Two-Step Sequential Screening for Frailty in Patients With Chronic Liver Disease: A Triage Efficiency Study of Liver Frailty Index Components.
- 1Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Abstract
Aim
To develop and validate a nurse-administered two-step sequential screening pathway based on single Liver Frailty Index components for identifying frailty in people with chronic liver disease.Design
A single-centre cross-sectional diagnostic accuracy study.Methods
Overall, 606 hospitalised patients with chronic liver disease were enrolled between August 2021 and August 2025. Timed chair-stands and grip strength served as step-one index tests against frailty defined by the Liver Frailty Index (score of 4.5 or higher); bedridden patients were counted as screen-positive. Cutoffs were derived with the Youden index and stress-tested with bootstrap resampling and split-sample validation.Results
Frailty prevalence was 18.6%. The either-positive rule (chair stands of 16.55 s or longer, or grip strength of 23.42 kg or lower) achieved 100% sensitivity and a negative predictive value of 1.000, missing zero frail patients, while sparing 62.3% of patients from the complete index assessment. Zero missed cases were reproduced in five split-sample analyses.Conclusion
In this cohort, nearly two-thirds of full assessments could have been avoided without missing LFI-defined frailty cases. Prospective multicentre external validation of the frozen cutoffs is required before routine implementation.Implications for the profession and/or patient care
The pathway may reduce the burden of complete frailty assessment in inpatient hepatology nursing practice, pending external validation.Impact
Universal frailty screening in chronic liver disease is hindered by the burden of completing the full index. In this cohort, the first step identified all LFI-defined frailty cases while avoiding nearly two-thirds of complete assessments. These findings matter to hepatology nurses and inpatient hepatology services seeking feasible, guideline-concordant universal screening.Reporting method
This study adhered to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guideline.No patient or public contribution
Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.
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BibTeX
@article{wang2026twostep,
title = {{Two-Step Sequential Screening for Frailty in Patients With Chronic Liver Disease: A Triage Efficiency Study of Liver Frailty Index Components.}},
author = {Juan Wang and Shan Ouyang and Lihua Zheng and Shuxian Jiang and Na He and Lili Li},
journal = {Nursing open},
year = {2026},
month = oct,
doi = {10.1002/nop2.70915},
url = {https://europepmc.org/article/MED/42896173},
note = {CC BY},
}
RIS
TY - JOUR
TI - Two-Step Sequential Screening for Frailty in Patients With Chronic Liver Disease: A Triage Efficiency Study of Liver Frailty Index Components.
AU - Juan Wang
AU - Shan Ouyang
AU - Lihua Zheng
AU - Shuxian Jiang
AU - Na He
AU - Lili Li
PY - 2026
DA - 2026/10/01
JO - Nursing open
DO - 10.1002/nop2.70915
UR - https://europepmc.org/article/MED/42896173
AB - Aim To develop and validate a nurse-administered two-step sequential screening pathway based on single Liver Frailty Index components for identifying frailty in people with chronic liver disease.Design A single-centre cross-sectional diagnostic accuracy study.Methods Overall, 606 hospitalised patients with chronic liver disease were enrolled between August 2021 and August 2025. Timed chair-stands and grip strength served as step-one index tests against frailty defined by the Liver Frailty Index (score of 4.5 or higher); bedridden patients were counted as screen-positive. Cutoffs were derived with the Youden index and stress-tested with bootstrap resampling and split-sample validation.Results Frailty prevalence was 18.6%. The either-positive rule (chair stands of 16.55 s or longer, or grip strength of 23.42 kg or lower) achieved 100% sensitivity and a negative predictive value of 1.000, missing zero frail patients, while sparing 62.3% of patients from the complete index assessment. Zero missed cases were reproduced in five split-sample analyses.Conclusion In this cohort, nearly two-thirds of full assessments could have been avoided without missing LFI-defined frailty cases. Prospective multicentre external validation of the frozen cutoffs is required before routine implementation.Implications for the profession and/or patient care The pathway may reduce the burden of complete frailty assessment in inpatient hepatology nursing practice, pending external validation.Impact Universal frailty screening in chronic liver disease is hindered by the burden of completing the full index. In this cohort, the first step identified all LFI-defined frailty cases while avoiding nearly two-thirds of complete assessments. These findings matter to hepatology nurses and inpatient hepatology services seeking feasible, guideline-concordant universal screening.Reporting method This study adhered to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guideline.No patient or public contribution Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.
SN - 2054-1058
ER -