ArticleNursing open2026
Two-Step Sequential Screening for Frailty in Patients With Chronic Liver Disease: A Triage Efficiency Study of Liver Frailty Index Components.
Article in Nursing open, 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
aimTo develop and validate a nurse-administered two-step sequential screening pathway based on single Liver Frailty Index components for identifying frailty in people with chronic liver disease.
designA single-centre cross-sectional diagnostic accuracy study.
methodsOverall, 606 hospitalised patients with chronic liver disease were enrolled between August 2021 and August 2025. Timed chair-stands and grip strength served as step-one index tests against frailty defined by the Liver Frailty Index (score of 4.5 or higher); bedridden patients were counted as screen-positive. Cutoffs were derived with the Youden index and stress-tested with bootstrap resampling and split-sample validation.
resultsFrailty prevalence was 18.6%. The either-positive rule (chair stands of 16.55 s or longer, or grip strength of 23.42 kg or lower) achieved 100% sensitivity and a negative predictive value of 1.000, missing zero frail patients, while sparing 62.3% of patients from the complete index assessment. Zero missed cases were reproduced in five split-sample analyses.
conclusionIn this cohort, nearly two-thirds of full assessments could have been avoided without missing LFI-defined frailty cases. Prospective multicentre external validation of the frozen cutoffs is required before routine implementation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The pathway may reduce the burden of complete frailty assessment in inpatient hepatology nursing practice, pending external validation. IMPACT: Universal frailty screening in chronic liver disease is hindered by the burden of completing the full index. In this cohort, the first step identified all LFI-defined frailty cases while avoiding nearly two-thirds of complete assessments. These findings matter to hepatology nurses and inpatient hepatology services seeking feasible, guideline-concordant universal screening. REPORTING
methodThis study adhered to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guideline. NO PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.
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