Frailty Is an Independent Predictor of Mortality in Japanese Patients With Chronic Liver Disease: A Multicenter Retrospective Cohort Study

Frailty is emerging as a prognostic factor in chronic liver disease (CLD). However, its clinical impact remains underexplored, particularly in Japan. This study aimed to evaluate the prognostic significance of frailty in Japanese patients with CLD. In addition, the prevalence and clinical characteristics of frailty in this population were assessed. The present multicenter retrospective study included patients with CLD who were admitted to three institutions in Japan. Frailty was diagnosed based on a Clinical Frailty Scale score of > 4. Factors associated with prognosis and frailty were evaluated using Cox proportional hazards regression and logistic regression models, respectively. Of 715 patients (median [interquartile range] age, 67 [56-74] years; 354 [49.5%] male; 227 [38.7%] with viral hepatitis), frailty was identified in 137 (19.2%). During the median follow-up of 2.9 years, 221 patients (28%) died. Patients with frailty had significantly shorter survival than those without frailty (median 2.4 vs. 10.6 years, p < 0.001). Multivariable Cox regression analysis showed that frailty was an independent adverse factor for mortality (hazard ratio, 1.75; 95% confidence interval, 1.25-2.45; p = 0.001) in patients with CLD. Regarding determinants of frailty, multivariable logistic regression analysis showed that older age, hepatic encephalopathy, hypoalbuminemia, thrombocytopenia, and prolonged international normalized ratio were associated with frailty. Frailty is prevalent in patients with CLD and independently predicts poor survival. Given its prognostic significance, frailty assessment should be incorporated for risk stratification, early intervention, and outcome improvement in patients with CLD.