Abstract
AIMS: Frailty predisposes patients with cirrhosis to hepatic encephalopathy (HE). This study aimed to evaluate the effect of frailty on risk stratification for covert HE (CHE) and overt HE (OHE) in patients with cirrhosis. METHODS: Hospitalized patients with cirrhosis and without history of OHE were retrospectively included. Frailty was assessed using the Clinical Frailty Scale (CFS). Factors associated with CHE and OHE development were evaluated using the logistic regression and Fine-Gray competing risk regression models, respectively. RESULTS: Among 262 patients (median [interquartile range] age, 65 [55-74] years; 154 [58.8%] female), frailty and CHE were identified in 25 (9.5%) and 82 (31.3%) patients, respectively. The prevalence of CHE was higher in patients with frailty than in those without frailty (84.0% vs. 25.7%; p < 0.001). During a median follow-up of 2.9 years, 40 patients (15.3%) developed OHE and 20 (7.6%) died. The incidence of OHE was higher in patients with frailty than in those without (incidence rates at 1, 3, and 5 years; 25%, 33%, and 36% vs. 5%, 11%, and 18%; p = 0.009). Multivariable analyses showed that CFS was an independent factor for CHE (odds ratio, 2.13; 95% confidence interval, 1.41-3.37; p < 0.001) and OHE development (subdistribution hazard ratio, 1.38; 95% confidence interval, 1.02-1.87; p = 0.037). CONCLUSION: Frailty assessed using the CFS is a robust factor to stratify the risk of CHE and OHE development in patients with cirrhosis. Patients with frailty should be screened and carefully monitored for HE.