Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2023; 29(46): 6028-6048
Published online Dec 14, 2023. doi: 10.3748/wjg.v29.i46.6028
Frailty in end-stage liver disease: Understanding pathophysiology, tools for assessment, and strategies for management
Mazen Elsheikh, Ahmed El Sabagh, Islam B Mohamed, Megha Bhongade, Manal M Hassan, Prasun Kumar Jalal
Mazen Elsheikh, Ahmed El Sabagh, Islam B Mohamed, Megha Bhongade, Prasun Kumar Jalal, Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX 77030, United States
Manal M Hassan, Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Elsheikh M and Jalal PK contributed to the study conception and design; Elsheikh M and El Sabagh A reviewed the literature and wrote the manuscript; Jalal PK, Mohamed IB, Bhongade M and Hassan MM critically reviewed the manuscript; all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mazen Elsheikh, MD, Research Assistant, Department of Gastroenterology and Hepatology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States. dr_mazenelsheikh@hotmail.com
Received: September 13, 2023
Peer-review started: September 13, 2023
First decision: October 17, 2023
Revised: November 8, 2023
Accepted: December 1, 2023
Article in press: December 1, 2023
Published online: December 14, 2023
Abstract

Frailty and sarcopenia are frequently observed in patients with end-stage liver disease. Frailty is a complex condition that arises from deteriorations across various physiological systems, including the musculoskeletal, cardiovascular, and immune systems, resulting in a reduced ability of the body to withstand stressors. This condition is associated with declined resilience and increased vulnerability to negative outcomes, including disability, hospitalization, and mortality. In cirrhotic patients, frailty is influenced by multiple factors, such as hyperammonemia, hormonal imbalance, malnutrition, ascites, hepatic encephalopathy, and alcohol intake. Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients. It can aid in making critical decisions regarding patients’ eligibility for critical care and transplantation. This, in turn, can guide the development of an individualized treatment plan for each patient with cirrhosis, with a focus on prioritizing exercise, proper nutrition, and appropriate treatment of hepatic complications as the primary lines of treatment. In this review, we aim to explore the topic of frailty in liver diseases, with a particular emphasis on pathophysiology, clinical assessment, and discuss strategies for preventing frailty through effective treatment of hepatic complications. Furthermore, we explore novel assessment and management strategies that have emerged in recent years, including the use of wearable technology and telemedicine.

Keywords: End-stage liver disease, Frailty, Liver cirrhosis, Malnutrition, Sarcopenia

Core Tip: Frailty is a common condition in patients with cirrhosis, and it is associated with increased morbidity and mortality. This review provides a comprehensive overview of the etiology, pathophysiology, assessment, and management of frailty in cirrhosis. It places particular emphasis on the management of frailty during complications, while also delving into the future of managing this condition.