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    Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist

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    Author
    Sinclair, M; Poltavskiy, E; Dodge, JL; Lai, JC
    Date
    2017-02-07
    Source Title
    World Journal of Gastroenterology
    Publisher
    BAISHIDENG PUBLISHING GROUP INC
    University of Melbourne Author/s
    Sinclair, Marie
    Affiliation
    Medicine and Radiology
    Metadata
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    Document Type
    Journal Article
    Citations
    Sinclair, M., Poltavskiy, E., Dodge, J. L. & Lai, J. C. (2017). Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist. WORLD JOURNAL OF GASTROENTEROLOGY, 23 (5), pp.899-905. https://doi.org/10.3748/wjg.v23.i5.899.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/254801
    DOI
    10.3748/wjg.v23.i5.899
    Abstract
    AIM: To investigate the impact of physical frailty on risk of hospitalisation in cirrhotic patients on the liver transplant waitlist. METHODS: Cirrhotics listed for liver transplantation at a single centre underwent frailty assessments using the Fried Frailty Index, consisting of grip strength, gait speed, exhaustion, weight loss, and physical activity. Clinical and biochemical data including MELD score as collected at the time of assessment. The primary outcome was number of hospitalised days per year; secondary outcomes included incidence of infection. Univariable and multivariable analysis was performed using negative binomial regression to associate baseline parameters including frailty with clinical outcomes and estimated incidence rate ratios (IRR). RESULTS: Of 587 cirrhotics, 64% were male, median age (interquartile range) was 60 (53-64) years and MELD score was 15 (12-18). Median Fried Frailty Index was 2 (1-3); 31.6% were classified as frail (fried frailty ≥ 3). During 12 mo of follow-up, 43% required at least 1 hospitalisation; 38% of which involved major infection. 107/184 (58%) frail and 142/399 (36%) non-frail patients were hospitalised at least once (P < 0.001). In univariable analysis, Fried Frailty Index was associated with total hospitalisation days per year (IRR = 1.51, 95%CI: 1.28-1.77; P ≤ 0.001), which remained significant on multivariable analysis after adjustment for MELD, albumin, and gender (IRR for frailty of 1.21, 95%CI: 1.02-1.44; P = 0.03). Incidence of infection was not influenced by frailty. CONCLUSION: In cirrhotics on the liver transplant waitlist, physical frailty is a significant predictor of hospitalisation and total hospitalised days per year, independent of liver disease severity.

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