This article is more than 5 years old. Information may no longer be current.

Frailty assessments may predict survival in patients hospitalized for cirrhosis

In a new study, assessing frailty at hospital admission accurately predicted 90-day survival in patients with cirrhosis, according to published data in Hepatology.

“Liver specialists currently use blood tests to assess risk, and while these are powerful tools, they only capture a small portion of the patient's risk,” Elliot Tapper, MD, clinical fellow in gastroenterology and hepatology at Beth Israel Deaconess Medical Center and Harvard Medical School, said in a press release. “There's a sense that there are things outside of those blood tests that are meaningful. We hypothesized that frailty, or decreased functional reserve, may be one of those factors, and it turns out that our nurses have been calculating that frailty all along, and we just haven't noticed.”

Elliot Tapper

Tapper and colleagues, including Michelle Lai, MD, MPH, a liver specialist in the division of gastroenterology and hepatology at BIDMC and assistant professor of medicine at Harvard Medical School, analyzed data of 734 patients with cirrhosis admitted to BIDMC’s liver unit between 2010 and 2013. Overall, the patients had been admitted in total 1,348 times during that time. In addition to patient records, the researchers analyzed data of assessments collected by nurses not specifically related to liver disease. Researchers looked at assessments that measured frailty through activities of daily living (ADL), the Braden Scale (BS) and Morse fall risk score, according to the research.

“These data points help determine a patient's level of frailty and inform very important nursing activities, but until now no one has actually looked at whether those metrics speak to a patient's overall risk,” Tapper said.

Tapper and colleagues also used a validated predictive model to randomly divide the patients into training and validation cohorts.

After combining patient data with the data from the nurses' assessments, the researchers were able to predict the 90-day mortality rate with 83% accuracy and the rate at which patients were discharged to a rehabilitation facility at 85% accuracy, according to the research.

The predictive model for 90-day mortality that included ADL and BS showed a c-statistics of 0.83  (95% CI, 0.8-0.86) in the derivation cohort and 0.77 (95% CI, 0.71-0.83) in the validation cohort. Analyses showed that length of hospital stay was associated with BS (HR = 0.63; 95% CI, 0.44-0.91) and none of the frailty measurements were associated with 30-day readmission.  

“This is a very significant improvement in our power to provide prognosis, be it 90-day survival, discharge to a rehabilitation hospital or length of stay in the hospital, based on a simple inexpensive clinical tool that is readily available in all hospitals across the country,” Lai said in the release.

“Readily available, standardized measures of frailty predict 90-day mortality, [length of stay] and rehabilitation needs for hospitalized patients with cirrhosis,” the researchers concluded. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.