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Frailty and cirrhosis

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https://www.readbyqxmd.com/read/30019835/hepatic-encephalopathy-impacts-the-predictive-value-of-the-fried-frailty-index
#1
Elliot B Tapper, Monica Konerman, Susan Murphy, Christopher J Sonnenday
Frailty is increasingly recognized as a predictor of poor outcomes in solid-organ transplantation. The most widely utilized frailty tool, the Fried Frailty Index (FFI), includes patient-reported exhaustion, weight-loss, and physical activity as well as measured walk-speed and hand-grip. Although hepatic encephalopathy (HE) is common among liver transplant candidates, data are lacking regarding its impact on the interpretation of frailty. We prospectively enrolled 685 patients with cirrhosis during their transplant evaluation, following them until death or transplantation...
July 18, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29979466/more-severe-deficits-in-functional-status-associated-with-higher-mortality-among-adults-awaiting-liver-transplantation
#2
Patrick McCabe, Robert J Wong
The impact of functional status on liver transplant (LT) waitlist outcomes is not well studied. Early evidence suggests frailty portends increased mortality. We aim to evaluate the association of functional status with LT waitlist survival and probability of receiving LT among adults with cirrhosis. Using 2005-2016 United Network for Organ Sharing (UNOS) data, we retrospectively assessed association of functional status, as determined by Karnofsky Performance Status Score (KPSS) with LT waitlist survival and probability of receiving LT using Kaplan-Meier and multivariate Cox proportional hazard models...
July 6, 2018: Clinical Transplantation
https://www.readbyqxmd.com/read/29964066/exercise-in-cirrhosis-translating-evidence-and-experience-to-practice
#3
REVIEW
Puneeta Tandon, Kathleen Patricia Ismond, Kenneth Riess, Andres Duarte-Rojo, Bandar Al-Judaibi, Michael Andrew Dunn, Jennifer Holman, Nancy Howes, Mark Joseph Franklin Haykowsky, Deborah Ann Josbeno, Margaret McNeely
Physical inactivity, sarcopenia, and frailty are highly prevalent, independent predictors of morbidity and mortality in patients with cirrhosis. Across a range of chronic diseases, exercise training is a key recommendation supported by guidelines and, in some conditions, even by governmental funding of exercise programs. Consistent with the broader chronic disease literature, the evidence for a benefit of exercise in cirrhosis is promising. Several small trials have reported significant improvements in muscle health (mass, strength, functional capacity), quality of life, fatigue, and reductions in the hepatic venous portal gradient, without adverse events...
June 28, 2018: Journal of Hepatology
https://www.readbyqxmd.com/read/29935102/frailty-in-advanced-liver-disease
#4
Robyn Laube, Hogan Wang, Laura Park, Joanne K Heyman, Helen Vidot, Avik Majumdar, Simone I Strasser, Geoffrey W McCaughan, Ken Liu
Prognostication of patients with cirrhosis is complex, depending on more than just the severity of liver disease. Scores such as the model for end-stage liver disease (MELD) and Child Pugh can assist with prognostication, yet by focusing on physiologic parameters they fail to completely capture the elements contributing to a patient's clinical status. Evidence is increasing to support an important role for physical functioning in patient outcomes. Frailty has been increasingly recognised in medical literature over recent years, including in hepatology where it is identified in nearly half of cirrhosis patients...
June 23, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29689120/acute-on-chronic-liver-failure-getting-ready-for-prime-time
#5
Jasmohan S Bajaj, Richard Moreau, Patrick S Kamath, Hugo E Vargas, Vicente Arroyo, K Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C Lai, Florence Wong
Acute on chronic liver failure (ACLF) is a culmination of chronic liver disease and extra-hepatic organ failures, which is associated with a high short-term mortality and immense healthcare expenditure. There are varying definitions for organ failures and ACLF in Europe, North America and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multi-factorial and related to interactions between the immuno-inflammatory system, microbiota and the precipitating factors...
