Daily step count may predict hospital admission and mortality rates in cirrhosis patients

A new study found that Daily step count predicted hospital admission and mortality rates in cirrhosis patients. The study was published in the journal 'Clinical Gastroenterology and Hepatology.' 

Daily step count measures cardiorespiratory fitness and has been associated with better clinical outcomes. But its utility in cirrhosis patients is largely unexplored. Hence, researchers conducted a study to investigate the association between step count, frailty metrics, and clinical outcomes in cirrhosis patients. Liver frailty index, 6-minute walk test, and gait speed test were used to evaluate frailty in the participants. A personal activity tracker (PAT) was given to the participants to monitor step count. Another subset used Exercise and Liver FITness (EL-FIT). Daily step counts from the first week of PAT use and frailty metrics were investigated as predictors of hospital admission and mortality. 

Results: 

• 116 patients aged 56 ± 11 years were included of which there was 55% male population with a body mass index of 31 ± 7. 
• The model for end-stage liver disease-sodium was 15 ± 7.
• The main etiologies of cirrhosis were alcohol-related (33%) and nonalcoholic steatohepatitis (30%).
• Monitoring for the week was accomplished in 80% of participants given both PAT+EL-FIT vs 62% in those with PAT only (P = .04).
• During follow-up evaluation, hospital admission was observed in 55% and death in 15%.
• Kaplan–Meir curves showed increased readmission and deaths among patients performing in the lowest quartile (ie, <1200 steps/d).
• When adjusted by model for end-stage liver disease-sodium and EL-FIT use, the lowest quartile was associated with hospital admission and death, along with the 6-minute walk test and gait speed test. 

Thus, the researchers concluded that similar to the current standard frailty metrics, daily step count predicted hospital admission and mortality rates in patients with cirrhosis. They also suggested that the incorporation of a physical training–dedicated smartphone application was associated with increased PAT use and step reporting. 

TAKE-HOME MESSAGE

This study assessed the impact that daily steps count has on patients with cirrhosis about hospital admission, frailty, and death. Overall, 116 patients with cirrhosis were assessed for frailty and followed for outcomes. All patients received a personal activity tracker (PAT), whereas some patients also used a smartphone-based application (EL-FIT). Monitoring of activity was more effective in patients who received PAT + EL-FIT. Patients in the lowest quartile of step count had an increased risk of hospital admission and death when adjusted for a model for end-stage liver disease sodium score and EL-FIT use, and daily step count had a moderate correlation with frailty metrics.

Daily step count predicts mortality and hospitalization in patients with cirrhosis. Improvement in step count through exercise interventions may aid in promoting physical health and managing peri-transplant outcomes in community-dwelling patients with cirrhosis.

For the full article, click here: https://doi.org/10.1016/j.cgh.2022.03.012 

Lin FP, Bloomer PM, Grubbs RK, et al. Low Daily Step Count Is Associated With a High Risk of Hospital Admission and Death in Community-Dwelling Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2022;20(8):1813-1820.e2.