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Applying Administrative Data-Based Coding Algorithms for Frailty in Patients With Cirrhosis.

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Summary

Claims-based frailty scores like HFRS and CFI do not fully capture physical frailty in cirrhosis patients. While associated with outcomes, they are outperformed by physical assessments for predicting survival.

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Area of Science:

  • Hepatology and Gastroenterology
  • Geriatrics and Gerontology
  • Health Services Research

Background:

  • Frailty is a key prognostic indicator in cirrhosis patients.
  • Claims-based frailty scores offer a non-invasive method to assess frailty.
  • Validation of these scores in cirrhosis populations is lacking.

Purpose of the Study:

  • To evaluate the validity of two claims-based frailty scores: Hospital Frailty Risk Score (HFRS) and Claims-Based Frailty Index (CFI) in cirrhosis.
  • To compare their association with physical frailty measures and their predictive performance for transplant-free survival.

Main Methods:

  • Analysis of 3 prospective cohorts (1100 cirrhosis patients).
  • Assessment of neuromuscular/neurocognitive function, Fried Frailty Index (FFI), chair stands, ADL, and falls.
  • Comparison of claims-based scores vs. physical frailty measures for predicting survival using competing risk regression.

Main Results:

  • CFI identified balance and strength deficits; HFRS identified only chair-stand performance.
  • Claims-based scores showed moderate discriminative ability for FFI, ADL, and falls (AUROCs 0.57-0.68).
  • FFI and chair stands outperformed claims-based scores in predicting survival; HFRS predicted survival, CFI did not.

Conclusions:

  • Claims-based frailty scores (HFRS, CFI) inadequately reflect physical frailty in cirrhosis.
  • These scores correlate with patient-reported outcomes like quality of life and sleep.
  • Physical frailty measures are superior for predicting survival in this population.