From the Guidelines
Hepatic frailty refers to a condition where patients with liver disease experience increased vulnerability and reduced physiological reserve, making them more susceptible to stressors and adverse health outcomes, as described in the 2021 practice guidance by the American Association for the Study of Liver Diseases 1. This condition is characterized by the compromise of not only liver function but also multiple body systems, leading to muscle wasting (sarcopenia), decreased physical function, cognitive impairment, and malnutrition. Key features of hepatic frailty include:
- Muscle wasting and sarcopenia
- Decreased physical function and mobility
- Cognitive impairment
- Malnutrition
- Fatigue, weakness, and unintentional weight loss
- Slow walking speed and reduced grip strength
According to the algorithm for the management of malnutrition, frailty, and sarcopenia in clinical practice 1, the ultimate goal is to prevent the occurrence of adverse health outcomes attributable to these conditions. The management of hepatic frailty focuses on:
- Nutritional support with adequate protein intake
- Regular physical activity, including both aerobic and resistance exercises
- Treating the underlying liver disease
- Early identification and reassessment of malnutrition risk, frailty, and sarcopenia, which should occur at least annually for patients with well-compensated disease, but as frequently as every 8-12 weeks among those with decompensated cirrhosis and/or those undergoing active management for these conditions 1.
It is essential to involve a multidisciplinary team, including the patient's primary care provider, gastroenterologist/hepatologist, registered dietician, certified exercise physiologist/physical therapist, and health behavior specialist, in the management of hepatic frailty, especially in patients being evaluated for liver transplantation, as frail patients have higher risks of complications during surgery and poorer post-transplant outcomes 1.
From the Research
Definition of Hepatic Frailty
There are no research papers provided to directly answer the question about the meaning of hepatic frailty.
Related Concepts
However, the provided studies discuss hepatic encephalopathy (HE), a condition related to liver disease, and its treatment with lactulose and rifaximin. Key points about HE treatment include:
- Rifaximin plus lactulose is more efficacious than lactulose alone for reducing the risk of overt HE recurrence and HE-related hospitalization 2, 3, 4, 5.
- The combination of lactulose and rifaximin is effective in treating overt HE, with significant decreases in mortality and hospital stay 3, 4.
- Lactulose and rifaximin can improve patient-reported outcomes, such as health-related quality of life, in patients with HE 6.
Hepatic Encephalopathy Treatment
The studies focus on the treatment of HE with lactulose and rifaximin, highlighting their effectiveness and safety in managing the condition. Some key findings include:
- Rifaximin plus lactulose reduces the risk of overt HE recurrence and HE-related hospitalization compared to lactulose alone 2, 4, 5.
- Lactulose is effective for the prevention of overt HE recurrence over the long term, and the addition of rifaximin to lactulose significantly reduces the risk of overt HE recurrence and HE-related hospitalization 5.