Liver Frailty Index for Prediction of Short-Term Rehospitalization in Patients with Liver Cirrhosis

Leonard Kaps; Lejla Lukac; Maurice Michel; Wolfgang Maximilian Kremer; Max Hilscher; Simon Johannes Gairing; Peter R Galle; Jörn M Schattenberg; Marcus-Alexander Wörns; Michael Nagel; Christian Labenz

doi:10.3390/diagnostics12051069

Liver Frailty Index for Prediction of Short-Term Rehospitalization in Patients with Liver Cirrhosis

Diagnostics (Basel). 2022 Apr 24;12(5):1069. doi: 10.3390/diagnostics12051069.

Authors

Leonard Kaps^{1

2}, Lejla Lukac^{1

2}, Maurice Michel^{1

2}, Wolfgang Maximilian Kremer^{1

2}, Max Hilscher^{1

2}, Simon Johannes Gairing^{1

2}, Peter R Galle^{1

2}, Jörn M Schattenberg¹, Marcus-Alexander Wörns^{1

2

3}, Michael Nagel^{1

2

3}, Christian Labenz^{1

2}

Affiliations

¹ Department of Internal Medicine I, University Medical Centre, Johannes Gutenberg-University, 55131 Mainz, Germany.
² Cirrhosis Centre Mainz (CCM), University Medical Centre, Johannes Gutenberg-University, 55131 Mainz, Germany.
³ Department of Gastroenterology, Hematology, Oncology and Endocrinology, Klinikum Dortmund, 44137 Dortmund, Germany.

Abstract

Background: Stratifying patients with liver cirrhosis for risk of rehospitalization is challenging with established scoring systems for chronic liver disease. Frailty captures the physical characteristics of patients with cirrhosis. Its value for predicting short-term rehospitalizations in hospitalized patients remains to be defined. Methods: Eighty-three non-electively hospitalized patients with liver cirrhosis were analyzed in this study. Frailty was assessed during the last 48 h of hospital stay with the liver frailty index (LFI). Patients were followed for 30-day rehospitalization. Results: In total, 26 (31%) patients were rehospitalized within 30 days. The median LFI was 4.5, and 43 (52%) patients were identified as frail. Rehospitalized patients had a significant higher LFI compared to patients without a rehospitalization within 30 days. In multivariable analysis, LFI as a metric variable (OR 2.36, p = 0.02) and lower platelet count (OR 0.98, p < 0.01) were independently associated with rehospitalization. LFI and its subtest chair stands had the best discriminative ability to predict rehospitalization, with AUROCs of 0.66 and 0.67, respectively. An LFI cut-off of >4.62 discriminated best between patients with and without elevated risk for rehospitalization within 30 days. Conclusions: Measures of frailty could be useful to identify patients at higher risk for short-term rehospitalization.

Keywords: complications of cirrhosis; end-stage liver disease; extrahepatic features of chronic liver disease; functional decline; point-of-care diagnostic; sarcopenia.