Eberhard Lurz1, Claudia Quammie1, Michael Englesbe2, Estella M Alonso3, Henry C Lin4, Evelyn K Hsu5, Katryn N Furuya6, Nitika A Gupta7, Veena L Venkat8, James F Daniel9, Mike A Leonis10, Tamir Miloh11, Grzegorz W Telega12, Jason Yap13, Jerome Menendez14, Linda S Book15, Ryan W Himes16, Shikha S Sundaram17, Rulan Parekh1, Chris Sonnenday2, John Bucuvalas10, Vicky L Ng1, Binita M Kamath18. 1. Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada. 2. Department of Transplantation Surgery, University of Michigan, Ann Arbor, MI, USA. 3. Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. 4. Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 5. Division of Gastroenterology, Hepatology and Nutrition, University of Washington-Seattle Children's Hospital, Seattle, WA, USA. 6. Division of Gastroenterology, Hepatology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, NC, USA; Division of Gastroenterology, Hepatology and Nutrition, Mayo clinic, Rochester, MN, USA. 7. Division of Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta Emory University School of Medicine, Atlanta, GA, USA. 8. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. 9. Division of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA. 10. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 11. Division of Gastroenterology, Hepatology and Nutrition, Phoenix Children's Hospital, Phoenix, AZ, USA; Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, TX, USA. 12. Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, WI, USA. 13. Division of Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital/Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. 14. Division of Pediatric Gastroenterology, Levine Children's Hospital Carolinas Health Care Center, Charlotte, NC, USA. 15. Division of Pediatric Gastroenterology, Primary Children's Hospital, Salt Lake, UT, USA. 16. Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, TX, USA. 17. Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA. 18. Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada. Electronic address: binita.kamath@sickkids.ca.
Abstract
OBJECTIVE: To assess frailty, a measure of physiologic declines in multiple organ systems, in children with chronic liver disease using a novel pediatric frailty tool. STUDY DESIGN: We performed a prospective cross-sectional multicenter study at 17 liver transplantation (LT) centers. 71 children (5-17 years of age), 36 with compensated chronic liver disease (CCLD) and 35 with end-stage liver disease (ESLD) and listed for LT, were assessed for frailty using validated pediatric tools to assess the 5 classic Fried Frailty Criteria-slowness, weakness, exhaustion, diminished physical activity, and shrinkage. Test scores were translated to age- and sex-dependent z scores, generating a maximum frailty score of 10. RESULTS: The median frailty score of the cohort was 4 (IQR 3, 5). Subjects with ESLD had significantly higher frailty scores (median 5; IQR 4, 7) than subjects with CCLD (median 3; IQR 2, 4); (P < .0001). Area under the curve receiver operating characteristic for frailty scores to discriminate between ESLD and CCLD was 0.83 (95% CI 0.73, 0.93). Forty-six percent of children with ESLD were frail and there was no correlation between pediatric frailty scores and physician's global assessments (r = -0.24, 95% CI -0.53, 0.10). CONCLUSIONS: A novel frailty tool assessed additional dimensions of health, not captured by standard laboratory measures and identified the sickest individuals among a cohort of children with chronic liver disease. This tool may have applicability to other children with chronic disease.
OBJECTIVE: To assess frailty, a measure of physiologic declines in multiple organ systems, in children with chronic liver disease using a novel pediatric frailty tool. STUDY DESIGN: We performed a prospective cross-sectional multicenter study at 17 liver transplantation (LT) centers. 71 children (5-17 years of age), 36 with compensated chronic liver disease (CCLD) and 35 with end-stage liver disease (ESLD) and listed for LT, were assessed for frailty using validated pediatric tools to assess the 5 classic Fried Frailty Criteria-slowness, weakness, exhaustion, diminished physical activity, and shrinkage. Test scores were translated to age- and sex-dependent z scores, generating a maximum frailty score of 10. RESULTS: The median frailty score of the cohort was 4 (IQR 3, 5). Subjects with ESLD had significantly higher frailty scores (median 5; IQR 4, 7) than subjects with CCLD (median 3; IQR 2, 4); (P < .0001). Area under the curve receiver operating characteristic for frailty scores to discriminate between ESLD and CCLD was 0.83 (95% CI 0.73, 0.93). Forty-six percent of children with ESLD were frail and there was no correlation between pediatric frailty scores and physician's global assessments (r = -0.24, 95% CI -0.53, 0.10). CONCLUSIONS: A novel frailty tool assessed additional dimensions of health, not captured by standard laboratory measures and identified the sickest individuals among a cohort of children with chronic liver disease. This tool may have applicability to other children with chronic disease.
Authors: Elizabeth J Carey; Jennifer C Lai; Christopher Sonnenday; Elliot B Tapper; Puneeta Tandon; Andres Duarte-Rojo; Michael A Dunn; Cynthia Tsien; Eric R Kallwitz; Vicky Ng; Srinivasan Dasarathy; Matthew Kappus; Mustafa R Bashir; Aldo J Montano-Loza Journal: Hepatology Date: 2019-08-19 Impact factor: 17.425
Authors: Julien Hogan; Michael F Schneider; Rima Pai; Michelle R Denburg; Amy Kogon; Ellen R Brooks; Frederick J Kaskel; Kimberly J Reidy; Jeffrey M Saland; Bradley A Warady; Susan L Furth; Rachel E Patzer; Larry A Greenbaum Journal: Pediatr Nephrol Date: 2020-01-13 Impact factor: 3.714
Authors: Jennifer C Lai; Christopher J Sonnenday; Elliot B Tapper; Andres Duarte-Rojo; Michael A Dunn; William Bernal; Elizabeth J Carey; Srinivasan Dasarathy; Binita M Kamath; Matthew R Kappus; Aldo J Montano-Loza; Shunji Nagai; Puneeta Tandon Journal: Am J Transplant Date: 2019-05-08 Impact factor: 8.086
Authors: Kristen Sgambat; Matthew B Matheson; Stephen R Hooper; Bradley Warady; Susan Furth; Asha Moudgil Journal: Pediatr Nephrol Date: 2019-08-02 Impact factor: 3.714
Authors: Karina Covarrubias; Xun Luo; Allan Massie; Kathleen B Schwarz; Jacqueline Garonzik-Wang; Dorry L Segev; Douglas B Mogul Journal: Pediatr Transplant Date: 2020-03-25
Authors: Jennifer C Lai; Puneeta Tandon; William Bernal; Elliot B Tapper; Udeme Ekong; Srinivasan Dasarathy; Elizabeth J Carey Journal: Hepatology Date: 2021-09 Impact factor: 17.298