Frailty in children with chronic liver disease: Prevalence and impact on outcomes.

Objectives: Frailty is a well-known complication of chronic liver disease and has been recognized as a poor prognostic factor in cirrhotic patients being associated with increased morbidity and mortality. There is limited available pediatric literature in this regard. The current study aimed to estimate the prevalence of frailty and analyze the predictive factors and their association with long-term outcomes in children with liver disease.

Methods: Children (6-18 years of age) with cirrhotic liver disease (CLD) and noncirrhotic portal hypertension (NCPH) were prospectively enrolled. Frailty assessment was performed using the five classic Fried Frailty criteria. The children were followed up for 12 months to assess long-term outcomes.

Results: The study included 170 children (CLD [n = 149; compensated CLD or CCLD, n = 109; decompensated CLD or DCLD, n = 40) and NCPH [n = 21]). The overall prevalence of frailty was 48% (40% in CCLD, 80% in DCLD group and 33% in NCPH group [p < 0.05]). Among the patients with CLD, 76 (51%) were identified as frail. Frail children had a significantly higher risk of decompensation and poorer hepatic synthetic functions, and their presence at baseline predicted future risk of decompensation, infectious complications, need for readmissions, and poor outcome (death) (p < 0.05).

Conclusion: There is a high prevalence of frailty in children with liver disease, which is associated with poorer clinical outcomes, including the risk of mortality. Thus, its presence in children with liver disease highlights the urgent unmet need for additional interventions to improve overall muscle mass and function.