Michael Ney1,1, Navdeep Tangri1, Bonnie Dobbs1, Jasmohan Bajaj1, Darryl Rolfson1, Mang Ma1, Thomas Ferguson1, Param Bhardwaj1, Robert J Bailey1, Juan Abraldes1, Puneeta Tandon1. 1. Cirrhosis Care Clinic, University of Alberta, Edmonton, AB, Canada. Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada. Division of Nephrology, University of Manitoba, Winnipeg, MB, Canada. Medically At-Risk Driver Center, Department of Family Medicine, University of Alberta, Edmonton, AB, Canada. Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA, USA. Division of Geriatrics, University of Alberta, Edmonton, AB, Canada. Division of Gastroenterology, Royal Alexandra Hospital, Edmonton, AB, Canada.
Abstract
INTRODUCTION: Hepatic encephalopathy (HE) is the most common potentially modifiable reason for admission in patients with cirrhosis. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for HE. We aimed to assess the utility of a composite score (MoCA-CFS) developed using the Montreal Cognitive Assessment (MoCA) and the Clinical Frailty Scale (CFS) for predicting HE admissions within 6 months. METHODS: Consecutive adult patients with cirrhosis were followed for 6 months or until death/transplant. Patients with overt HE and dementia were excluded. Primary outcome was the prediction of HE-related admissions at 6 months. RESULTS: A total of 355 patients were included; mean age 55.9 ± 9.6; 62.5% male; Hepatitis C and alcohol etiology in 64%. Thirty-six percent of patients had cognitive impairment according to the MoCA (≤24) and 14% were frail on the CFS (>4). The MoCA-CFS independently predicted HE hospitalization within 6 months, a MoCA-CFS score of 1 and 2 respectively increasing the odds of hospitalization by 3.3 (95% CI:1.5-7.7) and 5.7 (95% CI:1.9-17.3). HRQoL decreased with increasing MoCA-CFS. Depression and older age were independent predictors of a low MoCA. CONCLUSIONS: Cognitive and physical frailty are common in patients with cirrhosis. In addition to being an independent predictor of HE admissions within 6 months, the MoCA-CFS composite score predicts impaired HRQoL and all-cause admissions within 6 months. These data support the predictive value of a "multidimensional" frailty tool for the prediction of adverse clinical outcomes and highlight the potential for a multi-faceted approach to therapy targeting cognitive impairment, physical frailty and depression.
INTRODUCTION: Hepatic encephalopathy (HE) is the most common potentially modifiable reason for admission in patients with cirrhosis. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for HE. We aimed to assess the utility of a composite score (MoCA-CFS) developed using the Montreal Cognitive Assessment (MoCA) and the Clinical Frailty Scale (CFS) for predicting HE admissions within 6 months. METHODS: Consecutive adult patients with cirrhosis were followed for 6 months or until death/transplant. Patients with overt HE and dementia were excluded. Primary outcome was the prediction of HE-related admissions at 6 months. RESULTS: A total of 355 patients were included; mean age 55.9 ± 9.6; 62.5% male; Hepatitis C and alcohol etiology in 64%. Thirty-six percent of patients had cognitive impairment according to the MoCA (≤24) and 14% were frail on the CFS (>4). The MoCA-CFS independently predicted HE hospitalization within 6 months, a MoCA-CFS score of 1 and 2 respectively increasing the odds of hospitalization by 3.3 (95% CI:1.5-7.7) and 5.7 (95% CI:1.9-17.3). HRQoL decreased with increasing MoCA-CFS. Depression and older age were independent predictors of a low MoCA. CONCLUSIONS: Cognitive and physical frailty are common in patients with cirrhosis. In addition to being an independent predictor of HE admissions within 6 months, the MoCA-CFS composite score predicts impaired HRQoL and all-cause admissions within 6 months. These data support the predictive value of a "multidimensional" frailty tool for the prediction of adverse clinical outcomes and highlight the potential for a multi-faceted approach to therapy targeting cognitive impairment, physical frailty and depression.
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: Jasmohan S Bajaj; Sili Fan; Leroy R Thacker; Andrew Fagan; Edith Gavis; Melanie B White; Douglas M Heuman; Michael Fuchs; Oliver Fiehn Journal: PLoS One Date: 2019-09-27 Impact factor: 3.240
Authors: Therese Bittermann; Kristen Dwinnells; Sakshum Chadha; Michael S Wolf; Kim M Olthoff; Marina Serper Journal: Liver Transpl Date: 2020-10-07 Impact factor: 5.799
Authors: Charlotte W Wernberg; Ove B Schaffalitzky de Muckadell; Hendrik Vilstrup; Mette M Lauridsen Journal: PLoS One Date: 2019-12-12 Impact factor: 3.240
Authors: Mette Munk Lauridsen; Peter Jepsen; Charlotte Wilhelmina Wernberg; Ove B Schaffalitzky de Muckadell; Jasmohan S Bajaj; Hendrik Vilstrup Journal: Hepatol Commun Date: 2020-07-03