Falls and malnutrition are associated with in-hospital mortality in patients with cirrhosis

Abstract

Background: Hospitalized patients with end-stage liver disease are at risk of malnutrition, reduced body function, and cognitive impairment due to HE. This combination may have an impact on in-hospital falls and mortality. The purpose of this study was to identify factors associated with the risk of falls and to analyze the consequences regarding in-hospital mortality.

Methods: We performed a retrospective analysis of patients hospitalized with liver cirrhosis between 2017 and 2019 at the Department of Gastroenterology at the University Hospital Frankfurt. Clinical data, laboratory work, and follow-up data were analyzed. Factors associated with the risk of falls and in-hospital mortality were calculated using a mixed effect poisson regression model and competing risk time-to-event analyses.

Results: Falls occurred with an incidence of 4% (80/1985), including 44 injurious falls with an incidence rate of 0.00005/100 patient-days (95% CI: 0.00001-0.00022). In the multivariate analysis malnutrition (incidence risk ratio: 1.77, 95% CI: 1.04-3.04) and implanted TIPS (incidence risk ratio: 20.09, 95% CI: 10.1-40.1) were independently associated with the risk of falling. In a total of 21/80 (26.25%) hospitalizations, patients with a documented fall died during their hospital stay versus 160/1905 (8.4%) deaths in hospitalizations without in-hospital fall. Multivariable analysis revealed as significant clinical predictors for in-hospital mortality a Nutritional Risk Screening ≥2 (HR 1.79, 95% CI: 1.32-2.4), a falling incident during hospitalization (HR 3.50, 95% CI: 2.04-6.0), high MELD, and admission for infections.

Conclusions: Malnutrition and TIPS are associated with falls in hospitalized patients with liver cirrhosis. The in-hospital mortality rate of patients with cirrhosis with falls is high. Specific attention and measures to ameliorate these risks are warranted.

Graphical abstract

FIGURE 1

Incidence of falls (A) or injurious falls (B) per 100 patient days. Abbreviations: BP, blood pressure; NRS, nutritional risk screening.

FIGURE 2

Cumulative incidence of falls in patients with different nutritional risk score. Notes: P-values are for analyzing NRS in a competing risk setting using transplantation and death as competing risks. Adjustment factors for the p values from multivariable analysis are shown in Table 2, not using acute hydropic decompensation in the subgroup analyses. Abbreviation: NRS, nutritional risk screening.

FIGURE 3

In-hospital survival in admissions of patients with (A) different nutritional risk scores or (B) patients with or without falling incidents. Notes: Adjustment factors for the p-values from the multivariable analysis are given in Table 3. Abbreviation: NRS, nutritional risk screening.