April 24, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29589278/frailty-in-patients-with-cirrhosis
#6
REVIEW
Beverley Kok, Puneeta Tandon
PURPOSE OF REVIEW: This review gives an overview of the evolving concept of physical frailty in patients with cirrhosis. As well as summarizing the available metrics that have been used to diagnose it, this review also examines the major recent trials that have investigated frailty in patients with cirrhosis. The complex relationship between sarcopenia and frailty is explored, and strategies to optimize frailty, such as including pharmacological and non-pharmacological therapies, are discussed...
June 2018: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/29479438/interventions-to-improve-physical-function-and-prevent-adverse-events-in-cirrhosis
#7
REVIEW
Hirsh D Trivedi, Elliot B Tapper
Cirrhosis is associated with debilitating complications that significantly impact on a patient's physical function and reduce quality of life. Owing to highly prevalent sarcopenia, malnutrition and hepatic encephalopathy, functional impairment or frailty is a common complication of cirrhosis. Frailty in turn increases the patient's risk of hospitalization, accidental falls and fractures, and death. The management of frailty and its associated adverse effects is imperative in improving the overall prognosis of patients with advanced liver disease...
February 2018: Gastroenterology Report
https://www.readbyqxmd.com/read/29231189/the-liver-frailty-index-improves-mortality-prediction-of-the-subjective-clinician-assessment-in-patients-with-cirrhosis
#8
Jennifer C Lai, Kenneth E Covinsky, Charles E McCulloch, Sandy Feng
OBJECTIVES: Frailty, a critical determinant of health outcomes, is most commonly assessed in patients with cirrhosis by general clinician assessment that is limited by its subjectivity. We aimed to compare the objective Liver Frailty Index (LFI), consisting of three performance-based tests (grip, chair stands, balance), with a subjective hepatologist assessment. METHODS: Outpatients with cirrhosis awaiting liver transplantation (LT) underwent: (1) objective measurement using the LFI and (2) subjective clinician assessment...
February 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29024353/exercise-and-physical-activity-for-patients-with-end-stage-liver-disease-improving-functional-status-and-sarcopenia-while-on-the-transplant-waiting-list
#9
Andrés Duarte-Rojo, Astrid Ruiz-Margáin, Aldo J Montaño-Loza, Ricardo U Macías-Rodríguez, Arny Ferrando, W Ray Kim
Sarcopenia and physical deconditioning are frequent complications in patients with cirrhosis and end-stage liver disease (ESLD). They are the end result of impaired dietary intake, chronic inflammation, altered macronutrient and micronutrient metabolism, and low physical activity. Frailty is the end result of prolonged sarcopenia and physical deconditioning. It severely affects a patient's functional status and presents in approximately 1 in 5 patients on the liver transplantation waiting list. Sarcopenia, poor physical fitness/cardiopulmonary endurance (CPE), and frailty are all associated with increased mortality in ESLD...
January 2018: Liver Transplantation
https://www.readbyqxmd.com/read/28512923/the-braden-scale-a-standard-tool-for-assessing-pressure-ulcer-risk-predicts-early-outcomes-after-liver-transplantation
#10
MULTICENTER STUDY
Vinay Sundaram, Jane Lim, Danielle M Tholey, Sentia Iriana, Irene Kim, Vignan Manne, Nicholas N Nissen, Andrew S Klein, Tram T Tran, Walid S Ayoub, Barry Schlansky
The Braden Scale is a standardized tool to assess pressure ulcer risk that is reported for all hospitalized patients in the United States per requirements of the Center for Medicare and Medicaid Services. Previous data have shown the Braden Scale can predict both frailty and mortality risk in patients with decompensated cirrhosis. Our aim was to evaluate the association of the Braden Scale score with short-term outcomes after liver transplantation (LT). We performed a retrospective cohort study of deceased donor LT recipients at 2 centers and categorized them according to the Braden Scale at hospital admission as low (>18), moderate (16-18), or high risk (<16) for pressure ulcer...
