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Clinical frailty scale better detects death in outpatients with cirrhosis

The clinical frailty scale — a 1-minute bedside screening test — appeared to better detect unplanned hospitalization or death in outpatients with cirrhosis, according to recent findings published in the American Journal of Gastroenterology.

“There are three key findings from our study,” Puneeta Tandon, MD, at the Zeidler Ledcor Center of the University of Alberta, and colleagues wrote. “First, unplanned hospitalizations are common in outpatients with cirrhosis. Second, frailty … is a robust predictor of unplanned hospitalization or death. Third, … the [clinical frailty scale] performed as well, if not better than the [Fried frailty criteria] and [short physical performance battery].”

According to Tandon and colleagues, there are not enough screening tools to determine which outpatients with cirrhosis are at highest risk for unplanned hospitalization. Since the clinical frailty scale previously appeared to be a good prognostic indicator, the researchers evaluated the test in 300 outpatients with cirrhosis. Mean age of the patients was 57 years, 35% were women, 81% were white and 66% had hepatitis C or an alcohol-related liver disease.

Researchers defined frailty as a clinical frailty score (CFS) greater than 4. The primary outcome was unplanned hospitalization or death within 6 months.

Eighteen percent of patients were frail and 30% had an unplanned hospitalization or death within 6 months.

A CFS greater than 4 was associated with an increased risk for unplanned hospitalization or death (adjusted OR [aOR] = 3.6; 95% CI, 1.7-7.5), with a dose-dependent response (aOR = 1.9 per 1-unit increase in CFS; 95% CI, 1.4-2.6). Further, a CFS greater than 4 had a greater discrimination than Fried frailty criteria or short physical performance battery (c-statistic = 0.84).

The researchers concluded this score could be easily adopted in live clinics.

“In outpatients with cirrhosis, frailty defined using the CFS is a robust, easy-to-use and independent predictor of unplanned hospitalizations or death within 6 months,” they wrote. “Validation of this finding in an independent cohort is needed before incorporating into clinical practice, but it is clear that measuring frailty is important.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.