Frailty in End-Stage Liver Disease: Understanding Pathophysiology, Tools for Assessment, and Strategies for Management

Authors

Mazen Elsheikh
Ahmed El Sabagh
Islam B Mohamed
Megha Bhongade
Manal M Hassan
Prasun Kumar Jalal

Publication Date

12-14-2023

Journal

World Journal of Hepatology

DOI

10.3748/wjg.v29.i46.6028

PMID

38130738

PMCID

PMC10731159

PubMedCentral® Posted Date

12-14-2023

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Humans, Frailty, End Stage Liver Disease, Liver Cirrhosis, Liver Diseases, Malnutrition, Sarcopenia, End-stage liver disease, Frailty, Liver cirrhosis, Malnutrition, Sarcopenia

Abstract

Frailty and sarcopenia are frequently observed in patients with end-stage liver disease. Frailty is a complex condition that arises from deteriorations across various physiological systems, including the musculoskeletal, cardiovascular, and immune systems, resulting in a reduced ability of the body to withstand stressors. This condition is associated with declined resilience and increased vulnerability to negative outcomes, including disability, hospitalization, and mortality. In cirrhotic patients, frailty is influenced by multiple factors, such as hyperammonemia, hormonal imbalance, malnutrition, ascites, hepatic encephalopathy, and alcohol intake. Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients. It can aid in making critical decisions regarding patients' eligibility for critical care and transplantation. This, in turn, can guide the development of an individualized treatment plan for each patient with cirrhosis, with a focus on prioritizing exercise, proper nutrition, and appropriate treatment of hepatic complications as the primary lines of treatment. In this review, we aim to explore the topic of frailty in liver diseases, with a particular emphasis on pathophysiology, clinical assessment, and discuss strategies for preventing frailty through effective treatment of hepatic complications. Furthermore, we explore novel assessment and management strategies that have emerged in recent years, including the use of wearable technology and telemedicine.