Abstract [from journal]
Background and aims: There is significant interest in identifying risk factors associated with acute on chronic liver failure (ACLF). In transplant candidates, frailty predicts waitlist mortality and post-transplant outcomes. However, the impact of frailty on ACLF development and mortality is unknown.
Methods: This was a retrospective study of U.S. Veterans with cirrhosis identified between 2008 to 2016. First hospitalizations were characterized as ACLF or non-ACLF admissions. Pre-hospitalization patient frailty was ascertained using a validated score based on administrative coding data. We used logistic regression to investigate the impact of increasing frailty score on the odds of ACLF hospitalization and short-term ACLF mortality. Cox regression was used to analyze the association between frailty and long-term survival from hospitalization.
Results: We identified 16,561 cirrhosis hospitalizations over median follow-up 4.19 years (interquartile range 2.47-6.34). In adjusted models, increasing frailty score was associated with significantly increased odds of ACLF hospitalization versus non-ACLF hospitalization (odds ratio [OR] 1.03 per point, 95% CI 1.02-1.03, p<0.001). By contrast, frailty score was not associated with ACLF 28- or 90-day mortality (p=0.13 and p=0.33, respectively). In adjusted Cox analysis of all hospitalizations, increasing frailty scores were associated with poorer long-term survival from the time of hospitalization (HR 1.02 per 5 points, 95% CI 1.01-1.04, p=0.004).
Conclusion: Frailty increases the likelihood of ACLF hospitalization among patients with cirrhosis, but does not impact short-term ACLF mortality. These findings have implications for clinicians caring for frail outpatients with cirrhosis, including tailored follow-up, risk mitigation strategies, and possible expedited transplant evaluation.