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Frailty in Patients With Cirrhosis

  • Liver (J Bajaj, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

This review gives an overview of the evolving concept of physical frailty in patients with cirrhosis. As well as summarizing the available metrics that have been used to diagnose it, this review also examines the major recent trials that have investigated frailty in patients with cirrhosis. The complex relationship between sarcopenia and frailty is explored, and strategies to optimize frailty, such as including pharmacological and non-pharmacological therapies, are discussed.

Recent findings

Though there is heterogeneity between studies on how physical frailty in cirrhosis has been assessed, it is nonetheless becoming increasingly apparent that frailty in cirrhosis contributes to poor outcomes. A growing body of evidence strongly supports that frailty, as an entity distinct from comorbidity or measurable by laboratory-based liver disease severity, contributes to pre-transplant mortality and unplanned hospital admissions. If taken into account, frailty may improve pre-transplant mortality risk prediction.

Summary

Physical frailty in cirrhosis may be objectively assessed by a number of validated metrics though at present, we lack a uniform consensus on the most appropriate tool. Early identification of frailty may allow optimization of the patient with the potential to avoiding adverse outcomes. Further studies are awaited validating and exploring optimal approaches to diagnosing and reversing frailty.

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Abbreviations

BCAA:

Branched-chain amino acids

CFS:

Clinical Frailty Scale

CP:

Childs-Pugh

CT:

Computed tomography

FFC:

Fried Frailty Criteria

MELD:

Model for end-stage liver disease

SPPB:

Short Physical Performance Battery

6MWD:

6-min walking distance

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Gastroenterology (Liver Unit), University of Alberta, 1-40 Zeidler Ledcor Building, Edmonton, Alberta, T6G 2X8, Canada

    Beverley Kok MBBS & Puneeta Tandon MD

Authors
  1. Beverley Kok MBBS
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  2. Puneeta Tandon MD
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BK: Drafted the final manuscript.

PT: Revision of the final manuscript.

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Correspondence to Puneeta Tandon MD.

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Beverley Kok declares that she has no conflict of interest.

Puneeta Tandon declares that she has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Liver

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Kok, B., Tandon, P. Frailty in Patients With Cirrhosis. Curr Treat Options Gastro 16, 215–225 (2018). https://doi.org/10.1007/s11938-018-0179-x

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