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'Simple' test may detect frailty in patients with advanced cirrhosis
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The rate a patient with advanced cirrhosis walks could be a key factor in determining his or her frailty, according to research published in The American Journal of Gastroenterology.
“Frailty is becoming known as the most prevalent and most lethal complication of advanced cirrhosis. It kills one in five transplant candidates,” Michael A. Dunn, MD, FACP, in the division of gastroenterology, hepatology and nutrition at the University of Pittsburgh, told Healio.com/Hepatology. “Recognizing frailty early is important, and we found that a simple test — gait speed in clinic — gives us that ability.”
Dunn and colleagues prospectively studied 373 patients — 82 with hepatocellular carcinoma— aged 21 and older undergoing pre-liver transplant evaluations or receiving ongoing pre-transplant care at a facility in Pittsburgh. Their sex, height and age were controlled co-variables.
Researchers calculated a patient’s typical gait speed three times from a dynamic start to 5 meters. They recorded these consecutive trials’ results to the nearest 0.1 m/second. According to the researchers, the average gait speed was 0.95 ± 0.25 m/second. Men showed faster mean gait speed (0.98 ± 0.24 m/second) than women (0.90 ± 0.25 m/second). A reduction of 0.1 m/second in gait speed meant a 22% increase in hospital days.
“The slower a cirrhotic patient moves, the greater their risk for excessive hospitalization for the complications of cirrhosis, just as has been reported for frail patients with advanced lung and kidney diseases,” Dunn told Healio.com/Hepatology.
Researchers also measured patients’ hand grip three times. In these tests the patient’s elbow was bent at 90 degrees. The object’s weight went up in 5 kg increments. Although the mean grip strength was 23.9 ± 10 kg, researchers recorded that men had a stronger average grip strength (28.0 ± 9.7 kg) than did women (17.5 ± 6.7 kg). These results mirrored similar systematic reviews where this particular skill did not present as strong a connection to hospitalization as gait speed in patients with advanced cirrhosis.
“[Gait speed] involves more complex coordination and a larger fraction of total body muscle mass compared with hand grip,” researchers wrote.
“If we can now easily recognize cirrhotic frailty, can we prevent or reverse it with exercise and nutrition to minimize patients’ risk for hospitalization, waitlist attrition, and mortality?” Dunn told Healio.com/Hepatology. – by Janel Miller
Disclosure: The researchers report no relevant financial disclosures.