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Deciphering the Cirrhotic Patient’s Present Status: The Overlap Between Physical Frailty, Disability, and Sarcopenia

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Book cover Frailty and Sarcopenia in Cirrhosis

Abstract

It is increasingly recognized that factors beyond traditional measures of liver severity like the Model for End-Stage Liver Disease such as disability, frailty, and sarcopenia are important predictors of meaningful outcomes for patients with cirrhosis. Although each concept is measured in different ways with clinical utility that is context dependent, they share a common biology. Understanding the overlap between these measures informs practice in important ways. Underlying each factor is malnutrition, deconditioning, and hepatic encephalopathy. Interventions to forestall or rehabilitate markers such as disability, frailty, and sarcopenia will require a deliberate, multimodal approach geared toward their specific drivers.

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References

  1. Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer. 1948;1(4):634–56.

    Article  Google Scholar 

  2. Tapper EB, Konerman M, Murphy S, Sonnenday CJ. Hepatic encephalopathy impacts the predictive value of the Fried Frailty Index. Am J Transplant. 2018;18:2566.

    Article  Google Scholar 

  3. Bajaj JS, Thacker LR, Heuman DM, Sterling RK, Stravitz RT, Sanyal AJ, et al. Cognitive performance as a predictor of hepatic encephalopathy in pretransplant patients with cirrhosis receiving psychoactive medications: a prospective study. Liver Transpl. 2012;18(10):1179–87.

    Article  Google Scholar 

  4. Kumar A, Davuluri G, Engelen MP, Ten Have GA, Prayson R, Deutz NE, et al. Ammonia lowering reverses sarcopenia of cirrhosis by restoring skeletal muscle proteostasis. Hepatology. 2017;65(6):2045–58.

    Article  CAS  Google Scholar 

  5. van Vugt J, Levolger S, de Bruin R, van Rosmalen J, Metselaar H, IJzermans J. Systematic review and meta-analysis of the impact of computed tomography–assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation. Am J Transplant. 2016;16(8):2277–92.

    Article  Google Scholar 

  6. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23.

    Article  Google Scholar 

  7. Montano-Loza AJ, Meza-Junco J, Prado CM, Lieffers JR, Baracos VE, Bain VG, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(2):166–73, 73 e1.

    Article  Google Scholar 

  8. Pereira RA, Cordeiro AC, Avesani CM, Carrero JJ, Lindholm B, Amparo FC, et al. Sarcopenia in chronic kidney disease on conservative therapy: prevalence and association with mortality. Nephrology Dialysis Transplantation. 2015;30(10):1718–25.

    Article  CAS  Google Scholar 

  9. Lai JC, Covinsky KE, Dodge JL, Boscardin WJ, Segev DL, Roberts JP, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology. 2017;66(2):564–74.

    Article  Google Scholar 

  10. Lai JC, Covinsky KE, Hayssen H, Lizaola B, Dodge JL, Roberts JP, et al. Clinician assessments of health status predict mortality in patients with end-stage liver disease awaiting liver transplantation. Liver Int. 2015;35(9):2167–73.

    Article  Google Scholar 

  11. Lai JC, Covinsky KE, McCulloch CE, Feng S. The Liver Frailty Index improves mortality prediction of the subjective clinician assessment in patients with cirrhosis. Am J Gastroenterol. 2018;113(2):235.

    Article  Google Scholar 

  12. Lai JC, Dodge JL, Sen S, Covinsky K, Feng S. Functional decline in patients with cirrhosis awaiting liver transplantation: results from the functional assessment in liver transplantation (FrAILT) study. Hepatology. 2016;63(2):574–80.

    Article  CAS  Google Scholar 

  13. Lai JC, Feng S, Terrault N, Lizaola B, Hayssen H, Covinsky K. Frailty predicts waitlist mortality in liver transplant candidates. Am J Transplant. 2014;14(8):1870–9.

    Article  CAS  Google Scholar 

  14. Samoylova ML, Covinsky KE, Haftek M, Kuo S, Roberts JP, Lai JC. Disability in patients with end-stage liver disease: results from the functional assessment in liver transplantation study. Liver Transpl. 2017;23(3):292–8.

    Article  Google Scholar 

  15. Tapper EB, Finkelstein D, Mittleman MA, Piatkowski G, Lai M. Standard assessments of frailty are validated predictors of mortality in hospitalized patients with cirrhosis. Hepatology. 2015;62(2):584–90.

    Article  Google Scholar 

  16. Orman ES, Ghabril M, Chalasani N. Poor performance status is associated with increased mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2016;14(8):1189–95. e1.

    Article  Google Scholar 

  17. Tandon P, Reddy KR, O'leary JG, Garcia-Tsao G, Abraldes JG, Wong F, et al. A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis. Hepatology. 2017;65(1):217–24.

    Article  Google Scholar 

  18. Thuluvath PJ, Thuluvath AJ, Savva Y. Karnofsky performance status before and after liver transplantation predicts graft and patient survival. J Hepatol. 2018;69:818.

    Article  Google Scholar 

  19. Serper M, Bittermann T, Rossi M, Goldberg DS, Thomasson AM, Olthoff KM, et al. Functional status, healthcare utilization, and the costs of liver transplantation. Am J Transplant. 2018;18(5):1187–96.

