{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T05:33:48Z","timestamp":1793338428928,"version":"4.5.0"},"reference-count":46,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003785","name":"Guangdong Medical Research Foundation","doi-asserted-by":"publisher","award":["A2023459"],"award-info":[{"award-number":["A2023459"]}],"id":[{"id":"10.13039\/501100003785","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Open"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To develop and validate a nurse\u2010administered two\u2010step sequential screening pathway based on single Liver Frailty Index components for identifying frailty in people with chronic liver disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A single\u2010centre cross\u2010sectional diagnostic accuracy study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Overall, 606 hospitalised patients with chronic liver disease were enrolled between August 2021 and August 2025. Timed chair\u2010stands and grip strength served as step\u2010one index tests against frailty defined by the Liver Frailty Index (score of 4.5 or higher); bedridden patients were counted as screen\u2010positive. Cutoffs were derived with the Youden index and stress\u2010tested with bootstrap resampling and split\u2010sample validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Frailty prevalence was 18.6%. The either\u2010positive rule (chair stands of 16.55\u2009s or longer, or grip strength of 23.42\u2009kg 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\u2010sample analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cohort, nearly two\u2010thirds of full assessments could have been avoided without missing LFI\u2010defined frailty cases. Prospective multicentre external validation of the frozen cutoffs is required before routine implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the Profession and\/or Patient Care<\/jats:title>\n                    <jats:p>The pathway may reduce the burden of complete frailty assessment in inpatient hepatology nursing practice, pending external validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>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\u2010defined frailty cases while avoiding nearly two\u2010thirds of complete assessments. These findings matter to hepatology nurses and inpatient hepatology services seeking feasible, guideline\u2010concordant universal screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>This study adhered to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guideline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>No Patient or Public Contribution<\/jats:title>\n                    <jats:p>Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.<\/jats:p>\n                  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