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• W4205748722 abstract "We thank Dr. Singh et al. for their insightful comments on the role of ethnicity/race and sex in the measurement of frailty. We applaud their efforts in deriving a Liver Frailty Index (LFI) cutoff specific to the Indian population and look forward to seeing the publication of those results. In the current series, we acknowledge that the LFI was derived in a predominantly Caucasian population, while our cohort consisted of 20% Asian patients. We are grateful for this opportunity to address a few observations noted by Singh and colleagues. First, contrary to what is presented in the letter by Singh et al., we would like to clarify that out of the 170 Asian patients in our cohort, 60 were frail (35%), compared to the 578 Caucasian/European patients, where 125 were frail (22%). The prevalence of frailty in the Asian cohort is similar to that of other races (Native/Aboriginal, 12 out of 40 [30%], other, 4 out of 11 [36%]) and within range of what is currently reported in the literature.[1] Singh et al. describe a prevalence of frailty of 59% in Indian patients awaiting liver transplantation, while our cohort included all outpatients with cirrhosis, including those not actively on the waitlist. Acknowledging that cutoff values may vary by ethnicity/race and sex, all our analyses for primary and secondary endpoints were also performed using the LFI as a continuous scale. With these analyses, our results remain unchanged. A 0.1 increase in the LFI was associated with an HR for death or progression of 1.05 (95% CI, 1.02–1.08) and 1.06 (95% CI, 1.04–1.08) in compensated and decompensated disease, respectively. Similarly, a 0.1 increase in the LFI was associated with an HR for death alone of 1.09 (95% CI, 1.04–1.15) and 1.08 (95% CI, 1.06–1.10) in compensated and decompensated disease, respectively. In response to Singh et al., we also ran an interaction term of Asian versus non‐Asian patients across all outcomes. The results show that there was a significant interaction between the Asian race and outcomes; however, the association of frailty with progression, death, and hospitalizations was stronger in the Asian population. Due to the small number of patients who were robust and Asian, the HRs were unstable and could not be precisely reported. Taken together, while we completely agree that ethnicity/race can play a role in cutoff values for frailty, our results remain robust after using the LFI as a continuous scale and with the Asian race as an interaction term. We look forward to further research in the area with a larger representation of the Asian population. CONFLICT OF INTEREST Nothing to report." @default.
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• W4205748722 date "2022-01-27" @default.
• W4205748722 modified "2023-09-23" @default.
• W4205748722 title "Reply" @default.
• W4205748722 cites W3181395511 @default.
• W4205748722 doi "https://doi.org/10.1002/hep.32325" @default.
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