    Article  Google Scholar 

  20. Dolgin NH, Martins PN, Movahedi B, Lapane KL, Anderson FA, Bozorgzadeh A. Functional status predicts postoperative mortality after liver transplantation. Clin Transpl. 2016;30(11):1403–10.

    Article  Google Scholar 

  21. Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition (Burbank, Los Angeles County, Calif). 2001;17(6):445–50.

    Article  CAS  Google Scholar 

  22. Merli M, Riggio O, Dally L. Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi). Hepatology (Baltimore, Md). 1996;23(5):1041–6.

    Article  CAS  Google Scholar 

  23. Plauth M, Cabre E, Riggio O, Assis-Camilo M, Pirlich M, Kondrup J, et al. ESPEN Guidelines on Enteral Nutrition: Liver disease. Clinical nutrition (Edinburgh, Scotland). 2006;25(2):285–94.

    Article  CAS  Google Scholar 

  24. Plauth M, Merli M, Kondrup J, Weimann A, Ferenci P, Muller MJ. ESPEN guidelines for nutrition in liver disease and transplantation. Clinical nutrition (Edinburgh, Scotland). 1997;16(2):43–55.

    Article  CAS  Google Scholar 

  25. O'Brien A, Williams R. Nutrition in end-stage liver disease: principles and practice. Gastroenterology. 2008;134(6):1729–40.

    Article  Google Scholar 

  26. Amodio P, Bemeur C, Butterworth R, Cordoba J, Kato A, Montagnese S, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus. Hepatology (Baltimore, Md). 2013;58(1):325–36.

    Article  CAS  Google Scholar 

  27. Kawaguchi T, Izumi N, Charlton MR, Sata M. Branched-chain amino acids as pharmacological nutrients in chronic liver disease. Hepatology (Baltimore, Md). 2011;54(3):1063–70.

    Article  CAS  Google Scholar 

  28. Les I, Doval E, Garcia-Martinez R, Planas M, Cardenas G, Gomez P, et al. Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study. Am J Gastroenterol. 2011;106(6):1081–8.

    Article  CAS  Google Scholar 

  29. Owen OE, Trapp VE, Reichard GA Jr, Mozzoli MA, Moctezuma J, Paul P, et al. Nature and quantity of fuels consumed in patients with alcoholic cirrhosis. J Clin Invest. 1983;72(5):1821–32.

    Article  CAS  Google Scholar 

  30. Plank LD, Gane EJ, Peng S, Muthu C, Mathur S, Gillanders L, et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology (Baltimore, Md). 2008;48(2):557–66.

    Article  Google Scholar 

  31. Sengupta S, Wroblewski K, Aronsohn A, Reau N, Reddy KG, Jensen D, et al. Screening for zinc deficiency in patients with cirrhosis: when should we start? Dig Dis Sci. 2015;60(10):3130–5.

    Article  CAS  Google Scholar 

  32. Takuma Y, Nouso K, Makino Y, Hayashi M, Takahashi H. Clinical trial: oral zinc in hepatic encephalopathy. Aliment Pharmacol Ther. 2010;32(9):1080–90.

    Article  CAS  Google Scholar 

  33. Murphy SL, Tapper EB, Blackwood J, Richardson JK. Why do individuals with cirrhosis fall? a mechanistic model for fall assessment, treatment, and research. Dig Dis Sci. 2018:1–8.

    Google Scholar 

  34. Tapper EB, Martinez-Macias R, Duarte-Rojo A. Is exercise beneficial and safe in patients with cirrhosis and portal hypertension? Current Hepatology Reports. 2018:1–9.

    Google Scholar 

  35. Tapper EB, Jiang ZG, Patwardhan VR, editors. Refining the ammonia hypothesis: a physiology-driven approach to the treatment of hepatic encephalopathy. Mayo Clinic Proceedings, vol. 90: Elsevier; 2015. p. 646.

    Google Scholar 

  36. Nabi E, Thacker LR, Wade JB, Sterling RK, Stravitz RT, Fuchs M, et al. Diagnosis of covert hepatic encephalopathy without specialized tests. Clin Gastroenterol Hepatol. 2014;12(8):1384–9. e2.

    Article  Google Scholar 

  37. Bajaj JS, Heuman DM, Wade JB, Gibson DP, Saeian K, Wegelin JA, et al. Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy. Gastroenterology. 2011;140(2):478–87. e1.

    Article  CAS  Google Scholar 

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Disclosure

  1. 1.

    Elliot Tapper is the guarantor of this article.

  2. 2.

    Funding: Elliot Tapper receives funding from the National Institutes of Health through the Michigan Institute for Clinical and Health Research (KL2TR002241).

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA

    Elliot B. Tapper

  2. Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

    Elliot B. Tapper

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  1. Elliot B. Tapper
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Correspondence to Elliot B. Tapper .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada

    Puneeta Tandon

  2. Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada

    Aldo J. Montano-Loza

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Tapper, E.B. (2020). Deciphering the Cirrhotic Patient’s Present Status: The Overlap Between Physical Frailty, Disability, and Sarcopenia. In: Tandon, P., Montano-Loza, A. (eds) Frailty and Sarcopenia in Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-030-26226-6_3

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  • DOI: https://doi.org/10.1007/978-3-030-26226-6_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26225-9

  • Online ISBN: 978-3-030-26226-6

  • eBook Packages: MedicineMedicine (R0)

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