Association of Frailty With Clinical and Financial Outcomes Following Liver Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-08-27 DOI:10.1111/ctr.15438

Giselle Porter, Sara Sakowitz, Saad Mallick, Amulya Vadlakonda, Joanna Curry, Konmal Ali, Jeffrey Balian, Peyman Benharash

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Abstract

Introduction

Frailty, a measure of physiological aging and reserve, has been validated as a prognostic indicator of mortality in patients with cirrhosis. However, large-scale analyses of the independent association of frailty with clinical and financial outcomes following liver transplantation (LT) are lacking.

Methods

Adults (≥18 years) undergoing LT were identified in the 2016–2020 National Readmissions Database. Frailty was defined using the binary Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable linear and logistic regression models were developed to evaluate the independent association of frailty with in-hospital mortality, perioperative complications, and costs.

Results

Of an estimated 34 442 patients undergoing LT, 8265 (24%) were frail. After adjustment, frailty was associated with greater odds of mortality (adjusted odds ratio [AOR] 1.80; 95% Confidence Interval [CI]: 1.49–1.18), postoperative length of stay (β + 11 days; 95% CI: +10, +12), and hospitalization costs (+$86 880; 95% CI: +75 660, +98 100), as well as a two-fold increase in relative risk of nonhome discharge (AOR 2.17, 95% CI: 1.90–2.49).

Conclusions

Frailty is associated with an increased risk of in-hospital mortality, complications, and resource utilization among LT recipients. As the proportion of frail LT patients continues to rise, our findings underscore the need for novel risk-stratification and individualized care protocols for such vulnerable patients.

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肝移植后体弱与临床和财务结果的关系

简介虚弱是一种衡量生理衰老和储备的指标，已被证实是肝硬化患者死亡率的预后指标。然而，目前还缺乏对虚弱与肝移植（LT）后临床和财务结果的独立关联的大规模分析：方法：从2016-2020年全国再入院数据库中识别出接受肝移植的成人（≥18岁）。采用二元约翰霍普金斯调整临床组虚弱指标对虚弱进行定义。建立了多变量线性和逻辑回归模型，以评估虚弱与院内死亡率、围手术期并发症和费用的独立关联：在约 34 442 名接受腰椎间盘突出症手术的患者中，有 8265 人（24%）体弱。经调整后，体弱与死亡率（调整赔率[AOR]1.80；95% 置信区间[CI]：1.49-1.18）、术后住院时间（β + 11 天；95% CI：+10，+12）和住院费用（+86 880 美元；95% CI：+75 660，+98 100）相关联，且非居家出院的相对风险增加了两倍（AOR 2.17，95% CI：1.90-2.49）：体弱与LT患者院内死亡率、并发症和资源使用风险的增加有关。随着体弱的LT患者比例持续上升，我们的研究结果凸显了对这类易感患者进行新的风险分级和个体化护理方案的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.