Unidad de Medicina Interna, Universidad Finis Terrae, Santiago, Chile; Unidad de Geriatría, Fundación Arturo López Pérez, Santiago, Chile.
Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Ann Hepatol. 2021 Nov-Dec;25:100327. doi: 10.1016/j.aohep.2021.100327. Epub 2021 Feb 14.
Frailty is characterized by a poor restoration of homeostasis after a stressor event. Although it is not usually diagnosed, it has been associated with decreased survival in cirrhotic patients. We aimed to evaluate the impact of frailty and decreased gait speed over survival in cirrhotic patients at long-term follow-up.
We included stable cirrhotic patients Child-Pugh B-C or MELD ≥12, ≥50 years old. We performed a clinical evaluation, anthropometry, and laboratory tests. Frailty was diagnosed using Fried Frailty Index. We evaluated survival at a 4-year follow-up.
We included 126 patients; mean age 64±8.3 years, median MELD-Na 15[12-17], median follow-up was 881 [349-1277] days. The main etiology was MAFLD (31.4%). Frailty was diagnosed in 65.1% of patients. There were no significant differences in baseline characteristics per frailty condition. Mortality was higher in frail patients than non-frail patients (68.2% versus 20.6% at 48 months, respectively; p-value <0.001). The mean gait speed in frail and non-frail patients was 0.86±0.3m/s and 1.16±0.2m/s, respectively (p-value <0.001). Interestingly, 26.9% of patients presented a reduced gait speed (≤0.8m/s). Patients with decreased gait speed also had higher mortality than patients with normal gait speed (79.9% versus 40.8%, respectively; p-value <0.001). A multivariate-adjusted model showed that decreased gait speed (HR=3.27, 95%CI:1.74-6.14; p<0.001) and frailty (HR=4.24, 95%CI:1.89-9.51; p<0.001) were associated with mortality.
Frailty is independently associated with decreased survival at long-term follow-up. Reduced gait speed is strongly associated with mortality and could be a surrogate marker of frailty in clinical practice.
衰弱的特点是在应激事件后，内稳态的恢复能力较差。尽管它通常不被诊断，但它与肝硬化患者的生存率降低有关。我们旨在评估在长期随访中，肝硬化患者的衰弱和行走速度下降对生存的影响。
我们纳入了稳定的肝硬化患者，Child-Pugh B-C 或 MELD≥12，年龄≥50 岁。我们进行了临床评估、人体测量和实验室检查。使用 Fried 衰弱指数诊断衰弱。我们在 4 年随访时评估了生存率。
我们纳入了 126 名患者；平均年龄 64±8.3 岁，中位 MELD-Na 15[12-17]，中位随访时间为 881[349-1277]天。主要病因是 MAFLD（31.4%）。65.1%的患者被诊断为衰弱。根据衰弱状况，基线特征无显著差异。衰弱患者的死亡率高于非衰弱患者（48 个月时分别为 68.2%和 20.6%，p 值<0.001）。衰弱和非衰弱患者的平均行走速度分别为 0.86±0.3m/s 和 1.16±0.2m/s（p 值<0.001）。有趣的是，26.9%的患者行走速度降低（≤0.8m/s）。行走速度降低的患者死亡率也高于行走速度正常的患者（分别为 79.9%和 40.8%，p 值<0.001）。多变量调整模型显示，行走速度降低（HR=3.27，95%CI：1.74-6.14；p<0.001）和衰弱（HR=4.24，95%CI：1.89-9.51；p<0.001）与死亡率相关。
衰弱与长期随访后的生存率降低独立相关。行走速度降低与死亡率密切相关，在临床实践中可能是衰弱的替代标志物。