September 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28422306/development-of-a-novel-frailty-index-to-predict-mortality-in-patients-with-end-stage-liver-disease
#11
Jennifer C Lai, Kenneth E Covinsky, Jennifer L Dodge, W John Boscardin, Dorry L Segev, John P Roberts, Sandy Feng
Cirrhosis is characterized by muscle wasting, malnutrition, and functional decline that confer excess mortality not well quantified by the Model for End-Stage Liver Disease (MELD) Sodium (MELDNa) score. We aimed to develop a frailty index to capture these extrahepatic complications of cirrhosis and enhance mortality prediction in patients with cirrhosis. Consecutive outpatients listed for liver transplantation at a single transplant center without MELD exceptions were assessed with candidate frailty measures...
August 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28400317/the-long-winding-road-to-transplant-how-sarcopenia-and-debility-impact-morbidity-and-mortality-on-the-waitlist
#12
REVIEW
Rahima A Bhanji, Elizabeth J Carey, Liu Yang, Kymberly D Watt
Frailty and sarcopenia are common complications of cirrhosis. Frailty has been described as an increased susceptibility to stressors secondary to a cumulative decline in physiologic reserve; this decline occurs with aging or is a result of the disease process, across multiple organ systems. Sarcopenia, a key component of frailty, is defined as progressive and generalized loss of skeletal muscle mass and strength. The presence of either of these complications is associated with increased morbidity and mortality, as these are tightly linked to decompensation and increased complication rates...
October 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28361840/patient-perceived-barriers-to-lifestyle-interventions-in-cirrhosis
#13
Michael Ney, Leah Gramlich, Vanessa Mathiesen, Robert J Bailey, Mark Haykowsky, Mang Ma, Juan G Abraldes, Puneeta Tandon
BACKGROUND/AIMS: Sarcopenia, muscle weakness, and physical frailty are independent predictors of mortality in cirrhosis. These adverse prognostic factors are potentially modifiable with lifestyle interventions, including adequate nutritional intake and physical activity. Our aim was to identify patient-perceived barriers and enablers to these interventions. PATIENTS AND METHODS: Adult patients with cirrhosis were prospectively recruited from two tertiary care liver clinics...
March 2017: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
https://www.readbyqxmd.com/read/28223735/frailty-is-independently-associated-with-increased-hospitalisation-days-in-patients-on-the-liver-transplant-waitlist
#14
Marie Sinclair, Eduard Poltavskiy, Jennifer L Dodge, Jennifer C Lai
AIM: To investigate the impact of physical frailty on risk of hospitalisation in cirrhotic patients on the liver transplant waitlist. METHODS: Cirrhotics listed for liver transplantation at a single centre underwent frailty assessments using the Fried Frailty Index, consisting of grip strength, gait speed, exhaustion, weight loss, and physical activity. Clinical and biochemical data including MELD score as collected at the time of assessment. The primary outcome was number of hospitalised days per year; secondary outcomes included incidence of infection...
February 7, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28213044/hepatocellular-carcinoma-screening-associated-with-early-tumor-detection-and-improved-survival-among-patients-with-cirrhosis-in-the-us
#15
Amit G Singal, Sahil Mittal, Olutola A Yerokun, Chul Ahn, Jorge A Marrero, Adam C Yopp, Neehar D Parikh, Steve J Scaglione
BACKGROUND: Professional societies recommend hepatocellular carcinoma screening in patients with cirrhosis, but high-quality data evaluating its effectiveness to improve early tumor detection and survival in "real world" clinical practice are needed. We aim to characterize the association between hepatocellular carcinoma screening and early tumor detection, curative treatment, and overall survival among patients with cirrhosis. METHODS: We performed a retrospective cohort study of patients diagnosed with hepatocellular carcinoma between June 2012 and May 2013 at 4 health systems in the US...
September 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/27924103/editorial-advancing-adoption-of-frailty-to-improve-the-care-of-patients-with-cirrhosis-time-for-a-consensus-on-a-frailty-index
#16
EDITORIAL
Jennifer C Lai
Frailty is a key determinant of outcomes in patients with cirrhosis. Two papers in this issue of the American Journal of Gastroenterology advance our understanding of the mechanism by which frailty impacts mortality-by increasing the risk of hospitalization for liver-related complications. We now have overwhelming justification to incorporate frailty into clinical practice, but this should be done in a systematic way to foster multi-center collaboration to accelerate research in this field. It is time for consensus on single frailty index to unify decision-making surrounding frailty and equalize outcomes for all cirrhotics across all centers...
