Falls and Cognitive Dysfunction Impair Health-related Quality of Life in Patients with Cirrhosis

Introduction: Falls are frequent in patients with cirrhosis and cognitive dysfunction and can deteriorate health-related quality of life (HRQoL).

Objective: To evaluate the relationship between previous falls and HRQoL in patients with cirrhosis.

Methods: We measured HRQoL in 118 outpatients with cirrhosis using the Medical Outcomes Study Short Form (SF-36) questionnaire, grouping items into the Physical Component Score (PCS) and the Mental Component Score (MCS). The incidence of accidental falls in the 12 months before the study was assessed using a specific questionnaire. The Psychometric Hepatic Encephalopathy Score (PHES) was administered to assess cognitive dysfunction. We considered cognitive dysfunction if PHES was less than -4. HRQoL was compared between patients with falls and patients without falls.

Results: HRQoL was lower in patients with previous falls than in patients without falls (P<0.05 in all domains of SF-36). In the multivariate analysis, the only independent factors that affected the HRQoL in the PCS were (B coefficient, 95% confidence interval) cognitive dysfunction (6.5, 3.2-9.7, P<0.001), previous variceal bleeding (3.9, 0.4-7.3, P=0.02), anemia (3.2, 0.07-6.4, P=0.049), and hyponatremia (9.3, 1.07-17.5, P<0.02). Multivariate analysis for MCS showed the independent factors for worse HRQoL were female sex (12.2, 6.9-17.5, P<0.001) and previous falls (10.3, 4.0-16.5, P=0.001).

Conclusion: Falls and cognitive dysfunction are independent factors associated with impaired HRQoL in patients with cirrhosis. Strategies addressed to improve HRQoL in these patients should consider the treatment of cognitive dysfunction and prevention of falls.