Tang Wen-Zhen, Zhu Sheng-Rui, Mo Shu-Tian, Xie Yuan-Xi, Tan Zheng-Ke-Ke, Teng Yan-Juan, Jia Kui
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
Department of Central Sterile Supply, The First Affiliated Hospital of Guangxi Medical University,, Nanning, Guangxi Zhuang Autonomous Region, China.
JMIR Med Inform. 2025 Feb 27;13:e60683. doi: 10.2196/60683.
BACKGROUND: Frailty is one of the most common symptoms in patients with cirrhosis. Many researchers have identified it as a prognostic factor for patients with cirrhosis. However, no quantitative meta-analysis has evaluated the prognostic value of frailty in patients with cirrhosis. OBJECTIVE: This systematic review and meta-analysis aimed to assess the prognostic significance of frailty in patients with cirrhosis. METHODS: The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. We conducted a comprehensive search of the literature using databases such as PubMed, Cochrane Library, Embase, and Web of Science, as well as China National Knowledge Infrastructure, encompassing the period from inception to 22 December 2023. Data were extracted for frailty to predict adverse outcomes in patients with cirrhosis. RevMan (version 5.3) and R (version 4.2.2) were used to assess the extracted data. RESULTS: A total of 26 studies with 9597 patients with cirrhosis were included. Compared with patients having low or no frailty, the frail group had a higher mortality rate (relative ratio, RR=2.07, 95% CI 1.82-2.34, P<.001), higher readmission rate (RR=1.50, 95% CI 1.22-1.84, P<.001), and lower quality of life (RR=5.78, 95% CI 2.25-14.82, P<.001). The summary receiver operator characteristic (SROC) curve of frailty for mortality in patients with cirrhosis showed that the false positive rate (FPR) was 0.25 (95% CI 0.17-0.34), diagnostic odds ratio (DOR) was 4.17 (95% CI 2.93-5.93), sensitivity was 0.54 (95% CI 0.39-0.69), and specificity was 0.73 (95% CI 0.64-0.81). The SROC curve of readmission showed that the FPR, DOR, sensitivity, and specificity were 0.39 (95% CI 0.17-0.66), 1.38 (95% CI 0.64-2.93), 0.46 (95% CI 0.28-0.64), and 0.60 (95% CI 0.28-0.85), respectively. CONCLUSIONS: This meta-analysis demonstrated that frailty is a reliable prognostic predictor of outcomes in patients with cirrhosis. To enhance the prognosis of patients with cirrhosis, more studies on frailty screening are required.
背景：衰弱是肝硬化患者最常见的症状之一。许多研究人员已将其确定为肝硬化患者的一个预后因素。然而，尚无定量荟萃分析评估衰弱对肝硬化患者的预后价值。 目的：本系统评价和荟萃分析旨在评估衰弱对肝硬化患者的预后意义。 方法：本系统评价按照PRISMA（系统评价和荟萃分析的首选报告项目）建议进行。我们使用PubMed、Cochrane图书馆、Embase和Web of Science等数据库以及中国知网对文献进行了全面检索，涵盖从起始到2023年12月22日的时间段。提取有关衰弱以预测肝硬化患者不良结局的数据。使用RevMan（5.3版）和R（4.2.2版）评估提取的数据。 结果：共纳入26项研究，涉及9597例肝硬化患者。与衰弱程度低或无衰弱的患者相比，衰弱组的死亡率更高（相对比，RR = 2.07，95%CI 1.82 - 2.34，P <.001），再入院率更高（RR = 1.50，95%CI 1.22 - 1.84，P <.001），生活质量更低（RR = 5.78，95%CI 2.25 - 14.82，P <.001）。肝硬化患者死亡率的衰弱总结性受试者工作特征（SROC）曲线显示，假阳性率（FPR）为0.25（95%CI 0.17 - 0.34），诊断比值比（DOR）为4.17（95%CI 2.93 - 5.93），灵敏度为0.54（95%CI 0.39 - 0.69），特异度为0.73（95%CI 0.64 - 0.81）。再入院的SROC曲线显示，FPR、DOR、灵敏度和特异度分别为0.39（95%CI 0.17 - 0.66）、1.38（95%CI 0.64 - 2.93）、0.46（95%CI 0.28 - 0.64）和0.60（95%CI 0.28 - 0.85）。 结论：本荟萃分析表明，衰弱是肝硬化患者结局的可靠预后预测指标。为改善肝硬化患者的预后，需要更多关于衰弱筛查的研究。
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