Duke Activity Status Index and Liver Frailty Index predict mortality in ambulatory patients with advanced chronic liver disease: A prospective, observational study
Williams, Felicity R Quinlan, Jonathan Freer, Alice Morrison, Breanna Sitch, Alice Hockey, Florence Klas, Natasza Towey, Jennifer Perera, Thamara P R Rajoriya, Neil
Williams, Felicity R
Quinlan, Jonathan
Freer, Alice
Morrison, Breanna
Sitch, Alice
Hockey, Florence
Klas, Natasza
Towey, Jennifer
Perera, Thamara P R
Rajoriya, Neil
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2024-01-03
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Background: There remains a lack of consensus on how to assess functional exercise capacity and physical frailty in patients with advanced chronic liver disease (CLD) being assessed for liver transplantation (LT). Aim To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.
Aim: To investigate prospectively the utility of the Duke Activity Status Index (DASI) and Liver Frailty Index (LFI) in ambulatory patients with CLD.
Methods: We recruited patients from outpatient clinics at University Hospitals Birmingham, UK (2018-2019). We prospectively collated the DASI and LFI to identify the prevalence of, respectively, functional capacity and physical frailty, and to evaluate their accuracy in predicting overall and pre-LT mortality.
Results: We studied 307 patients (57% male; median age 54 years; UKELD 52). Median DASI score was 28.7 (IQR 16.2-50.2), mean LFI was 3.82 (SD = 0.72), and 81% were defined either 'pre-frail' or 'frail'. Female sex and hyponatraemia were significant independent predictors of both DASI and LFI. Age and encephalopathy were significant independent predictors of LFI, while BMI significantly predicted DASI. DASI and LFI were significantly related to overall (HR 0.97, p = 0.001 [DASI], HR 2.04, p = 0.001 [LFI]) and pre-LT mortality (HR 0.96, p = 0.02 [DASI], HR 1.94, p = 0.04 [LFI]).
Conclusions: Poor functional exercise capacity and physical frailty are highly prevalent among ambulatory patients with CLD who are being assessed for LT. The DASI and LFI are simple, low-cost tools that predict overall and pre-LT mortality. Implementation of both should be considered in all outpatients with CLD to highlight those who may benefit from targeted nutritional and exercise interventions.
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Williams FR, Quinlan J, Freer A, Morrison B, Sitch A, Hockey F, Klas N, Towey J, Perera TPR, Rajoriya N, Lord JM, Armstrong MJ. Duke Activity Status Index and Liver Frailty Index predict mortality in ambulatory patients with advanced chronic liver disease: A prospective, observational study. Aliment Pharmacol Ther. 2024 Feb;59(4):547-557. doi: 10.1111/apt.17834. Epub 2024 Jan 3
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