Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more?
Minimal hepatic encephalopathy (MHE) is considered a risk factor for falls in patients with liver cirrhosis. However, MHE is prevalent in patients with muscle alterations (sarcopenia and myosteatosis) probably due to the role of muscle in ammonia handling. To assess the respective role of muscle alt...
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| Veröffentlicht in: | Digestive and liver disease 2022-03, Vol.54 (3), p.371-377 |
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| creator | Nardelli, Silvia Gioia, Stefania Ridola, Lorenzo Carlin, Michele Cioffi, Antonio Davide Merli, Manuela Spagnoli, Alessandra Riggio, Oliviero |
| description | Minimal hepatic encephalopathy (MHE) is considered a risk factor for falls in patients with liver cirrhosis. However, MHE is prevalent in patients with muscle alterations (sarcopenia and myosteatosis) probably due to the role of muscle in ammonia handling.
To assess the respective role of muscle alterations and MHE on the risk of falls in cirrhotic patients.
Fifty cirrhotics were studied for MHE detection by using Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT). CT scan was used to quantify the skeletal muscle index (SMI) and muscle attenuation, as a measure of myosteatosis. The risk of falls was evaluated by the Timed Up&Go test (TUG). The occurrence of falls during follow up was also detected.
32 patients (64%) had an abnormal TUG (< 14 s). In the group with TUG ≥ 14 s, MHE (72vs31%, p |
| doi_str_mv | 10.1016/j.dld.2021.06.019 |
| format | Article |
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To assess the respective role of muscle alterations and MHE on the risk of falls in cirrhotic patients.
Fifty cirrhotics were studied for MHE detection by using Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT). CT scan was used to quantify the skeletal muscle index (SMI) and muscle attenuation, as a measure of myosteatosis. The risk of falls was evaluated by the Timed Up&Go test (TUG). The occurrence of falls during follow up was also detected.
32 patients (64%) had an abnormal TUG (< 14 s). In the group with TUG ≥ 14 s, MHE (72vs31%, p<0.005) and myosteatosis (94vs50%, p = 0.002) were significantly more frequent than in patients with TUG<14 s. At multivariate the variables independently associated to TUG ≥ 14 s were myosteatosis, MHE and chronic beta-blockers use. During a mean follow-up of 25±16.9 months, 12 patients fell; the percentage of falls was significantly higher in patients with TUG ≥ 14 s (50%vs9%, p = 0.001) as well as in patients with myosteatosis (33%vs6%, p = 0.03), but similar in patients with or without MHE (35%vs15%, NS).
In cirrhotic patients both muscle alterations and cognitive impairment, as well as chronic beta-blockers use, are associated to the risk of falls.</description><identifier>ISSN: 1590-8658</identifier><identifier>EISSN: 1878-3562</identifier><identifier>DOI: 10.1016/j.dld.2021.06.019</identifier><identifier>PMID: 34233863</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Accidental Falls - statistics & numerical data ; Adrenergic beta-Antagonists - adverse effects ; Cognitive Dysfunction - etiology ; Cognitive Dysfunction - physiopathology ; Falls ; Female ; Follow-Up Studies ; Hepatic Encephalopathy - etiology ; Hepatic Encephalopathy - physiopathology ; Hepatic Encephalopathy - psychology ; Humans ; Liver Cirrhosis - complications ; Male ; Middle Aged ; Minimal hepatic encephalopathy ; Muscle, Skeletal - diagnostic imaging ; Muscle, Skeletal - physiopathology ; Myosteatosis ; Psychometrics ; Sarcopenia ; Sarcopenia - etiology ; Sarcopenia - physiopathology ; Sarcopenia - psychology ; Time and Motion Studies ; Timed up and go test ; Tomography, X-Ray Computed</subject><ispartof>Digestive and liver disease, 2022-03, Vol.54 (3), p.371-377</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-237fb6115b7ff337d1a12feb2db5f7f79bf4c2e0ade7daa06c58bb5b6cc508223</citedby><cites>FETCH-LOGICAL-c353t-237fb6115b7ff337d1a12feb2db5f7f79bf4c2e0ade7daa06c58bb5b6cc508223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1590865821003339$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34233863$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nardelli, Silvia</creatorcontrib><creatorcontrib>Gioia, Stefania</creatorcontrib><creatorcontrib>Ridola, Lorenzo</creatorcontrib><creatorcontrib>Carlin, Michele</creatorcontrib><creatorcontrib>Cioffi, Antonio Davide</creatorcontrib><creatorcontrib>Merli, Manuela</creatorcontrib><creatorcontrib>Spagnoli, Alessandra</creatorcontrib><creatorcontrib>Riggio, Oliviero</creatorcontrib><title>Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more?</title><title>Digestive and liver disease</title><addtitle>Dig Liver Dis</addtitle><description>Minimal hepatic encephalopathy (MHE) is considered a risk factor for falls in patients with liver cirrhosis. However, MHE is prevalent in patients with muscle alterations (sarcopenia and myosteatosis) probably due to the role of muscle in ammonia handling.
