Prevalence of Frailty and Its Impact on Mortality and Hospitalization in Patients With Cirrhosis: A Systematic Review and Meta-analysis

Abstract

Background & AimsFrailty in patients with cirrhosis is associated with increased morbidity and mortality. In this study, we aimed to determine the prevalence of frailty and its impact on mortality and hospitalization in patients with cirrhosis. MethodsAn elaborate search was undertaken in the following databases: "PubMed, Scopus, Web of Science, Cochrane, and preprint servers”, and an assessment of all published articles till 17 February 2023 was done. Studies that provided data on prevalence, mortality and hospitalization, among frail patients with cirrhosis were included. The study characteristics and data on the prevalence, mortality, and hospitalization were extracted from included studies. The primary outcome was to estimate the pooled prevalence of frailty and determine its impact on mortality and hospitilization in patients with cirrhosis. ResultsOverall, 12 studies were included. Data on prevalence of frailty and mortality was available in 11 studies while seven studies reported data on hospitalization. The analysis conducted amongst 6126 patients with cirrhosis revealed pooled prevalence of frailty to be 32% (95% confidence interval [CI] 24-41). A total of 540 events of death revealed pooled mortality rate of 29% (95% CI, 19-41). Six months and twelve months pooled estimates of mortality were found to be 24% (95% CI, 17-33) and 33% (95% CI, 23-45) respectively. The pooled hospitalization rate among the seven studies was 43% (95% CI, 21-68). ConclusionsThe prevalence of frailty in patients with cirrhosis is high leading to poor outcomes. Frailty assessment should become an integral part of cirrhosis evaluation. Registry and registration number of studyPROSPERO 2022 CRD42022377507.