Does the change in Liver Frailty Index over the first week of hospitalisation predict mortality in patients with acute-on- chronic liver failure? A prospective cohort study from a Slovak liver centre
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Na stiahnutie
Dátum
2025
Názov časopisu
ISSN časopisu
Názov zväzku
Vydavateľ
BMJ Group : Londýn
ISBN
ISSN
2044-6055
Abstrakt
Objective Hospital admissions for advanced chronic liver disease (ACLD) are associated with increased mortality, disability, a decline in quality of life and significant economic costs. Being admitted to the hospital usually indicates a triggering event that disrupted a previously stable condition, leading to decompensation or complications of ACLD. The most acute and severe manifestation of this imbalance is acute-on-chronic liver failure (ACLF), a syndrome representing a critical juncture. Reliable prognostic stratification of patients admitted with ACLF could facilitate the systematic delivery of tailored care, ranging from palliative care to intensive interventions like extracorporeal liver support devices and prioritised liver transplantation. Disease-specific prognostic tools, such as the Model for End-Stage Liver Disease score, are effective but have limitations, particularly in reflecting a patient’s potential for recovery. The concept of the body’s functional reserve in the context of ACLD/ACLF is gaining attention, with the Liver Frailty Index (LFI) potentially emerging as a recommended diagnostic tool.
Methods Patients were selected from our cirrhosis registry (RH7). The LFI serves as an indicator of the patient’s prognosis. The LFI measurement takes place at two time intervals: on the patient’s admission and after 7 days of hospitalisation.
Results Our RH7 registry included 154 patients (15.1%) who were diagnosed with ACLF. The primary cause of the underlying ACLD was alcohol-associated liver disease in the majority (79.8%) of cases. The mean value of LFI at admission was 4.50 (± 0.94). When patients with liver cirrhosis were categorised into three subgroups based on the LFI on day 7, survival exhibited a statistically significant decrease (p≤0.05) across all three ACLF grades. This decline in survival was observed from the ‘improved LFI’ cohort, through the ‘stable LFI’ group, to the ‘worsened LFI’ group.
Conclusion The impact of day 7 LFI on the survival of patients with ACLF is notable. Nevertheless, it does not markedly enhance the predictive capability of the LFI assessed on admission. Consequently, the initial LFI on day 1 continues to be the most valuable and commonly used instrument for promptly recognising individuals with ACLF.
Popis
In: BMJ Open. Londýn : BMJ Group, 2025. ISSN 2044-6055. Vol. 15, no. 5 (2025), pp. 1-10.
Kľúčové slová
index krehkosti pečene, Liver Frailty Index, pečeň, ochorenia
Výstup z projektu
VAIA 09I03-03-V05-00009 Early Stage Granty - UMB v Banskej Bystrici
Citácia
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CC BY-NC Creative Commons Attribution-NonCommercial 4.0. International
info:eu-repo/semantics/openAccess
info:eu-repo/semantics/openAccess