ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2026
Frailty Increases Hospitalization Rates in an Ambulatory Cohort of Patients With Cirrhosis: The North American Consortium for the Study of End-Stage Liver Disease 3 Prospective Cohort.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND &
aimsFrailty predicts mortality in liver transplant candidates, but its impact on hospitalizations in general hepatology outpatients-and whether related components such as functional capacity provide additional prognostic value- remains unclear.
methodsWe analyzed data from the North American Consortium for the Study of End-Stage Liver Disease (NACSELD), a multicenter prospective ambulatory cirrhosis cohort. Frailty was assessed using the Liver Frailty Index, categorized as robust (≤3.2), prefrail (3.2-4.4), and frail (≥4.4), and the Duke Activity Status Index. The primary outcome was hospitalization at 6 months.
resultsAmong 1007 patients, at enrollment, 12.9% were robust, 70.6% were prefrail, and 16.5% were frail. Twenty-four percent of the cohort was hospitalized within 6 months, and hospitalization rates increased with frailty at 3 months (5%, 12%, and 21%, respectively; P = .001) and almost doubled by 6 months (11%, 21%, and 31%, respectively; P = .002). In multivariable modeling, the Liver Frailty Index (odds ratio, 1.6; P = .03) or the Duke Activity Status Index (odds ratio, 0.99; P = .04), after controlling for Model for End-stage Liver Disease 3.0, Charlson Comorbidity Index, cirrhosis etiology, diabetes, prior cirrhosis complications, admission medications, and Child-Turcotte-Pugh score remained independently associated with 6-month hospitalization risk. The Liver Frailty Index and the Duke Activity Status Index were inversely correlated (Pearson -0.37; P < .001); with every 0.1 unit increase in the Liver Frailty Index, the Duke Activity Status Index decreased by 0.95 units. Low 6-month mortality underpowered the association of the Liver Frailty Index with mortality.
conclusionMeasures of frailty (by Liver Frailty Index) and functional capacity (by Duke Activity Status Index) independently predict 6-month hospitalization in ambulatory patients with cirrhosis. One-third of frail patients and almost one-quarter of prefrail patients with a median Model for End-stage Liver Disease 3.0 of 11 required hospitalization by 6 months. Routine assessment with the Liver Frailty Index may improve risk stratification and guide interventions to reduce health care utilization.
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