Frailty in Children with Liver Disease: A Prospective Multicenter Study - 23/02/18

Doi : 10.1016/j.jpeds.2017.10.066

Eberhard Lurz, MD ^1,², Claudia Quammie, BSc ^1,², Michael Englesbe, MD ³, Estella M. Alonso, MD ⁴, Henry C. Lin, MD ⁵, Evelyn K. Hsu, MD ⁶, Katryn N. Furuya, MD ^7,⁸, Nitika A. Gupta, MD ⁹, Veena L. Venkat, MD ¹⁰, James F. Daniel, MD ¹¹, Mike A. Leonis, MD, PhD ¹², Tamir Miloh, MD ^13,¹⁴, Grzegorz W. Telega, MD ¹⁵, Jason Yap, MD ¹⁶, Jerome Menendez, DNP, MSN ¹⁷, Linda S. Book, MD ¹⁸, Ryan W. Himes, MD ¹⁴, Shikha S. Sundaram, MD ¹⁹, Rulan Parekh, MD ^1,², Chris Sonnenday, MD ³, John Bucuvalas, MD ¹², Vicky L. Ng, MD ^1,^2,^{*
Contributed equally.}, Binita M. Kamath, MBBChir ^1,^2,^*^{*
Contributed equally.}
¹ Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
² Department of Pediatric, University of Toronto, Toronto, Ontario, Canada
³ Department of Transplantation Surgery, University of Michigan, Ann Arbor, MI, USA
⁴ Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
⁵ Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
⁶ Division of Gastroenterology, Hepatology and Nutrition, University of Washington—Seattle Children's Hospital, Seattle, WA, USA
⁷ Division of Gastroenterology, Hepatology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, NC, USA
⁸ Division of Gastroenterology, Hepatology and Nutrition, Mayo clinic, Rochester, MN, USA
⁹ Division of Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta Emory University School of Medicine, Atlanta, GA, USA
¹⁰ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
¹¹ Division of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
¹² Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
¹³ Division of Gastroenterology, Hepatology and Nutrition, Phoenix Children's Hospital, Phoenix, AZ, USA
¹⁴ Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, TX, USA
¹⁵ Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, WI, USA
¹⁶ Division of Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital/Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
¹⁷ Division of Pediatric Gastroenterology, Levine Children's Hospital Carolinas Health Care Center, Charlotte, NC, USA
¹⁸ Division of Pediatric Gastroenterology, Primary Children's Hospital, Salt Lake, UT, USA
¹⁹ Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA

^*Reprint requests: Binita M. Kamath, MBBChir, Department of Pediatrics, University of Toronto, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.Department of PediatricsUniversity of TorontoDivision of Gastroenterology, Hepatology and NutritionThe Hospital for Sick Children555 University AveTorontoONM5G 1X8Canada

Abstract

Objective

To assess frailty, a measure of physiologic declines in multiple organ systems, in children with chronic liver disease using a novel pediatric frailty tool.

Study design

We performed a prospective cross-sectional multicenter study at 17 liver transplantation (LT) centers. 71 children (5–17 years of age), 36 with compensated chronic liver disease (CCLD) and 35 with end-stage liver disease (ESLD) and listed for LT, were assessed for frailty using validated pediatric tools to assess the 5 classic Fried Frailty Criteria—slowness, weakness, exhaustion, diminished physical activity, and shrinkage. Test scores were translated to age- and sex-dependent z scores, generating a maximum frailty score of 10.

Results

The median frailty score of the cohort was 4 (IQR 3, 5). Subjects with ESLD had significantly higher frailty scores (median 5; IQR 4, 7) than subjects with CCLD (median 3; IQR 2, 4); (P < .0001). Area under the curve receiver operating characteristic for frailty scores to discriminate between ESLD and CCLD was 0.83 (95% CI 0.73, 0.93). Forty-six percent of children with ESLD were frail and there was no correlation between pediatric frailty scores and physician's global assessments (r = -0.24, 95% CI -0.53, 0.10).

Conclusions

A novel frailty tool assessed additional dimensions of health, not captured by standard laboratory measures and identified the sickest individuals among a cohort of children with chronic liver disease. This tool may have applicability to other children with chronic disease.

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Keywords : frailty, comprehensive clinical assessment, pediatric liver transplantation, end-stage liver disease

Abbreviations : 6-MWT, AUC, BMI, CCLD, CDC, ESLD, LT, MELD, PAQ, PELD, ROC, TSF

Plan

Association of Frailty scores with PELD and MELD-Na Scores and Physicians' Global Assessment

Accuracy of the Pediatric Frailty Score

Frailty Cut-Off Score in Children

Discussion

Funded by the Hospital for Sick Children Transplant and Regenerative Medicine Center Astellas Pilot Grant and the Lina Sweeney Foundation. The authors declare no conflicts of interest.

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Vol 194

P. 109 - mars 2018 Retour au numéro

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Frailty in Children with Liver Disease: A Prospective Multicenter Study - 23/02/18

Abstract

Objective

Study design

Results

Conclusions

Plan

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