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Liver Frailty Index improves waitlist mortality prediction in cirrhosis cases

The Liver Frailty Index combined with hepatologist assessment significantly improved mortality risk prediction in patients with cirrhosis compared with subjective clinical assessment alone, according to a recently published study.

“One of the most important ‘tools’ that a clinician uses for medical decision-making is his or her overall appraisal of a patient’s health,” Jennifer C. Lai, MD, MBA, from the University of California in San Francisco, and colleagues wrote. “However, because it is rooted in the ‘eyeball test’ — which currently lacks any standardized, objective measurement — the subjective clinician assessment may result in high variability in clinical decision-making.”

Lai and colleagues accessed data on 529 patients with cirrhosis who were actively listed for liver transplantation. All patients underwent an objective measurement of frailty using grip strength, timed chair stands and balance testing.

One the same day, each patient’s hepatologist provided a subjective assessment of overall health compared with other patients with underlying liver disease.

Univariate analysis showed that each unit increase in the Liver Frailty Index correlated significantly with waitlist mortality (HR = 2.9; 95% CI, 2.2-3.7). Subjective clinician assessment demonstrated a similar significant association (HR = 1.9; 95% CI, 1.6-2.3).

Both the Liver Frailty Index and subjective assessment remained significantly associated with prediction of waitlist mortality in multivariate analysis.

While individually both the Liver Frailty Index and subjective assessment correctly ranked patients according to the risk for mortality, the addition of the Liver Frailty Index to subjective assessment significantly improved waitlist mortality prediction (P < .02). In contrast, the addition of subjective assessment did not improve individual prediction with the Liver Frailty Index.

The addition of the Liver Frailty Index correctly reclassified 17% of deaths and delisting and 17% of surviving patients for a total net reclassification index of 34%.

“Our data demonstrate that the Liver Frailty Index is as vital a sign to a patient with cirrhosis as blood pressure or heart rate and can enhance the subjective assessments that clinicians must make about their patients, providing strong justification for the implementation of the Liver Frailty Index along with the traditional vital signs at every clinic visit,” Lai and colleagues concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.