The Activity Measure for Postacute Care “6-Clicks” Basic Mobility Score is Associated with Pre- and Posttransplant Mortality in Hospitalized Patients with Cirrhosis

BACKGROUND: Functional status and mobility are well-established predictors of liver transplant (LT) outcomes when measured in the ambulatory setting, but are less well studied in the inpatient setting. The Activity Measure for Postacute Care "6-Clicks" Basic Mobility (AM-PAC) score is a rapid, validated mobility assessment tool for hospitalized patients. METHODS: Adult patients with cirrhosis listed for transplant at a single center with a pre-LT hospitalization (2015-2024) were included. All pre-LT AM-PAC scores (range, 6-24; with 6 = severe impairment) were extracted from inpatient encounters. AM-PAC cut points were identified by optimizing model fit (pseudo-log-likelihood) in multivariable competing-risks regression models for waitlist mortality (WLM; death or delisting due to illness). Cox regression assessed risk of post-LT mortality. RESULTS: Among 465 patients with cirrhosis, median (interquartile range) Model for End-Stage Liver Disease score on admission was 25 (19-31); 21% of patients experienced WLM and 67% underwent LT. Optimizing model fit yielded AM-PAC cut points of 15 and 23, stratifying patients into low- (34%), intermediate- (55%), and high-risk (11%) groups. On multivariable analysis, adjusting for Model for End-Stage Liver Disease score, both intermediate-risk (scores 16-23; subdistribution hazard ratio [SHR], 2.01; 95% confidence interval [CI], 1.10-3.69) and high-risk (scores 6-15; SHR, 5.11; 95% CI, 2.20-11.89) groups were associated with WLM. Among patients who underwent LT (n = 301), each point decrease in the final pretransplant AM-PAC score was associated with a 15% increase in post-LT mortality (HR, 1.15; 95% CI, 1.04-1.28). CONCLUSIONS: Inpatient mobility, as measured by AM-PAC score, is strongly associated with both waitlist and post-LT mortality. As it is already embedded in inpatient workflows and rapidly administered, the AM-PAC tool offers a practical, scalable approach to risk stratify LT patients.