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Frailty in children with chronic liver disease: Prevalence and impact on outcomes
Deepika Yadav1, Vikrant Sood1, Bikrant Bihari Lal1
1Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Insights
Frailty is common in children with liver disease, affecting nearly half of them. Frail children face higher risks of complications and mortality, highlighting the need for interventions.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Geriatrics
- Clinical Medicine
Background:
- Frailty is a known complication in chronic liver disease, linked to poor prognosis in adults.
- Limited research exists on frailty in pediatric liver disease populations.
- Frailty in children with liver disease is associated with increased morbidity and mortality.
Purpose of the Study:
- To determine the prevalence of frailty in children with liver disease.
- To identify predictive factors for frailty in this population.
- To analyze the association between frailty and long-term clinical outcomes.
Main Methods:
- Prospective enrollment of children aged 6-18 with cirrhotic liver disease (CLD) or noncirrhotic portal hypertension (NCPH).
- Frailty assessed using the five Fried Frailty criteria.
- Children followed for 12 months to evaluate outcomes.
Main Results:
- 170 children included: 149 with CLD (109 compensated, 40 decompensated) and 21 with NCPH.
- Overall frailty prevalence was 48% (40% compensated CLD, 80% decompensated CLD, 33% NCPH).
- Frail children showed higher risk of decompensation, poorer hepatic function, infections, readmissions, and mortality.
Conclusions:
- High prevalence of frailty observed in pediatric liver disease.
- Frailty is a significant predictor of adverse clinical outcomes, including mortality.
- Urgent need for interventions to enhance muscle mass and function in frail children with liver disease.
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.
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