Abstract
Background Physical frailty increases susceptibility to stressors and predicts adverse outcomes of cirrhosis. Data on disease course in different etiologies are scarce, so we aimed to compare the prevalence and risk factors of frailty and its impact on prognosis in nonalcoholic fatty liver (NAFLD) and alcoholic (ALD) cirrhosis. Patients and Methods. Cirrhosis registry RH7 operates since 2014 and includes hospitalized patients with decompensated cirrhosis, pre-LT evaluation, or curable hepatocellular carcinoma (HCC). From the RH7, we identified 280 ALD and 105 NAFLD patients with at least 6 months of follow-up. Results Patients with NAFLD compared with ALD were older and had a higher proportion of females, higher body mass index (BMI) and mid-arm circumference (MAC), lower MELD score, CRP, and lower proportion of refractory ascites. The liver frailty index did not differ, and the prevalence of HCC was higher (17.1 vs. 6.8%, p=0.002). Age, sex, serum albumin, and C-reactive protein (CRP) were independent predictors of frailty. In NAFLD, frailty was also associated with BMI and MAC and in ALD, with the MELD score. The Cox model adjusted for age, sex, MELD, CRP, HCC, and LFI showed that NAFLD patients had higher all-cause mortality (HR = 1.88 95% CI 1.32–2.67, p < 0.001) and were more sensitive to the increase in LFI (HR = 1.51, 95% CI 1.05–2.2). Conclusion Patients with NAFLD cirrhosis had a comparable prevalence of frailty compared to ALD. Although prognostic indices showed less advanced disease, NAFLD patients were more sensitive to frailty, which reflected their higher overall disease burden and led to higher all-cause mortality.
Highlights
Pandemics of inactivity and sarcopenic obesity rapidly increase the global burden of nonalcoholic fatty liver disease (NAFLD) [1, 2], which is estimated at 25% and is expected to increase substantially until 2030 [3, 4]
Patients and Methods e HEGITO7 registry (RH7) operates in the Department of Hepatology, Gastroenterology, and Transplantation (HEGITO), since 2014. e entry criteria for the registry are as follows: signed informed consent, advanced chronic liver disease (ACLD) requiring hospitalization, and event of cirrhosis decompensation, or evaluation for liver transplantation (LT), or hospitalization for hepatocellular carcinoma (HCC) within the Milan criteria. e registry does not include patients hospitalized for elective procedures, or terminal stages of ACLD or HCC, or with a severely limited life expectancy. e registry contains the date of index hospitalization, basic demographics, medical history, cirrhosis etiology and complications, body mass index (BMI), hand grip strength (HGS, in kg, using the dynamometer Kern MAP80), mid-arm circumference (MAC, in cm), and tricipital skinfold
Patients with NAFLD were significantly older and had a higher proportion of females, higher BMI, MAC, and the triceps skinfold (Table 1). Functional parameters such as hand grip strength, chair stands per second, or balance time did not differ between the groups. e Liver frailty index (LFI) was numerically lower in NAFLD patients, but the difference was not statistically significant
Summary
Pandemics of inactivity and sarcopenic obesity rapidly increase the global burden of NAFLD [1, 2], which is estimated at 25% and is expected to increase substantially until 2030 [3, 4]. E leading cause is alcoholic liver disease (ALD), and the fastestgrowing cause is NAFLD [7]. Sarcopenia in NAFLD compared to other cirrhosis etiologies lies higher upstream in the disease pathophysiology. Data on disease course in different etiologies are scarce, so we aimed to compare the prevalence and risk factors of frailty and its impact on prognosis in nonalcoholic fatty liver (NAFLD) and alcoholic (ALD) cirrhosis. Patients with NAFLD compared with ALD were older and had a higher proportion of females, higher body mass index (BMI) and mid-arm circumference (MAC), lower MELD score, CRP, and lower proportion of refractory ascites. E liver frailty index did not differ, and the prevalence of HCC was higher (17.1 vs 6.8%, p 0.002). In NAFLD, frailty was associated with BMI and MAC and in ALD, with the MELD score
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