在一项多中心研究中，虚弱与等待名单死亡率相关，与腹水和肝性脑病无关。
Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study.
机构信息
Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, California.
Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Baylor Scott and White, Dallas, Texas.
出版信息
Gastroenterology. 2019 May;156(6):1675-1682. doi: 10.1053/j.gastro.2019.01.028. Epub 2019 Jan 19.
BACKGROUND & AIMS: Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated Liver Frailty Index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between LFI scores, ascites, and hepatic encephalopathy (HE) and mortality.
METHODS
Adults without hepatocellular carcinoma who were on the liver transplantation waitlist at 9 centers in the United States (N = 1044) were evaluated using the LFI; LFI scores of at least 4.5 indicated that patients were frail. We performed logistic regression analyses to assess associations between frailty and ascites or HE and competing risk regression analyses (with liver transplantation as the competing risk) to estimate sub-hazard ratios (sHRs) of waitlist mortality (death or removal from the waitlist).
RESULTS
Of study subjects, 36% had ascites, 41% had HE, and 25% were frail. The odds of frailty were higher for patients with ascites (adjusted odd ratio 1.56, 95% confidence interval [CI] 1.15-2.14) or HE (odd ratio 2.45, 95% CI 1.80-3.33) than for those without these features. Larger proportions of frail patients with ascites (29%) or HE (30%) died while on the waitlist compared with patients who were not frail (17% of patients with ascites and 20% with HE). In univariable analysis, ascites (sHR 1.52, 95% CI 1.14-2.05), HE (sHR 1.84, 95% CI 1.38-2.45), and frailty (sHR 2.38, 95% CI 1.77-3.20) were associated with waitlist mortality. In adjusted models, only frailty remained significantly associated with waitlist mortality (sHR 1.82, 95% CI 1.31-2.52); ascites and HE were not.
CONCLUSIONS
Frailty is a prevalent complication of cirrhosis that is observed more frequently in patients with ascites or HE and independently associated with waitlist mortality. LFI scores can be used to objectively quantify risk of death related to frailty-in excess of liver disease severity-in patients with cirrhosis.
背景与目的
衰弱与肝硬化患者的死亡率相关。我们使用 3 项简单的测试来测量衰弱，并为多个门诊中心的患者计算肝衰弱指数 (LFI) 评分。我们调查了 LFI 评分、腹水和肝性脑病 (HE) 与死亡率之间的关系。
方法
美国 9 个中心的肝移植等候名单上的无肝细胞癌成年人（N=1044 人）使用 LFI 进行评估；LFI 评分至少为 4.5 表明患者衰弱。我们进行逻辑回归分析以评估衰弱与腹水或 HE 之间的关系，并进行竞争风险回归分析（以肝移植为竞争风险）以估计等候名单死亡率的亚危险比 (sHR)（死亡或从等候名单中除名）。
结果
研究对象中，36%有腹水，41%有 HE，25%衰弱。有腹水（调整后的优势比 1.56，95%置信区间 [CI] 1.15-2.14）或 HE（优势比 2.45，95% CI 1.80-3.33）的患者发生衰弱的可能性高于无这些特征的患者。有腹水（等候名单上死亡率为 29%）或 HE（等候名单上死亡率为 30%）的衰弱患者比例高于没有腹水（等候名单上死亡率为 17%）或 HE（等候名单上死亡率为 20%）的患者。在单变量分析中，腹水（sHR 1.52，95% CI 1.14-2.05）、HE（sHR 1.84，95% CI 1.38-2.45）和衰弱（sHR 2.38，95% CI 1.77-3.20）与等候名单死亡率相关。在调整后的模型中，只有衰弱与等候名单死亡率显著相关（sHR 1.82，95% CI 1.31-2.52）；腹水和 HE 则不然。
结论
衰弱是肝硬化的一种常见并发症，在有腹水或 HE 的患者中更为常见，与等候名单死亡率独立相关。LFI 评分可用于客观量化与衰弱相关的死亡风险，超过了肝硬化的严重程度，在肝硬化患者中。
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