Abstracts of the 2023 Annual Meeting of the ALEH
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Introduction and ObjectivesFrailty is associated with an increased morbidity and mortality among patients with cirrhosis. However, there is no specific strategy recommended for these patients. We evaluated the effectiveness of a strategy based on physical and nutritional intervention improving frailty in cirrhotic patients listed for transplantation.
Patients / Materials and MethodsPatients with increased Liver Frailty Index (LFI) (≥3.2) were randomized to the intervention group (guided by physical therapist and dietitian) or control group (standard counseling) for 12 weeks. Based on LFI patients were classified as frail or prefrail. The change on LFI was evaluated at the end of study. Health related quality of life was evaluated employing CLDQ.
Results and DiscussionSixty-six patients were included (34 to the control group and 32 to the intervention group), age 59.3±8.8, male 51.5%, main etiologies: MASLD(40.9%), ALD(15.2%), MetALD(6.1%), PBC(6.1%), autoimmune hepatitis(4.5%), overlap(AIH/PBC)(6.1%), MELD Na 17.2±5, Child Pugh A/B/C 13.6%/57.6%/28.8%, Na 137±3mEq/L, creatinine 0.8±0.3 mg/dL, bilirubin 3.3±3 mg/dL, INR 1.5±0.4, albumin 3.3±0.5 g/dL, LFI 4.23 ±0.5, frail/prefrail (%) 34.8/65.2, CLDQ 4.2±1.1, gait speed 0.86 m/s±0.5. There was a significant improvement of LFI at the end of the study in the intervention group (ΔLFI 0.4 vs ΔLFI 0.16,p=0.02). Notably, we found a significant reduction of the proportion of frail patients in the intervention group vs control group (28.1% vs 8.8%, p=0.02) at the end of the study (Figure). There was a significant improvement in the activity domain of CLDQ in the intervention group(0.52±1.8 vs -0.25±1.5,p=0.04).
ConclusionsThis is the first randomized controlled trial performed in patients with cirrhosis showing that a dual intervention can reduce frailty in patients listed for transplantation.
