Higher scores in the Clinical Frailty Scale are associated with covert and overt hepatic encephalopathy in patients with cirrhosis

Eva Maria Schleicher; Leonard Kaps; Jörn M Schattenberg; Peter Robert Galle; Marcus-Alexander Wörns; Simon Johannes Gairing; Christian Labenz

doi:10.1016/j.dld.2023.12.001

Higher scores in the Clinical Frailty Scale are associated with covert and overt hepatic encephalopathy in patients with cirrhosis

Dig Liver Dis. 2024 Jun;56(6):1046-1053. doi: 10.1016/j.dld.2023.12.001. Epub 2023 Dec 16.

Authors

Eva Maria Schleicher¹, Leonard Kaps¹, Jörn M Schattenberg², Peter Robert Galle¹, Marcus-Alexander Wörns³, Simon Johannes Gairing¹, Christian Labenz⁴

Affiliations

¹ Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
² Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
³ Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Department of Gastroenterology, Hematology, Oncology and Endocrinology, Klinikum Dortmund, Germany.
⁴ Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. Electronic address: Christian.labenz@unimedizin-mainz.de.

PMID: 38105147
DOI: 10.1016/j.dld.2023.12.001

Abstract

Background: Frailty increases the vulnerability to internal and external stressors and may therefore be an indicator of a higher frequency of cirrhosis complications. We aimed to investigate the association of the Clinical Frailty Scale (CFS) with covert (CHE) and overt HE (OHE) development in patients with cirrhosis.

Methods: This study analyzed data of 228 patients with cirrhosis. Frailty was assessed using CFS. Patients were examined for the presence of CHE (using PHES) at study inclusion and followed for OHE.

Results: Median CFS was 3 and 26 (11 %) patients were at least pre-frail (CFS>3). In multivariable logistic regression analysis in patients without a history of OHE (n = 195), a higher CFS was associated with the presence of CHE at baseline (OR 1.6, p = 0.039). During follow-up, 42 (18 %) patients developed an episode of OHE. In multivariable competing risk regression analyses, a higher CFS was independently associated with the development of an OHE episode in the total cohort (sHR 1.97, p < 0.001) and in the subcohort of patients without a history of OHE (sHR 1.88, p = 0.008).

Conclusion: CFS appears to be a reliable tool to identify patients at higher risk of HE in whom intensified monitoring and treatment may be justified.

Keywords: Bedside screening test; Clinical Frailty Scale; Frailty; Liver cirrhosis; Multimorbidity.

MeSH terms

Aged
Female
Frailty* / complications
Frailty* / diagnosis
Hepatic Encephalopathy* / diagnosis
Hepatic Encephalopathy* / etiology
Humans
Liver Cirrhosis* / complications
Logistic Models
Male
Middle Aged
Multivariate Analysis
Risk Factors
Severity of Illness Index