December 2016: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27575708/frailty-as-tested-by-gait-speed-is-an-independent-risk-factor-for-cirrhosis-complications-that-require-hospitalization
#17
Michael A Dunn, Deborah A Josbeno, Amit D Tevar, Vikrant Rachakonda, Swaytha R Ganesh, Amy R Schmotzer, Elizabeth A Kallenborn, Jaideep Behari, Douglas P Landsittel, Andrea F DiMartini, Anthony Delitto
OBJECTIVES: Frailty is a known risk factor for major life-threatening liver transplant complications, deaths, and waitlist attrition. Whether frailty indicates risk for adverse outcomes in cirrhosis short of lethality is not well defined. We hypothesized that clinical measurements of frailty using gait speed and grip strength would indicate the risk of subsequent hospitalization for the complications of cirrhosis. METHODS: We assessed frailty as gait speed and grip strength in a 1-year prospective study of 373 cirrhotic patients evaluated for or awaiting liver transplantation...
December 2016: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27495749/performance-based-measures-associate-with-frailty-in-patients-with-end-stage-liver-disease
#18
Jennifer C Lai, Michael L Volk, Debra Strasburg, Neil Alexander
BACKGROUND: Physical frailty, as measured by the Fried Frailty Index, is increasingly recognized as a critical determinant of outcomes in patients with cirrhosis. However, its utility is limited by the inclusion of self-reported components. We aimed to identify performance-based measures associated with frailty in patients with cirrhosis. METHODS: Patients with cirrhosis, aged 50 years or older, underwent: 6-minute walk test (cardiopulmonary endurance), chair stands in 30 seconds (muscle endurance), isometric knee extension (lower extremity strength), unipedal stance time (static balance), and maximal step length (dynamic balance/coordination)...
December 2016: Transplantation
https://www.readbyqxmd.com/read/27481305/a-rapid-bedside-screen-to-predict-unplanned-hospitalization-and-death-in-outpatients-with-cirrhosis-a-prospective-evaluation-of-the-clinical-frailty-scale
#19
Puneeta Tandon, Navdeep Tangri, Lesley Thomas, Laura Zenith, Tahira Shaikh, Michelle Carbonneau, Mang Ma, Robert J Bailey, Saumya Jayakumar, Kelly W Burak, Juan G Abraldes, Amanda Brisebois, Thomas Ferguson, Sumit R Majumdar
OBJECTIVES: Screening tools to determine which outpatients with cirrhosis are at highest risk for unplanned hospitalization are lacking. Frailty is a novel prognostic factor but conventional screening for frailty is time consuming. We evaluated the ability of a 1 min bedside screen (Clinical Frailty Scale (CFS)) to predict unplanned hospitalization or death in outpatients with cirrhosis and compared the CFS with two conventional frailty measures (Fried Frailty Criteria (FFC) and Short Physical Performance Battery (SPPB))...
December 2016: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27348200/the-gap-between-clinically-assessed-physical-performance-and-objective-physical-activity-in-liver-transplant-candidates
#20
Michael A Dunn, Deborah A Josbeno, Amy R Schmotzer, Amit D Tevar, Andrea F DiMartini, Douglas P Landsittel, Anthony Delitto
Frailty with sarcopenia in cirrhosis causes liver transplant wait-list attrition and deaths. Regular physical activity is needed to protect patients with cirrhosis from frailty. We subjectively assess physical performance in selecting patients for transplant listing, but we do not know whether clinical assessments reflect the extent of activity patients actually perform. To investigate this question, 53 wait-listed patients self-assessed their performance of ordinary physical tasks using the Rosow-Breslau survey, and clinicians assessed their physical performance status with the Karnofsky index...
October 2016: Liver Transplantation
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