Lai Jennifer C, Dodge Jennifer L, McCulloch Charles E, Covinsky Kenneth E, Singer Jonathan P
Department of Medicine University of California, San Francisco San Francisco CA.
Department of Surgery University of California, San Francisco San Francisco CA.
Hepatol Commun. 2019 Oct 31;4(1):126-133. doi: 10.1002/hep4.1444. eCollection 2020 Jan.
Frailty results from the chronic effects of malnutrition and muscle wasting in patients with cirrhosis. It is well-established that frailty is strongly associated with mortality in this population. However, little is known of its relationship with physical disability, a critical patient-centered outcome. Adults with cirrhosis underwent outpatient testing of frailty using the Liver Frailty Index (LFI) and disability using activities of daily living (ADL; range 0-6) and Instrumental ADL (IADL; range 0-8) scales at one center between 2012 and 2016. We used adjusted multilevel logistic mixed-effects regression to test the association between frailty and current disability (impairment with ≥1 ADL or IADL) and incident disability at 6 months among those without baseline disability. Of the 983 participants, 20% were robust, 32% were less robust, 33% were prefrail, and 15% were frail; 587 (60%) had at least 1 assessment. The percentage of participants with at least 1 baseline ADL or IADL impairment was 28% and 37%, respectively. In adjusted regression models, each point LFI increase was associated with a 3.3 and 4.6 higher odds of current difficulty with at least 1 ADL and IADL ( < 0.001 for each), respectively. Among participants without baseline disability, each point LFI increase was associated with a 2.6 and 1.7 higher odds of having difficulty with at least 1 ADL and IADL at 6 months, respectively. Frailty is strongly associated with concurrent and incident disability in patients with cirrhosis. In the clinic, the LFI can be used to identify those in greatest need for additional support/resources to maintain functional independence. In research settings, the LFI may help to identify an enriched population for clinical trials of interventions aimed at those most vulnerable to disability.
衰弱是由肝硬化患者营养不良和肌肉萎缩的慢性影响所致。众所周知，衰弱与该人群的死亡率密切相关。然而，对于其与身体残疾（一个以患者为中心的关键结局）之间的关系却知之甚少。2012年至2016年期间，在一个中心，成年肝硬化患者接受了使用肝脏衰弱指数（LFI）进行的衰弱门诊测试，以及使用日常生活活动（ADL；范围0 - 6）和工具性日常生活活动（IADL；范围0 - 8）量表进行的残疾测试。我们使用调整后的多水平逻辑混合效应回归来检验衰弱与当前残疾（≥1项ADL或IADL受损）以及在无基线残疾者中6个月时的新发残疾之间的关联。在983名参与者中，20%为强壮，32%为不太强壮，33%为衰弱前期，15%为衰弱；587名（60%）有至少1次评估。至少有1项基线ADL或IADL受损的参与者百分比分别为28%和37%。在调整后的回归模型中，LFI每增加1分，分别与至少1项ADL和IADL当前困难的几率高3.3倍和4.6倍相关（每项均<0.001）。在无基线残疾的参与者中，LFI每增加1分，分别与6个月时至少1项ADL和IADL出现困难的几率高2.6倍和1.7倍相关。衰弱与肝硬化患者的并发残疾和新发残疾密切相关。在临床中，LFI可用于识别那些最需要额外支持/资源以维持功能独立性的患者。在研究环境中，LFI可能有助于识别出一个富集人群，用于针对那些最易出现残疾的人群的干预临床试验。
