Falls tied to increased morbidity, mortality in patients with cirrhosis
Patients with cirrhosis are more likely to incur severe injuries from falls, thus increasing hospital costs and risk of death, reports a study.
“Poor outcomes are most associated with ascites, hepatic encephalopathy, alcohol abuse and infection, highlighting the subgroups at highest risk and most likely to benefit from preventative interventions,” the authors said.
The study identified 102,977 visits involving patients with cirrhosis and 26,996,120 patients without cirrhosis who presented with a fall.
Overall, patients with cirrhosis vs those with congestive heart failure had higher adjusted relative risk (ARR) of severe injury, including intracranial haemorrhage (ARR, 2.33; 95 percent CI, 2.02–2.68), skull fracture (ARR, 1.75; 1.53–2.00) and pelvic fracture (ARR, 1.71; 1.56–1.88). Risk was lower for less-severe injuries, including concussion (ARR, 0.95; 0.86–1.06) and lower-leg fracture (ARR, 0.86; 0.80–0.91).
On multivariate analysis, risk factors such as hepatic encephalopathy, alcohol abuse and infection significantly positively correlated with severe injury. In addition, cirrhosis correlated with increased risk of in-hospital death, longer length of stay and higher costs after a fall.
“All outcomes were worse compared with those for patients with congestive heart failure,” according to the authors.
The nationally representative National Emergency Department Sample, an all-payer database including all patients presenting with falls, was examined from 2009–2012. The authors determined the relative risks for and clinical associations with severe injuries.
Outcomes, including hospitalization, costs, length of stay and in-hospital death, were compared with those of patients with congestive heart failure.