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Frailty in Children with Liver Disease: A Prospective Multicenter Study

Eberhard Lurz1, Claudia Quammie1, Michael Englesbe2

  • 1Division 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.

The Journal of Pediatrics
|February 27, 2018
PubMed

Insights

A new tool effectively measures frailty in children with chronic liver disease, identifying sicker patients. This pediatric frailty assessment tool shows promise for broader applications in pediatric chronic diseases.

Area of Science:

  • Pediatric Gastroenterology and Hepatology
  • Gerontology and Geriatric Medicine
  • Clinical Medicine

Background:

  • Chronic liver disease (CLD) in children leads to physiologic decline.
  • Frailty assessment is crucial for understanding disease severity and outcomes.
  • Existing tools may not fully capture frailty in pediatric populations.

Purpose of the Study:

  • To evaluate a novel pediatric frailty tool in children with chronic liver disease.
  • To assess frailty differences between compensated chronic liver disease (CCLD) and end-stage liver disease (ESLD) requiring liver transplantation (LT).

Main Methods:

  • Prospective, cross-sectional, multicenter study at 17 LT centers.
  • 71 children (5-17 years) with CCLD or ESLD were assessed using validated pediatric frailty criteria.
  • Frailty scores were age- and sex-adjusted, with a maximum score of 10.

Main Results:

  • The overall median frailty score was 4.
  • Children with ESLD had significantly higher frailty scores (median 5) than those with CCLD (median 3; P < .0001).
  • The tool discriminated between ESLD and CCLD with an AUC of 0.83; 46% of ESLD children were frail.

Conclusions:

  • A novel pediatric frailty tool effectively assesses health dimensions beyond standard lab tests.
  • The tool identifies the most vulnerable children with chronic liver disease.
  • This frailty assessment may be applicable to other pediatric chronic conditions.
Abstract

Keywords:
comprehensive clinical assessmentend-stage liver diseasefrailtypediatric liver transplantation

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