Abstract
Background/Aims Unplanned hospitalisation is a marker of poor prognosis and a major financial burden in patients with cirrhosis. Frailty-screening tools could determine the risk for unplanned hospital admissions and death. The study aims to evaluate the bedside frailty-screening tool (Short Physical Performance Battery (SPPB)) in prediction of mortality in patients with liver cirrhosis. Methods One hundred forty-five patients with liver cirrhosis were recruited from Cairo University Hospital. Clinical assessment and routine laboratory tests were performed, and the SPPB frailty index, Child score, and model for end-stage liver disease (MELD) score were calculated on admission. These metrics were compared to assess mortality outcomes over the course of 90 days. Results The mean age of the patients was 60 ± 7 years, and frailty index score (SD) was 6 ± 3. The overall 90-day readmission rate was 43.4%, while the overall 90-day mortality rate was 18.6%. SPPB scores differed significantly between survivors (4.1 ± 1.4) and nonsurvivors (6.47 ± 2.8) (P value ≤ 0.001) as well as between readmitted patients (7.5 ± 2.9) and patients who were not readmitted (4.5 ± 1.9) (P value ≤ 0.001), while the Child and MELD scores showed no associations with patient outcomes. SPPB performed better with a specificity of 72.3% and a sensitivity of 72.2% for predicting mortality. Conclusions SPPB could be a screening tool used to detect frailty and excelled over traditional scores as a predictor of death. A low SPPB frailty score among hospitalised patients with cirrhosis is associated with poor outcomes.
Highlights
Frailty is defined by decreased strength, power, and diminished physiological function that in turn leads to increased physical dependency and increased risk of mortality especially in older age and those with debilitating diseases [1].Posthepatitic liver cirrhosis has a high prevalence in Egypt
hepatitis C virus (HCV)-related cirrhosis is strongly associated with protein energy malnutrition (PEM), sarcopenia, frailty, and physical atrophy
Patients with posthepatitic cirrhosis who were ≥ 18 years old were selected from the internal medicine wards, while patients with current hepatic or extrahepatic malignancies; patients with overt hepatic encephalopathy; patients in comas; patients with any medical, physical, neurological disabilities; and patients who used medications that compromised their balance were excluded from the study
Summary
Posthepatitic liver cirrhosis has a high prevalence in Egypt. A comprehensive assessment of hepatitis C virus (HCV) epidemiology was conducted in 2018, revealing high incidence and prevalence levels across all populations in Egypt. The pooled mean HCV prevalence was estimated to be 11.9% in the general population, 55.6% among populations at high risk, 14.3% among populations at intermediate risk, and 56.0% among populations with liver-related conditions including liver cirrhosis [2]. HCV-related cirrhosis is strongly associated with protein energy malnutrition (PEM), sarcopenia, frailty, and physical atrophy. This was found to be caused by the release of musclewasting cytokines, the derangement of muscle proteins, and the increased autophagy of muscles, all of which are mediated by elevated levels of tumour necrosis factor, elevated concentrations of ammonia, and impaired ureagenesis [3]
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