Liver frailty index predicts poor outcomes in patients hospitalized for acute decompensation of cirrhosis

Background and aims Physical frailty is common in patients with cirrhosis and has been associated with poor outcomes. Liver Frailty Index (LFI) is a standardized tool to assess frailty in cirrhotic patients on liver transplant waiting list. However, there is a paucity of data on the prognostic value of LFI in patients hospitalized for acute decompensation (AD) of cirrhosis. We evaluated LFI in patients hospitalized for AD and its association with complications during hospitalization and 90-day survival. Patients and Methods Cirrhotic patients admitted for AD between 2019 and 2022 were enrolled. LFI was measured at the time of hospital admission and complications (hepatic encephalopathy [HE], sepsis, organ failures, ACLF) during hospitalization were recorded. Patients were followed up until death, liver transplant or 90 days. Results We enrolled 161 patients (mean age=64+10 years, male=71%, MELD-Na=20+7). The majority of patients had alcohol-related cirrhosis (57%). Median LFI was 6.1. LFI showed a weak, but significant, correlation with age (r=0.185; p=0.019), MELD-Na (r=0.218; p=0.006) and C-Reactive Protein (r=0.214; p=0.013).LFI was significantly higher in patients developing HE, sepsis, organ failures and ACLF than in those who did not (Figure 1). Patients transferred to the ICU had significantly higher LFI than those who did not.LFI was significantly higher in patients who died than in those who survived during hospitalization (median=6.54 vs 5.99; p<0.001) and at 90 days (6.51 vs 5.57; p<0.001). In multivariable analysis (adjusted for age, gender, MELD-Na, HE and infections), LFI was an independent risk factor of 90-day mortality (HR=2.18; p<0.001), along with MELD-Na (HR=1.11; p<0.001). Conclusions In patients with cirrhosis hospitalized for AD, LFI identifies those at higher risk of worse outcomes and can be used for assessing frailty in these patients.