Falls in Patients With Liver Cirrhosis

Yıldırım, Meriç

doi:10.1097/sga.0000000000000145

Cited by 13 publications

(7 citation statements)

References 37 publications

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“…Covariates (for adjustment only) for both outcomes included dichotomous indicators of female sex and non-White race or Hispanic ethnicity. They also included an indicator for those with two or more of the following chronic physical conditions (identified by ICD9 codes): cognitive impairment, dementia, 45,46 stroke, 47 seizure disorder, 48 diabetes, 41 anemia, 49 HCV, cirrhosis, 50 renal disease, 51 hypertension, 52 abnormal gait and osteoarthritis. 53 We further included a flag for participants who had at least one mental health diagnosis 54 (anxiety, major depressive disorder, bipolar disorder, schizophrenia, and psychosis).…”

Section: Risk Factors and Covariatesmentioning

confidence: 99%

Assessing the contributions of modifiable risk factors to serious falls and fragility fractures among older persons living with HIV

Womack

Murphy

Bates

et al. 2023

J American Geriatrics Society

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Background Although 50 years represents middle age among uninfected individuals, studies have shown that persons living with HIV (PWH) begin to demonstrate elevated risk for serious falls and fragility fractures in the sixth decade; the proportions of these outcomes attributable to modifiable factors are unknown. Methods We analyzed 21,041 older PWH on antiretroviral therapy (ART) from the Veterans Aging Cohort Study from 01/01/2010 through 09/30/2015. Serious falls were identified by Ecodes and a machine‐learning algorithm applied to radiology reports. Fragility fractures (hip, vertebral, and upper arm) were identified using ICD9 codes. Predictors for both models included a serious fall within the past 12 months, body mass index, physiologic frailty (VACS Index 2.0), illicit substance and alcohol use disorders, and measures of multimorbidity and polypharmacy. We separately fit multivariable logistic models to each outcome using generalized estimating equations. From these models, the longitudinal extensions of average attributable fraction (LE‐AAF) for modifiable risk factors were estimated. Results Key risk factors for both outcomes included physiologic frailty (VACS Index 2.0) (serious falls [15%; 95% CI 14%–15%]; fractures [13%; 95% CI 12%–14%]), a serious fall in the past year (serious falls [7%; 95% CI 7%–7%]; fractures [5%; 95% CI 4%–5%]), polypharmacy (serious falls [5%; 95% CI 4%–5%]; fractures [5%; 95% CI 4%–5%]), an opioid prescription in the past month (serious falls [7%; 95% CI 6%–7%]; fractures [9%; 95% CI 8%–9%]), and diagnosis of alcohol use disorder (serious falls [4%; 95% CI 4%–5%]; fractures [8%; 95% CI 7%–8%]). Conclusions This study confirms the contributions of risk factors important in the general population to both serious falls and fragility fractures among older PWH. Successful prevention programs for these outcomes should build on existing prevention efforts while including risk factors specific to PWH.

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Section: Risk Factors and Covariatesmentioning

confidence: 99%

Assessing the contributions of modifiable risk factors to serious falls and fragility fractures among older persons living with HIV

Womack

Murphy

Bates

et al. 2023

J American Geriatrics Society

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“…21 We controlled for risk factors associated with fragility fractures identified among older adults including demographics (age, sex, and race/ethnicity), body mass index (BMI), 22 and pain. We also included a count of chronic medical conditions (identified by ICD9 codes): cognitive impairment, dementia, 23,24 stroke, 25 seizure disorder, 26 vision impairment (blindness and cataracts), 27 diabetes, 28 anemia, 29 HCV, cirrhosis, 30 renal disease, 31 hypertension, 32 abnormal gait, and osteoarthritis. 33 We included a flag for participants who had at least 1 mental health diagnosis 34 (anxiety, major depressive disorder, bipolar disorder, schizophrenia, and psychosis).…”

Section: Primary Predictor and Covariatesmentioning

confidence: 99%

Brief Report: Are Serious Falls Associated With Subsequent Fragility Fractures Among Veterans Living With HIV?

Womack

Murphy

Ramsey

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:The extensive research on falls and fragility fractures among persons living with HIV (PWH) has not explored the association between serious falls and subsequent fragility fracture. We explored this association.Setting:Veterans Aging Cohort Study.Methods:This analysis included 304,951 6-month person- intervals over a 15-year period (2001–2015) contributed by 26,373 PWH who were 50+ years of age (mean age 55 years) and taking antiretroviral therapy (ART). Serious falls (those falls significant enough to result in a visit to a health care provider) were identified by the external cause of injury codes and a machine learning algorithm applied to radiology reports. Fragility fractures were identified using ICD9 codes and included hip fracture, vertebral fractures, and upper arm fracture and were modeled with multivariable logistic regression with generalized estimating equations.Results:After adjustment, serious falls in the previous year were associated with increased risk of fragility fracture [odds ratio (OR) 2.10; 95% confidence interval (CI): 1.83 to 2.41]. The use of integrase inhibitors was the only ART risk factor (OR 1.17; 95% CI: 1.03 to 1.33). Other risk factors included the diagnosis of alcohol use disorder (OR 1.49; 95% CI: 1.31 to 1.70) and having a prescription for an opioid in the previous 6 months (OR 1.40; 95% CI: 1.27 to 1.53).Conclusions:Serious falls within the past year are strongly associated with fragility fractures among PWH on ART—largely a middle-aged population—much as they are among older adults in the general population.

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“…Traffic accidents are more common in patients with MHE compared to normal individuals, as the driving process in patients with MHE is affected by defects in many factors such as, defects in attention and information processing, slow reactions, improper estimation of traffic conditions, and lack of coordination [48,62]. As many as 33% of MHE patients reported a traffic accident or violation within the past year [63].…”

Section: Effect Of Mhe On Drivingmentioning

confidence: 99%

Minimal Hepatic Encephalopathy: Silent Tragedy

Shiha¹,

Mousa²

2019

Liver Disease and Surgery [Working Title]

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Hepatic encephalopathy (HE) is brain dysfunction caused by both acute and chronic liver diseases that produces a spectrum of neuropsychiatric symptoms in the absence of other known brain diseases. Minimal hepatic encephalopathy (MHE) is the mildest form of this spectrum. MHE is defined as HE without symptoms on clinical or neurological examination, but with deficits in the performance of psychometric tests, working memory, psychomotor speed, and visuospatial ability. Minimal hepatic encephalopathy is associated with impaired driving skills and increased risk of motor vehicle accidents and has been associated with increased hospitalizations and death. Despite its clinical importance, a large number of clinicians had never investigated whether their cirrhotic patients might have MHE. Although, there is no single gold standard test for diagnosis of MHE, a combination of two neuropsychological tests or psychometric hepatic encephalopathy score battery test and/or neurophysiological test is standard for diagnosis of MHE. It was found that, treatment for MHE improves neuropsychiatric performance and quality of life and decreases the risk of developing overt HE (OHE). The agents used to treat OHE have been tested in patients with MHE. In particular, lactulose, rifaximin, probiotics and l-ornithine and l-aspartate (LOLA) have all been shown to be beneficial, with documented improvement in psychometric performance after treatment.

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Falls in Patients With Liver Cirrhosis

Cited by 13 publications

References 37 publications

Assessing the contributions of modifiable risk factors to serious falls and fragility fractures among older persons living with HIV

Assessing the contributions of modifiable risk factors to serious falls and fragility fractures among older persons living with HIV

Brief Report: Are Serious Falls Associated With Subsequent Fragility Fractures Among Veterans Living With HIV?

Minimal Hepatic Encephalopathy: Silent Tragedy

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