Evidence for the assessment of physical frailty and sarcopenia in hospitalized patients and the role of assessing changes over time

Abstract

Patient with advanced cirrhosis frequently require hospital treatment. In addition to the standard risk assessment tools (Child-Pugh stage, MELD-Na score), sarcopenia and physical frailty have been identified as independent risk factors for an unfavorable outcome. The diagnosis of sarcopenia is ideally confirmed with a normalized muscularity analysis on cross-sectional CT or MRI images at the level of the 3rd lumbar vertebra. Frailty can be assessed with relatively simple bedside tools that have been developed in other fields of medicine and recently evaluated in hospitalized patients with cirrhosis [activities of daily living (ADL) score, the Braden scale, and the Morse fall scale]. Based on the assessment of sarcopenia and frailty, patients at risk for further complications and unfavorable outcome can be identified, and a tailored treatment strategy with nutritional therapy and physical exercise can be implemented. Whether these intervention strategies improve the overall outcome of patients with advanced liver cirrhosis needs to be confirmed in future prospective trials.