Prognostic Significance of Frailty in Liver Cirrhosis Patients: A Prospective Single-Center Study

<b>Background:</b> Liver cirrhosis is a systemic disease characterized by progressive hepatic dysfunction and frequent decompensation events. Conventional prognostic models such as the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores primarily reflect liver-specific severity and may not fully capture the multidimensional vulnerability of patients with cirrhosis. Frailty, a syndrome reflecting reduced physiological reserve, has emerged as a potential prognostic marker in this population. <b>Methods:</b> In this prospective single-center cohort study, 134 patients with liver cirrhosis were enrolled between March and October 2021 and followed at three-month intervals. Frailty was assessed at baseline using the Fried Frailty Index (FFI). Patients were categorized as fit/prefrail or frail. The primary endpoints were cirrhosis-related complications, unplanned hospitalizations, and all-cause mortality. Associations between frailty, its individual components, and clinical outcomes were evaluated. <b>Results:</b> Frailty was present in 41% of patients. Frail patients were older and had higher MELD and CTP scores. During follow-up, frailty was significantly associated with higher rates of ascites (<i>p</i> < 0.001), hepatic encephalopathy (<i>p</i> < 0.001), hepatorenal syndrome (<i>p</i> < 0.001), spontaneous bacterial peritonitis (<i>p</i> = 0.01), and unplanned hospitalizations (<i>p</i> < 0.001). Mortality occurred in 22% of frail patients compared with 3.8% in non-frail patients (<i>p</i> < 0.001). Each frailty component, including reduced grip strength, slow gait speed, low physical activity, exhaustion, and unintentional weight loss, was independently associated with adverse outcomes. <b>Conclusions:</b> Frailty, as assessed by the Fried Frailty Index, is a strong predictor of complications, hospitalization, and mortality in patients with liver cirrhosis. Incorporating frailty assessment into routine clinical practice may improve risk stratification and guide long-term management strategies.