between sarcopenia and frailty is explored, and strategies to optimize frailty, such as including pharmacological and non-pharmacological therapies, are discussed...
June 2018: Current Treatment Options in Gastroenterology
Hirsh D Trivedi, Elliot B Tapper
Cirrhosis is associated with debilitating complications that significantly impact on a patient's physical function and reduce quality of life. Owing to highly prevalent sarcopenia, malnutrition and hepatic encephalopathy, functional impairment or frailty is a common complication of cirrhosis. Frailty in turn increases the patient's risk of hospitalization, accidental falls and fractures, and death. The management of frailty and its associated adverse effects is imperative in improving the overall prognosis of patients with advanced liver disease...
February 2018: Gastroenterology Report
Jennifer C Lai, Kenneth E Covinsky, Charles E McCulloch, Sandy Feng
OBJECTIVES: Frailty, a critical determinant of health outcomes, is most commonly assessed in patients with cirrhosis by general clinician assessment that is limited by its subjectivity. We aimed to compare the objective Liver Frailty Index (LFI), consisting of three performance-based tests (grip, chair stands, balance), with a subjective hepatologist assessment. METHODS: Outpatients with cirrhosis awaiting liver transplantation (LT) underwent: (1) objective measurement using the LFI and (2) subjective clinician assessment...
February 2018: American Journal of Gastroenterology
Andrés Duarte-Rojo, Astrid Ruiz-Margáin, Aldo J Montaño-Loza, Ricardo U Macías-Rodríguez, Arny Ferrando, W Ray Kim
Sarcopenia and physical deconditioning are frequent complications in patients with cirrhosis and end-stage liver disease (ESLD). They are the end result of impaired dietary intake, chronic inflammation, altered macronutrient and micronutrient metabolism, and low physical activity. Frailty is the end result of prolonged sarcopenia and physical deconditioning. It severely affects a patient's functional status and presents in approximately 1 in 5 patients on the liver transplantation waiting list. Sarcopenia, poor physical fitness/cardiopulmonary endurance (CPE), and frailty are all associated with increased mortality in ESLD...
January 2018: Liver Transplantation
Vinay Sundaram, Jane Lim, Danielle M Tholey, Sentia Iriana, Irene Kim, Vignan Manne, Nicholas N Nissen, Andrew S Klein, Tram T Tran, Walid S Ayoub, Barry Schlansky
The Braden Scale is a standardized tool to assess pressure ulcer risk that is reported for all hospitalized patients in the United States per requirements of the Center for Medicare and Medicaid Services. Previous data have shown the Braden Scale can predict both frailty and mortality risk in patients with decompensated cirrhosis. Our aim was to evaluate the association of the Braden Scale score with short-term outcomes after liver transplantation (LT). We performed a retrospective cohort study of deceased donor LT recipients at 2 centers and categorized them according to the Braden Scale at hospital admission as low (>18), moderate (16-18), or high risk (<16) for pressure ulcer...
September 2017: Liver Transplantation
Jennifer C Lai, Kenneth E Covinsky, Jennifer L Dodge, W John Boscardin, Dorry L Segev, John P Roberts, Sandy Feng
Cirrhosis is characterized by muscle wasting, malnutrition, and functional decline that confer excess mortality not well quantified by the Model for End-Stage Liver Disease (MELD) Sodium (MELDNa) score. We aimed to develop a frailty index to capture these extrahepatic complications of cirrhosis and enhance mortality prediction in patients with cirrhosis. Consecutive outpatients listed for liver transplantation at a single transplant center without MELD exceptions were assessed with candidate frailty measures...
August 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Rahima A Bhanji, Elizabeth J Carey, Liu Yang, Kymberly D Watt
Frailty and sarcopenia are common complications of cirrhosis. Frailty has been described as an increased susceptibility to stressors secondary to a cumulative decline in physiologic reserve; this decline occurs with aging or is a result of the disease process, across multiple organ systems. Sarcopenia, a key component of frailty, is defined as progressive and generalized loss of skeletal muscle mass and strength. The presence of either of these complications is associated with increased morbidity and mortality, as these are tightly linked to decompensation and increased complication rates...
October 2017: Clinical Gastroenterology and Hepatology
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