To assess the respective role of muscle alterations and MHE on the risk of falls in cirrhotic patients.
Fifty cirrhotics were studied for MHE detection by using Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT). CT scan was used to quantify the skeletal muscle index (SMI) and muscle attenuation, as a measure of myosteatosis. The risk of falls was evaluated by the Timed Up&Go test (TUG). The occurrence of falls during follow up was also detected.
32 patients (64%) had an abnormal TUG (< 14 s). In the group with TUG ≥ 14 s, MHE (72vs31%, p<0.005) and myosteatosis (94vs50%, p = 0.002) were significantly more frequent than in patients with TUG<14 s. At multivariate the variables independently associated to TUG ≥ 14 s were myosteatosis, MHE and chronic beta-blockers use. During a mean follow-up of 25±16.9 months, 12 patients fell; the percentage of falls was significantly higher in patients with TUG ≥ 14 s (50%vs9%, p = 0.001) as well as in patients with myosteatosis (33%vs6%, p = 0.03), but similar in patients with or without MHE (35%vs15%, NS).
In cirrhotic patients both muscle alterations and cognitive impairment, as well as chronic beta-blockers use, are associated to the risk of falls.</description><subject>Accidental Falls - statistics & numerical data</subject><subject>Adrenergic beta-Antagonists - adverse effects</subject><subject>Cognitive Dysfunction - etiology</subject><subject>Cognitive Dysfunction - physiopathology</subject><subject>Falls</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hepatic Encephalopathy - etiology</subject><subject>Hepatic Encephalopathy - physiopathology</subject><subject>Hepatic Encephalopathy - psychology</subject><subject>Humans</subject><subject>Liver Cirrhosis - complications</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minimal hepatic encephalopathy</subject><subject>Muscle, Skeletal - diagnostic imaging</subject><subject>Muscle, Skeletal - physiopathology</subject><subject>Myosteatosis</subject><subject>Psychometrics</subject><subject>Sarcopenia</subject><subject>Sarcopenia - etiology</subject><subject>Sarcopenia - physiopathology</subject><subject>Sarcopenia - psychology</subject><subject>Time and Motion Studies</subject><subject>Timed up and go test</subject><subject>Tomography, X-Ray Computed</subject><issn>1590-8658</issn><issn>1878-3562</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kElvFDEQRi0EIgv8gFyQj1y642W8DBxQlA2kSEgIzpaXcuKhezzY7qD8-ziawDGnqsOrr6oeQieUjJRQeboZwxRGRhgdiRwJXb9Ch1QrPXAh2eveizUZtBT6AB3VuiEdlIK8RQd8xTjXkh-i-Ueqv3GOONppqjht8c62BNtW8d_U7rBPpdzlmiqGezsttkHA7gG3NPdm2WG7Dfg24wa1fcIXGSqel-onwLlgV2zPm21rUPCcC3x5h970PRXeP9dj9Ovq8uf51-Hm-_W387ObwXPB28C4ik5SKpyKkXMVqKUsgmPBiaiiWru48gyIDaCCtUR6oZ0TTnoviGaMH6OP-9xdyX-WfpuZU_UwTXYLeamGidVaaq2U7Cjdo77kWgtEsytptuXBUGKeLJuN6ZbNk2VDpOmW-8yH5_jFdQ__J_5p7cDnPQD9yfsExVTfpXoIqYBvJuT0QvwjhAaOXg</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Nardelli, Silvia</creator><creator>Gioia, Stefania</creator><creator>Ridola, Lorenzo</creator><creator>Carlin, Michele</creator><creator>Cioffi, Antonio Davide</creator><creator>Merli, Manuela</creator><creator>Spagnoli, Alessandra</creator><creator>Riggio, Oliviero</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202203</creationdate><title>Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more?</title><author>Nardelli, Silvia ; Gioia, Stefania ; Ridola, Lorenzo ; Carlin, Michele ; Cioffi, Antonio Davide ; Merli, Manuela ; Spagnoli, Alessandra ; Riggio, Oliviero</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-237fb6115b7ff337d1a12feb2db5f7f79bf4c2e0ade7daa06c58bb5b6cc508223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Accidental Falls - statistics & numerical data</topic><topic>Adrenergic beta-Antagonists - adverse effects</topic><topic>Cognitive Dysfunction - etiology</topic><topic>Cognitive Dysfunction - physiopathology</topic><topic>Falls</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hepatic Encephalopathy - etiology</topic><topic>Hepatic Encephalopathy - physiopathology</topic><topic>Hepatic Encephalopathy - psychology</topic><topic>Humans</topic><topic>Liver Cirrhosis - complications</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minimal hepatic encephalopathy</topic><topic>Muscle, Skeletal - diagnostic imaging</topic><topic>Muscle, Skeletal - physiopathology</topic><topic>Myosteatosis</topic><topic>Psychometrics</topic><topic>Sarcopenia</topic><topic>Sarcopenia - etiology</topic><topic>Sarcopenia - physiopathology</topic><topic>Sarcopenia - psychology</topic><topic>Time and Motion Studies</topic><topic>Timed up and go test</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nardelli, Silvia</creatorcontrib><creatorcontrib>Gioia, Stefania</creatorcontrib><creatorcontrib>Ridola, Lorenzo</creatorcontrib><creatorcontrib>Carlin, Michele</creatorcontrib><creatorcontrib>Cioffi, Antonio Davide</creatorcontrib><creatorcontrib>Merli, Manuela</creatorcontrib><creatorcontrib>Spagnoli, Alessandra</creatorcontrib><creatorcontrib>Riggio, Oliviero</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive and liver disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nardelli, Silvia</au><au>Gioia, Stefania</au><au>Ridola, Lorenzo</au><au>Carlin, Michele</au><au>Cioffi, Antonio Davide</au><au>Merli, Manuela</au><au>Spagnoli, Alessandra</au><au>Riggio, Oliviero</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more?</atitle><jtitle>Digestive and liver disease</jtitle><addtitle>Dig Liver Dis</addtitle><date>2022-03</date><risdate>2022</risdate><volume>54</volume><issue>3</issue><spage>371</spage><epage>377</epage><pages>371-377</pages><issn>1590-8658</issn><eissn>1878-3562</eissn><abstract>Minimal hepatic encephalopathy (MHE) is considered a risk factor for falls in patients with liver cirrhosis. However, MHE is prevalent in patients with muscle alterations (sarcopenia and myosteatosis) probably due to the role of muscle in ammonia handling.
To assess the respective role of muscle alterations and MHE on the risk of falls in cirrhotic patients.
Fifty cirrhotics were studied for MHE detection by using Psychometric Hepatic Encephalopathy Score (PHES) and Animal Naming Test (ANT). CT scan was used to quantify the skeletal muscle index (SMI) and muscle attenuation, as a measure of myosteatosis. The risk of falls was evaluated by the Timed Up&Go test (TUG). The occurrence of falls during follow up was also detected.
32 patients (64%) had an abnormal TUG (< 14 s). In the group with TUG ≥ 14 s, MHE (72vs31%, p<0.005) and myosteatosis (94vs50%, p = 0.002) were significantly more frequent than in patients with TUG<14 s. At multivariate the variables independently associated to TUG ≥ 14 s were myosteatosis, MHE and chronic beta-blockers use. During a mean follow-up of 25±16.9 months, 12 patients fell; the percentage of falls was significantly higher in patients with TUG ≥ 14 s (50%vs9%, p = 0.001) as well as in patients with myosteatosis (33%vs6%, p = 0.03), but similar in patients with or without MHE (35%vs15%, NS).
In cirrhotic patients both muscle alterations and cognitive impairment, as well as chronic beta-blockers use, are associated to the risk of falls.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>34233863</pmid><doi>10.1016/j.dld.2021.06.019</doi><tpages>7</tpages></addata></record> |
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| ispartof | Digestive and liver disease, 2022-03, Vol.54 (3), p.371-377 |
| issn | 1590-8658 1878-3562 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Accidental Falls - statistics & numerical data Adrenergic beta-Antagonists - adverse effects Cognitive Dysfunction - etiology Cognitive Dysfunction - physiopathology Falls Female Follow-Up Studies Hepatic Encephalopathy - etiology Hepatic Encephalopathy - physiopathology Hepatic Encephalopathy - psychology Humans Liver Cirrhosis - complications Male Middle Aged Minimal hepatic encephalopathy Muscle, Skeletal - diagnostic imaging Muscle, Skeletal - physiopathology Myosteatosis Psychometrics Sarcopenia Sarcopenia - etiology Sarcopenia - physiopathology Sarcopenia - psychology Time and Motion Studies Timed up and go test Tomography, X-Ray Computed |
| title | Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more? |
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