Is Liver Frailty and functional capacity associated with severity of liver disease in patients awaiting Liver Transplantation? - A prospective Observational Study

Abstract

Background: Liver is a major metabolic organ, interfering with the function of all organs and systems. So, the patients with severe liver disease may display wide manifestations of metabolic disorders, loss of muscle mass and function. Combination of these factors leads to decreased exercise tolerance and physical inactivity and it may be exaggerated with increasing severity of liver disease. The functional capacity could be severely affected due to multiple physiological derangements in these population. Hence, a liver transplant is the only cure for end stage liver disease. Currently only few literature are available that evaluated and described the status of frailty and functional capacity in these population. So we have tried to evaluate the same in Indian Population. Methodology: After ethical committee approval and written inform consent, 85 cirrhotic patients who fulfilled the Inclusion and Exclusion criteria were included in the study. Disease specific history, Severity of Liver disease, Physical evaluation of frailty via Hand grip strength, Balance and time taken to do 5 chair stands , subjective functional capacity evaluation was done through Duke activity status Index (DASI). Result: In 85 patients, the average Hand grip strength was 23.70 ± 10.60kg in males and 15.02± 5.08kg in females , average value of timed chair stands (TCS) was 18.18± 6.60 in males and 14.18± 8.65 in females , average balance score was 28.00 ±4.99 in males and 29.33± 2.58 in females and the average value of MELDNa was 22.2± 6.9. Conclusion: When compared with normal Indian standard Liver cirrhotic patient, form of frailty and reduced functional capacity non predominant. That stressed emphasis on rehabilitation and nutritional counselling during waiting period for Transplantation.