Cognitive dysfunction in cirrhosis is associated with falls: A prospective study
Por:
Soriano G., Román E., Córdoba J., Torrens M., Poca M., Torras X., Villanueva C., Gich I.J., Vargas V., Guarner C.
Publicada:
1 ene 2012
Resumen:
Falls are frequent among patients with debilitating disorders and can have a serious effect on health status. Mild cognitive disturbances associated with cirrhosis may increase the risk for falls. Identifying subjects at risk may allow the implementation of preventive measures. Our aim was to assess the predictive value of the Psychometric Hepatic Encephalopathy Score (PHES) in identifying patients likely to sustain falls. One hundred and twenty-two outpatients with cirrhosis were assessed using the PHES and were followed at specified intervals. One third of them exhibited cognitive dysfunction (CD) according to the PHES (<-4). Seventeen of the forty-two patients (40.4%) with CD had at least one fall during follow-up. In comparison, only 5 of 80 (6.2%) without CD had falls (P < 0.001). Fractures occurred in 4 patients (9.5%) with CD, but in no patients without CD (P = 0.01). Patients with CD needed more healthcare (23.8% versus 2.5%; P < 0.001), more emergency room care (14.2% versus 2.5%; P = 0.02), and more hospitalization (9.5% versus 0%; P = 0.01) as a result of falls than patients without CD. Patients taking psychoactive treatment (n = 21) had a higher frequency of falls, and this was related to an abnormal PHES. In patients without psychoactive treatment (n = 101), the incidence of falls was 32.4% in patients with CD versus 7.5% in those without CD (P = 0.003). In the multivariate analysis, CD was the only independent predictive factor of falls (odds ratio, 10.2; 95% confidence interval, 3.4-30.4; P < 0.001). The 1-year probability of falling was 52.3% in patients with CD and 6.5% in those without (P < 0.001). Conclusion: An abnormal PHES identifies patients with cirrhosis who are at risk for falls. This psychometric test may be useful to promote awareness of falls and identify patients who may benefit from preventive strategies. © 2012 American Association for the Study of Liver Diseases.
Filiaciones:
Soriano G.:
Department of Gastroenterology, Institut d'Investigació Biomèdica (IIB) Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Román E.:
Department of Gastroenterology, Institut d'Investigació Biomèdica (IIB) Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Escola Universitària d'Infermeria Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Córdoba J.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Escola Universitària d'Infermeria Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
Torrens M.:
Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain
Poca M.:
Department of Gastroenterology, Institut d'Investigació Biomèdica (IIB) Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Torras X.:
Department of Gastroenterology, Institut d'Investigació Biomèdica (IIB) Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Villanueva C.:
Department of Gastroenterology, Institut d'Investigació Biomèdica (IIB) Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Gich I.J.:
Department of Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Vargas V.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain
Guarner C.:
Department of Gastroenterology, Institut d'Investigació Biomèdica (IIB) Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Bronze, All Open Access; Bronze
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