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Hepatic encephalopathy score can predict risk for falls in patients with cirrhosis

The Psychometric Hepatic Encephalopathy Score can identify patients with cirrhosis who are at greater risk for falls, according to a recent study.

Researchers evaluated 122 patients with cirrhosis using the Psychometric Hepatic Encephalopathy Score (PHES), with follow-up consisting of telephone interviews every 3 months for 1 year. Falls taking place during follow-up were documented in order to assess the predictive value of the PHES.

Forty-two participants exhibited cognitive dysfunction (CD), indicated by a PHES score less than –4. The mean follow-up was 9.5±3.7 months in patients with CD, compared with 11.2±2.1 months for patients without CD (P=.008), which researchers attributed to a higher mortality rate among CD patients (23.8% vs. 3.8%; P=.001).

Of the patients with CD, 17 (40.4%) fell at least once during the follow-up period for a total of 32 falls, as opposed to five patients (6.2%) who fell a total of six times among participants without CD (P<.001). Four patients in the CD group experienced fractures, compared with no patients in the nondysfunctional group (P=.01). No correlation was found between participants’ PHES scores and frequency of falls (r=–0.08, P=.60).

Investigators also found that patients with CD who fell tended to require more health care than participants in the nonCD group who fell (23.8% vs. 2.5%, P<.001), as well as more emergency room care (14.2% vs. 2.5%, P=.02) and more frequent hospitalization (9.5% vs. 0%, P=.01). Multivariate analysis, which included gender, CD and use of antidepressants, indicated that CD was the only independent predictor of falling (OR=10.2; 95% CI, 3.4-30.4). Patients with CD had a 52.3% probability of falling within 1 year compared with 6.5% in nonCD patients (P<.001).

“This is the first prospective study showing that CD defined by an impaired PHES is a predictive factor of falls in outpatients with cirrhosis,” the researchers wrote. “… Falls in these patients are a significant cause of morbidity and healthcare requirements. Further studies are warranted to address the mechanisms implicated in this predisposition and to design preventive strategies.”