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How Do Frailty and Sarcopenia Affect Outcomes of Patients With IBD?

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Frailty index scores associate with hospitalization-related outcomes and mortality in adults with inflammatory bowel diseases (IBD), researchers report in the new AGA Journal Gastro Hep Advances. Future research should focus on identifying and validating frailty and sarcopenia tools that might better help predict adverse outcomes and response to therapy in patients with IBD.

Management of patients with IBD is often guided by patient age, but frailty and sarcopenia, which are related but distinct entities that increase in prevalence with age, are associated with outcomes of patients with chronic illnesses. Katherine Bedard et al conducted a systematic review to assess the association between frailty or sarcopenia and adverse, non-surgical outcomes in adults with IBD.

Bedard et al analyzed data from 16 studies on frailty or sarcopenia and non-surgical outcomes of patients with IBD (8 frailty-based and 8 sarcopenia-based; 14 high quality and 2 low quality). In these studies, the tools used to measure frailty were diverse and included the Canadian Study of Health and Aging Frailty Index, the Hospital Frailty Risk Score, the Charlson Comorbidity Index, the Johns Hopkins Adjusted Clinical Groups Frailty Indicator, and T3/T4 ratio. Sarcopenia was primarily defined by skeletal muscle index cut-offs at the L3 vertebra determined by imaging analyses. The authors discuss the limitations to these different quantification tools.

Bedard et al found that frailty was associated with hospitalization and hospital readmission and length of stay as well as mortality, whereas the data regarding sarcopenia and hospitalizations were equivocal.

Some studies associated frailty and/or sarcopenia with response to treatment and need for therapy escalation but other studies did not. One study associated sarcopenia with infections in patients older than 50 years. A separate study found that higher proportions of frail patients developed infections after treatment (19% after [TNF] antagonist and 17% after immunomodulator therapy) compared with fit patients (9% after TNF and 7% after immunomodulator therapy).

In a study of other outcomes, frailty was independently associated with 57% higher risk of mortality, a 21% higher risk of all-cause readmission, and 22% higher risk of readmission to the hospital for severe IBD. Frail patients with IBD spent a median 9 days in the hospital annually (vs a median 5 days for non-frail patients), with higher costs of hospitalization ($17,791 for frail vs $10,924 for non-frail patients). This study found that infections, rather than IBD, were the leading cause of hospitalization for frail patients.

Bedard et al conclude that frailty and sarcopenia are challenges to study, because they overlap with many other factors, such as malnutrition, comorbidities, social determinants of health, cognition, and mental health. Retrospective studies of frailty can be limited by misclassification bias and the fact that diagnostic coding does not take into account how clinicians weigh the various aspects of frailty for individual patients.

Frailty and sarcopenia are important yet understudied prognostic factors for patients with IBD. Prospective studies are needed, with standard definitions of frailty and sarcopenia and well-defined outcomes such as response to therapy, adverse events and hospitalizations. Bedard et al recommend that sarcopenia studies include not only measures of muscle quantity or quality, but also strength or function, such as handgrip strength or gait speed assessments. The goal is to identify complete measures or markers of biological age or physiological reserve, and validate existing measures of IBD patients to tailor care not only for the elderly, but for all IBD patients

Gastro Hep Advances is the newest peer-reviewed journal published by the American Gastroenterological Association (AGA), joining Gastroenterology, Clinical Gastroenterology and Hepatology (CGH), Cellular and Molecular Gastroenterology and Hepatology (CMGH), and Techniques and Innovations in Gastrointestinal Endoscopy (TIGE). Gastro Hep Advances is a broad-scope, online-only, open access journal that publishes papers on basic, clinical and translational gastroenterology and hepatology. The open access model enables authors with funding mandates to have a high-quality home for their research. SUBMIT TODAY!

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Kristine Novak

Kristine Novak

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About The Author:

Dr. Kristine Novak

Dr. Kristine Novak

Dr. Kristine Novak is a science writer and editor based in San Francisco. She has extensive experience covering gastroenterology, hepatology, immunology, oncology, clinical, and biotechnology research discoveries.

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