In Cirrhosis, Less Activity Equals Worse Outcomes

Daily step count measured by a a wearable sensor-based personal activity tracker predicted risk of hospital admission and mortality for patients with cirrhosis, a study found.

After adjusting for model for end-stage liver disease sodium (MELD-Na) and usage of a smartphone-based app designed for patients with end-stage liver disease, those in the lowest quartile of daily steps (<1,200 steps per day) had a significantly greater risk of hospitalizations and death:

• Hospitalization HR 1.90 (95% CI 1.09-3.30)
• Death HR 3.46 (95% CI 1.23-9.68)

Independent of MELD-Na and use of the app, the risk of hospital admission was reduced by 5% and the risk of death was reduced by 12% with every additional 500 steps walked per day, reported Andrés Duarte-Rojo, MD, PhD, of the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues in Clinical Gastroenterology and Hepatology.

In addition, better performance on the 6-minute walk test and gait speed test were each associated with lower risk of hospital admission and death, respectively:

• 6-minute walk test: HR 0.63 (95% CI 0.47-0.83) and HR 0.66 (95% CI 0.44-0.99) per 100 m
• Gait speed test: HR 0.29 (95% CI 0.11-0.72) and (HR 0.21, 95% CI 0.05-0.84)

"This is the first study to demonstrate the relationship between step counts and prevalence of frailty in patients with end-stage liver disease," the authors wrote.

"Daily step count can potentially substitute or supplement the current recommended frailty metrics when assessing and identifying physical frailty in community-dwelling adults with end-stage liver disease," they added.

"I think the bottom line is people who don't move are going to stay sick. I would say the average patient is not overly aggressive in documenting their steps or exercise because many of the patients are so sick by the time they get to us, they are nearly immobile," said Joseph Galati, MD, of Houston Methodist Hospital in Texas, who was not involved in this study.

"If we could give our patients access to these monitoring devices to keep track of their steps and movement that would help," he told MedPage Today. "We need to do this before they become really end-stage."

For this study, Duarte-Rojo and colleagues examined data on 116 patients with cirrhosis from the University of Pittsburgh Medical Center. Mean age was 56 years, 55% were men, mean MELD-Na score was 15, and mean body mass index was 31.

The most common etiologies of liver disease were alcohol-related cirrhosis (33%) and non-alcoholic steatohepatitis (30%). Over half of patients were listed for liver transplant.

Patients were excluded if they had received or were ineligible for a liver transplant, did not have access to a smartphone or wireless internet, or had overt hepatic encephalopathy.

The study participants were divided into those using a personal activity tracker alone (FitBit; n=71) or a tracker plus the EL-FIT app (n=45). Weekly monitoring of steps was completed in 80% of those who used the tracker with the app versus 62% of those who used the tracker alone (P=0.040).

During a follow-up of 223 days, 55% of patients were hospitalized and 15% died.

Duarte-Rojo and colleagues acknowledged that patients with gait disturbances, poor digital literacy, or those who experience physical discomfort during exercise may not be able to use a personal activity tracker, which was a limitation to their study.

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