Frailty is a key determinant of outcomes in patients with cirrhosis. Two papers in this issue of the American Journal of Gastroenterology advance our understanding of the mechanism by which frailty impacts mortality-by increasing the risk of hospitalization for liver-related complications. We now have overwhelming justification to incorporate frailty into clinical practice, but this should be done in a systematic way to foster multi-center collaboration to accelerate research in this field. It is time for consensus on single frailty index to unify decision-making surrounding frailty and equalize outcomes for all cirrhotics across all centers.