Frailty in Children with Liver Disease: A Prospective Multicenter Study

Eberhard Lurz, Claudia Quammie, Michael Englesbe, Estella M. Alonso, Henry C. Lin, Evelyn K. Hsu, Katryn N. Furuya, Nitika A. Gupta, Veena L. Venkat, James F. Daniel, Mike A. Leonis, Tamir Miloh, Grzegorz W. Telega, Jason Yap, Jerome Menendez, Linda S. Book, Ryan W. Himes, Shikha S. Sundaram, Rulan Parekh, Chris SonnendayJohn Bucuvalas, Vicky L. Ng, Binita M. Kamath

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Objective: To assess frailty, a measure of physiologic declines in multiple organ systems, in children with chronic liver disease using a novel pediatric frailty tool. Study design: We performed a prospective cross-sectional multicenter study at 17 liver transplantation (LT) centers. 71 children (5–17 years of age), 36 with compensated chronic liver disease (CCLD) and 35 with end-stage liver disease (ESLD) and listed for LT, were assessed for frailty using validated pediatric tools to assess the 5 classic Fried Frailty Criteria—slowness, weakness, exhaustion, diminished physical activity, and shrinkage. Test scores were translated to age- and sex-dependent z scores, generating a maximum frailty score of 10. Results: The median frailty score of the cohort was 4 (IQR 3, 5). Subjects with ESLD had significantly higher frailty scores (median 5; IQR 4, 7) than subjects with CCLD (median 3; IQR 2, 4); (P <.0001). Area under the curve receiver operating characteristic for frailty scores to discriminate between ESLD and CCLD was 0.83 (95% CI 0.73, 0.93). Forty-six percent of children with ESLD were frail and there was no correlation between pediatric frailty scores and physician's global assessments (r = -0.24, 95% CI -0.53, 0.10). Conclusions: A novel frailty tool assessed additional dimensions of health, not captured by standard laboratory measures and identified the sickest individuals among a cohort of children with chronic liver disease. This tool may have applicability to other children with chronic disease.

Original languageEnglish
Pages (from-to)109-115.e4
JournalJournal of Pediatrics
StatePublished - Mar 2018
Externally publishedYes


  • comprehensive clinical assessment
  • end-stage liver disease
  • frailty
  • pediatric liver transplantation


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