Accepted for/Published in: JMIR Medical Informatics
Date Submitted: May 18, 2024
Date Accepted: Jan 12, 2025
Predictive value of frailty on outcomes of patients with cirrhosis: A systematic review and meta-analysis
ABSTRACT
Background:
Frailty is one of the common symptoms in patients with cirrhosis. Many researchers have identified it as a prognosis factor for cirrhosis patients. However, no quantitative meta-analysis exists on the prognostic value of frailty in cirrhosis patients.
Objective:
This systematic review and meta-analysis aimed to assess the prognostic significance of frailty in cirrhosis patients.
Methods:
The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. We conducted a comprehensive search of the literature using databases such as PubMed, Cochrane Library, Embase, and Web of Science, as well as China National Knowledge Infrastructure, encompassing the period from inception to Dec 22, 2023. Data were extracted for frailty to predict adverse outcomes in cirrhosis patients. RevMan5.3 and R.4.2.2 were used to assess the extracted data.
Results:
26 studies with 9597 cirrhosis participants were included. Compared with patients having low or no frailty, the frail group had higher mortality [relative ratio (RR)=2.07; 95% CI: 1.82–2.34; P<.001], higher readmission (RR=1.50; 95% CI: 1.22–1.84; P<.001), lower QoL (RR=5.78; 95% CI: 2.25–14.82; P<.001). The summary receiver operator characteristic (SROC) curve of frailty for morality in cirrhosis patients showed that the false positive rate (FPR) was 0.25 (95% CI: 0.17, 0.34), diagnostic odds ratio (DOR) was 4.17 (95% CI: 2.93, 5.93), sensitivity was 0.54 (95% CI: 0.39, 0.69), and specificity was 0.73 (95% CI: 0.64, 0.81). The SROC curve of readmission showed that FPR, DOR, sensitivity, and specificity were 0.39 (95% CI: 0.17, 0.66), 1.38 (95% CI: 0.64, 2.93), 0.46 (95% CI: 0.28, 0.64), and 0.60 (95% CI: 0.28, 0.85), respectively.
Conclusions:
Our meta-analysis demonstrates that frailty is a reliable prognostic predictor of outcomes in cirrhosis patients. To enhance the prognosis of cirrhosis patients, more studies on frailty screening are required. Clinical Trial: PROSPERO International Prospective Register of Systematic Reviews (CRD42024497698); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=497698.
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