The Comprehensive Frailty Severity Index (FSI) for End-Stage Liver Disease can be used to identify frailty in a patient undergoing liver transplant. This consists of multiple components, including a nutritional assessment. The authors are from the University of Miami.
Patient selection: liver transplant recipient
Parameters:
(1) psoas muscle index (PMI) in square cm per meter square
(2) sex
(3) unintentional weight loss as percent of baseline body weight
(4) energy score as percent of monthly requirement (? dietary intake)
(5) abdominal distention (? ascites)
(6) pitting edema in mm
(7) muscle depletion score (temporalis, pectoralis, trapezius, quadriceps, gastrocnemius)
(8) fat depletion score (orbital, upper arm, triceps, thoraco-lumbar regions)
Parameter |
Finding |
Points |
psoas muscle index |
male and > 7.4 |
1 |
|
male and 6 to 7.4 |
2 |
|
male and 4.6 to 5.9 |
3 |
|
male and < 4.6 |
4 |
|
female and > 5.7 |
1 |
|
female and 4.9 to 5.7 |
2 |
|
female and 3.8 to 4.8 |
3 |
|
female and < 3.8 |
4 |
unintentional weight loss |
< 1% in 1 week; < 5% in 1 month; < 7.5% in 3 mo |
0 |
|
1-2% in 1 week; 5% in 1 month; 7.5% in 3 months |
1 |
|
> 2% in 1 week; > 5% in 1 month; > 7.5% in 3 months |
2 |
energy score |
> 75% of requirements |
0 |
|
51 to 75% |
1 |
|
<= 50% of requirements |
2 |
abdominal distention |
none |
0 |
|
mild or moderate |
1 |
|
marked |
2 |
pitting edema |
0 mm |
0 |
|
1 to 4 mm |
1 |
|
>= 5 mm |
2 |
muscle depletion |
well-defined muscles |
0 |
|
slight decrease |
1 |
|
hollowing, scooping, no definition |
2 |
fat depletion score |
slight fat pad bulge |
0 |
|
fat not ample; mild depression between ribs; mild prominence iliac crest |
1 |
|
hollow look; significant depression between ribs; prominent iliac crest |
2 |
where:
• Scoring of fluid accumulation is a little unclear. Here assumed that fluid accumulation incorporated abdominal distention and pitting edema.
nutritional subscore =
= SUM(points for all of the parameters)
Interpretation:
• minimum subscore: 1
• maximum subscore: 16