Tesis

Frailty Berdasarkan Liver Frailty Index sebagai Prediktor Mortalitas dan Kejadian Dekompensasi pada Pasien Sirosis Hati: Sebuah Telaah Sistematis dan Meta-analisis = Frailty Based on The Liver Frailty Index as predictor of Mortality and Decompensation in Liver Cirrhosis Patients: A Systematic Review and Meta-analysis.

Latar belakang: Frailty merupakan sindrom biologis yang dapat menyebabkan kerentanan terhadap hasil yang lebih buruk terhadap pasien. Penilaian frailty saat ini berkembang pada populasi penyakit lainnya antara lain pada populasi pasien sirosis hati. Modalitas yang dikembangkan dan sudah divalidasi untuk menilai frailty pada populasi sirosis hati adalah dengan Liver Frailty Index (LFI). Prevalensi pasien sirosis hati yang mengalami frail ternyata cukup tinggi. Dipikirkan pasien yang mengalami frail akan meningkatkan mortalitas pada pasien sirosis hati. Tujuan: Menilai apakah frailty berdasarkan Liver Frailty Index dapat menjadi prediktor mortalitas pada pasien sirosis hati Metode: Penelusuran literatur dilakukan melalui basis data daring: PubMed/ MEDLINE, EMBASE, ProQuest, dan EBSCOhost dengan menggunakan kata kunci “sirosis hati” dan “liver frailty index” dalam Bahasa Inggris dan Indonesia. Pencarian manual dilakukan melalui portal data nasional, e-library fakultas kedokteran, dan snowballing. Studi yang dimasukkan ke dalam penelitian adalah studi kohort prospektif dan retrospektif yang mengikutsertakan pasien sirosis hati tanpa keganasan hati dan melaporkan mortalitas pasien berdasarkan status frailty. Hasil: Sebanyak 7 artikel diikutsertakan dalam telaah sistematis ini, 3 diantaranya diikutkan dalam meta-analisis untuk menilai hubungan dengan mortalitas dan 2 studi menilai hubungan dengan kejadian dekompensasi. Risiko mortalitas lebih tinggi pada pasien sirosis dengan frailty (HR 1,68; IK 95% 1,36-2,08; p < 0,00001). Frailty berhubungan dengan kejadian asites (OR 1,84 IK 95% 1,41-2,40; p < 0,00001). Tidak didapatkan adanya hubungan antara frailty dengan kejadian EH pada pasien sirosis hati (OR 1,57 IK 95% 0,65-3,80; p=0,31). Kesimpulan: Frailty merupakan prediktor mortalitas pada pasien sirosis hati. Pasien sirosis hati dengan frailty memiliki risiko kematian lebih besar dibandingkan pasien sirosis hati tanpa frailty.
Kata kunci: frailty, liver frailty index, sirosis hati, mortalitas, dekompensasi


Background: Frailty is a biologic syndrome that can lead to susceptibility to poorer outcomes for patients. Frailty assessment is currently developing in other disease populations, including the population of patients with liver cirrhosis. The developed and validated modality to assess frailty in the liver cirrhosis population is the Liver Frailty Index (LFI). The prevalence of liver cirrhosis patients who experience frail is quite high. It is thought that patients who experience frail will increase mortality in patients with liver cirrhosis. Objective: Assessing whether frailty based on the Liver Frailty Index can be a predictor of mortality in patients with liver cirrhosis Methods: Literature search was conducted through online databases: PubMed/MEDLINE, EMBASE, ProQuest, and EBSCOhost using the keywords “cirrhosis of the liver” and “liver frailty index” in English and Indonesian. Manual searches were carried out through national data portals, medical faculty e-libraries, and snowballing. The studies included in the study were prospective and retrospective cohort studies that included patients with liver cirrhosis without liver malignancy and reported patient mortality based on frailty status. Results: A total of 7 articles were included in this systematic review, 3 of which were included in a meta-analysis to assess the association with mortality and 2 studies assessed the association with the incidence of decompensation. There was a higher risk of mortality in cirrhotic patients with frailty (HR 1.68; 95% CI 1.36-2.08; p < 0.00001). Frailty was found to be associated with the incidence of ascites (OR 1.84 95% CI 1.41-2.40; p < 0.00001). There was no association between frailty and the incidence of HE in patients with liver cirrhosis (OR 1.57 95% CI 0.65-3.80; p=0.31). Conclusion: Frailty is a predictor of mortality in patients with liver cirrhosis. Liver cirrhosis patients with frailty have a greater risk of death than patients with liver cirrhosis without frailty.
Keywords: frailty, liver frailty index, liver cirrhosis, mortality, decompensation