Las caídas en los pacientes con cirrosis hepática. Relación con el deterioro cognitivo y la calidad de vida

Abstract

The thesis directs attention towards falls in patients with liver cirrhosis, a problem that until now had not been studied in these patients, despite its important consequences regarding morbidity, mortality, quality of life impairment and economic and social costs. The two studies included in the thesis analyze the problem of falls in patients with cirrhosis from different perspectives. A previous study carried out a retrospective analysis in a cohort of patients with cirrhosis and is included in the annexes. In this first article it was described for the first time how the presence of cognitive impairment (minimal hepatic encephalopathy) is associated with falls in these patients. This study represents the starting point of this thesis, which includes two clinical studies evaluating the relationship between falls, cognitive impairment and quality of life in patients with cirrhosis. The first study of this thesis prospectively analyzed the predictive value of the Psychometric Hepatic Encephalopathy Score (PHES), as an instrument to assess cognitive impairment, to identify those patients with cirrhosis at risk of falls. This study includes a prospective cohort composed by 122 patients followed for one year, and confirms the relationship between cognitive impairment and falls in cirrhosis. The results of this study establish a method to identify cirrhotic patients with high risk of falls: the presence of an altered value in the results of the neuropsychological battery that constitutes the PHES. Patients with altered PHES showed a probability of falling of 52.3% at one year-follow-up. It is interesting to point out the high use of health resources (hospitalization, stays in emergency room and outpatient consultations) as a result of falls, as well as the identification of other factors involved in the increase of the risk of falls in patients with cirrhosis, such as female gender and antidepressant drugs. The second study analyzes the relationship between falls and quality of life from a physical and mental perspective in patients with cirrhosis using the quality of life SF-36 questionnaire. This study demonstrates the importance of falls in the deterioration of quality of life in patients with cirrhosis, since previous falls were an independent factor associated with worse quality of life in the multivariate analysis. Other factors associated with impaired quality of life were: female gender, the presence of anemia, hyponatremia, previous gastrointestinal bleeding and cognitive dysfunction. In summary, the studies that compose the present thesis demonstrate that falls are a significant problem in patients with cirrhosis, establish a method (the PHES) to identify patients at high risk of falling, and demonstrate that falls are an important factor in the deterioration of quality of life in cirrhosis.

Date of Award	8 Feb 2013
Original language	Spanish
Supervisor	German Soriano Pastor (Director) & Juan Córdoba Cardona (Tutor)