EncephalApp and Critical Flicker Frequency are Associated With Accidental Falls in Liver Cirrhosis

Background and Aim: To assess the impact of minimal hepatic encephalopathy (MHE), detected by critical flicker frequency (CFF), paper-pencil (PHES) and computerized psychometric test (EncephalApp) on the risk of accidental falls in liver cirrhosis. Methods: This was a retrospective study including 45 patients with liver cirrhosis. MHE was evaluated by CFF (pathological <39 Hz), PHES (pathological ≤4 points) and EncephalApp (pathological ≥200 s). All tests were performed on the same day by the same operator. Accidental falls requiring healthcare assistance were collected before and after the evaluation of MHE. Results: MHE was detected in 42.2% (19/42) of patients by CFF, in 31.1% (14/44) by PHES and 60% (27/45) by EncephalApp. CFF and EncephalApp were associated with the presence of falls; (a) CFF <39 Hz 47.4% (9/19) vs. CFF > 39 Hz 13% (3/23) (P = 0.02); (b) EncephalApp ≥200 s 40.7% (11/27) vs. <200 s 5.6% (1/18) (P = 0.01). According to PHES, the 42.9% (6/14) of patients with PHES ≤4 points suffered from falls compared with 20% (6/30) in those with ≥4 points (P = 0.15). The percentage of falls increased progressively with the number of impaired test; 0% (0/10) with normal test, 18.8% (3/16) with one impaired test, 40% (4/10) with two altered tests and 62.5% (5/8) with three pathological tests. Other variables such as age, sex, liver function or prior episodes of HE were not associated with falls. Instead, we did observe a relationship with the value of creatinine (0.82 mg/dL vs. 0.67 mg/dL; P = 0.03). In multivariate analysis, CFF <39 (OR 6.15 (95%CI (0.98–38.9); P = 0.05)), EncephalApp <200 s (OR 0.08 (CI95% (0.01–0.83); P = 0.03)) and creatinine (OR 0.16 (95%CI (0.01–1.24); P = 0.062)) were independently associated with the risk of falls. On a receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.86 (CI95% (0.74–0.98); P < 0.0001)) (Figure 1). Conclusions: Critical flicker frequency and EncephalApp were associated with accidental falls in patients showing liver cirrhosis. Particularly, EncephalApp represents a good alternative to other common tests for MHE. The authors have none to declare.