# Frailty Diagnosed With the Clinical Frailty Scale Stratifies the Risk of Covert and Overt Hepatic Encephalopathy in Patients With Cirrhosis

## TL;DR

Frailty, measured by a clinical scale, increases the risk of both hidden and overt brain dysfunction in cirrhosis patients.

## Contribution

Frailty, as measured by the Clinical Frailty Scale, is shown to independently predict covert and overt hepatic encephalopathy in cirrhosis patients.

## Key findings

- Frail patients had a significantly higher prevalence of covert hepatic encephalopathy (CHE) compared to non-frail patients.
- Frailty was an independent predictor of both CHE and overt hepatic encephalopathy (OHE) development.
- Frail patients had a higher incidence of OHE during follow-up compared to non-frail patients.

## Abstract

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.

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.

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).

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.