Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, California, USA.
Department of Surgery, University of California, Los Angeles, California, USA.
Clin Transplant. 2024 Sep;38(9):e15438. doi: 10.1111/ctr.15438.
Frailty, a measure of physiological aging and reserve, has been validated as a prognostic indicator of mortality in patients with cirrhosis. However, large-scale analyses of the independent association of frailty with clinical and financial outcomes following liver transplantation (LT) are lacking.
Adults (≥18 years) undergoing LT were identified in the 2016-2020 National Readmissions Database. Frailty was defined using the binary Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable linear and logistic regression models were developed to evaluate the independent association of frailty with in-hospital mortality, perioperative complications, and costs.
Of an estimated 34 442 patients undergoing LT, 8265 (24%) were frail. After adjustment, frailty was associated with greater odds of mortality (adjusted odds ratio [AOR] 1.80; 95% Confidence Interval [CI]: 1.49-1.18), postoperative length of stay (β + 11 days; 95% CI: +10, +12), and hospitalization costs (+$86 880; 95% CI: +75 660, +98 100), as well as a two-fold increase in relative risk of nonhome discharge (AOR 2.17, 95% CI: 1.90-2.49).
Frailty is associated with an increased risk of in-hospital mortality, complications, and resource utilization among LT recipients. As the proportion of frail LT patients continues to rise, our findings underscore the need for novel risk-stratification and individualized care protocols for such vulnerable patients.
衰弱是衡量生理衰老和储备能力的指标，已被验证可作为预测肝硬化患者死亡率的指标。然而，缺乏关于衰弱与肝移植（LT）后临床和经济结局的独立相关性的大规模分析。
在 2016 年至 2020 年国家再入院数据库中确定接受 LT 的成年人（≥18 岁）。使用二进制约翰霍普金斯调整临床组衰弱指标来定义衰弱。采用多变量线性和逻辑回归模型来评估衰弱与住院内死亡率、围手术期并发症和成本的独立相关性。
在估计接受 LT 的 34442 例患者中，8265 例（24%）衰弱。调整后，衰弱与更高的死亡率相关（调整后的优势比 [AOR] 1.80；95%置信区间 [CI]：1.49-1.18）、术后住院时间（β+11 天；95% CI：+10，+12）和住院费用（+$86880；95% CI：+75660，+98100），以及非家庭出院的相对风险增加两倍（AOR 2.17，95% CI：1.90-2.49）。
衰弱与 LT 受者住院内死亡率、并发症和资源利用增加相关。随着衰弱 LT 患者的比例继续上升，我们的发现强调了为这些脆弱患者制定新的风险分层和个体化护理方案的必要性。
