In Cirrhosis, Women Have Worse Frailty Scores Than Men

MONDAY, Jan. 4, 2021 -- Among patients with cirrhosis, women have worse frailty scores than men, which accounts for part of the gender gap in mortality while awaiting liver transplantation, according to a study published online Dec. 30 in JAMA Surgery.

Jennifer C. Lai, M.D., from the University of California in San Francisco, and colleagues examined whether frailty is associated with the gender gap in mortality among 1,405 adults with cirrhosis on a wait list for liver transplantation (41 percent women; 59 percent men).

The researchers found that women and men had similar median scores on the laboratory-based Model for End-stage Liver Disease incorporating sodium levels (18 versus 18), but women had a higher baseline Liver Frailty Index (LFI: mean, 4.12 versus 4.00). Worse balance of less than 30 seconds, worse sex-adjusted grip, and fewer chair stands per second were seen for women. LFI was 0.16 units higher in women than men after adjustment for other variables associated with frailty. Women experienced a 34 percent higher risk for wait-list mortality than men according to an unadjusted regression analysis. This association was not altered with sequential covariate adjustment; however, the mortality gap between women and men was attenuated with adjustment for LFI. Frailty mediated an estimated 13.0 percent of the gender gap in wait-list mortality.

"Clinicians can use these data to advise women awaiting liver transplant of their frailty-related excess mortality risk as motivation to engage in exercise and nutrition-based interventions in an attempt to mitigate this effect," the authors write.

Several authors disclosed financial ties to the pharmaceutical and health care venture capital industries.

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Posted: January 2021