Prognostic value of the liver fragility index to predict hospitalization and mortality in outpatients with cirrhosis.

OBJECTIVE: To evaluate the association between LFI and the risk of hospitalization and mortality in outpatients with liver cirrhosis. PATIENTS AND METHODS: Prospective observational study of ambulatory patients with cirrhosis. After removal of duplicate records, 118 unique patients were analyzed. LFI was measured at baseline and categorized as robust, pre-frail, or frail. Time to first hospitalization and mortality were assessed using Cox proportional hazards models. Multivariable models were fitted, and the prognostic performance of Child-Pugh versus Child-Pugh + LFI was compared using Harrell's C-index and likelihood-ratio testing. RESULTS: Mean age was 65.5 ± 11.0 years and 61.0% were women. Overall, 56.8% were pre-frail and 20.3% were frail. During follow-up, 29 patients (24.6%) were hospitalized and 13 (11.0%) died. Continuous LFI was associated with hospitalization (HR 1.72; 95% CI 1.10-2.68; p=0.016) and mortality (HR 2.67; 95% CI 1.30-5.51; p=0.008) in univariable Cox models, but it did not remain statistically significant in the broader multivariable models. Adding LFI to Child-Pugh class increased the C-index from 0.665 to 0.719 for hospitalization (likelihood-ratio p=0.046) and from 0.765 to 0.859 for mortality (p=0.025). CONCLUSION: LFI was associated with hospitalization and mortality in ambulatory patients with cirrhosis. Although independent prognostic value was not demonstrated in the broader multivariable models, adding LFI to Child-Pugh class improved model fit and numerically increased discrimination. These findings support further evaluation of LFI as a complementary risk-stratification tool in larger cohorts.