Comprehensive Frailty Severity Index for End-Stage Liver Disease Predicts Early Outcomes After Liver Transplantation

Yehuda Raveh, Joshua Livingstone, Jared Mahan, Akin Tekin, Gennaro Selvaggi, Molly Bowdon-Romero, Ramona Nicolau-Raducu

Research output: Contribution to journalArticle

Abstract

Background: Frailty is rampant in candidates of liver transplantation (LT); however, its impact on posttransplant survival is inconclusive. Most studies have used a single measure of frailty; however, a comprehensive frailty severity index (FSI) has not been developed. The objectives of this study were to (1) evaluate frailty utilizing several metrics, (2) develop an FSI for end-stage liver disease (ESLD), and (3) determine its predictive abilities for outcomes after LT. Methods: Frailty metrics included (1) modified nutrition assessment of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition that includes height-adjusted third lumbar vertebra psoas mass index, (2) physical performance assessment combining Karnofsky Performance Status and pressure injury scale, and (3) Controlling Nutritional Status as a measure of severity of liver disease and inflammation. Results: Moderate to severe frailty was reported in 52%–97% of recipients depending on the metric. A statistically significant threshold FSI value was identified for each adverse outcome studied. FSI ≥ 14 was associated with decreased survival (88% vs 97% for FSI < 14). Conclusions: The proposed FSI for ESLD is predictive of poorer outcomes after LT.

Original languageEnglish (US)
JournalJournal of Parenteral and Enteral Nutrition
DOIs
StateAccepted/In press - Jan 1 2019

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End Stage Liver Disease
Liver Transplantation
Karnofsky Performance Status
Lumbar Vertebrae
Nutrition Assessment
Dietetics
Nutritional Status
Liver Diseases
Inflammation
Pressure
Wounds and Injuries

Keywords

  • frailty
  • liver transplantation
  • malnutrition
  • muscle wasting
  • outcomes
  • physical performance

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Comprehensive Frailty Severity Index for End-Stage Liver Disease Predicts Early Outcomes After Liver Transplantation. / Raveh, Yehuda; Livingstone, Joshua; Mahan, Jared; Tekin, Akin; Selvaggi, Gennaro; Bowdon-Romero, Molly; Nicolau-Raducu, Ramona.

In: Journal of Parenteral and Enteral Nutrition, 01.01.2019.

Research output: Contribution to journalArticle

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AU - Mahan, Jared

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AU - Selvaggi, Gennaro

AU - Bowdon-Romero, Molly

AU - Nicolau-Raducu, Ramona

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