Liver Transplant Is Associated with Sustained Improvement in Tandem Gait and Risk of Falls
| Autor: | Felicia Tinsley, Melanie B. White, Leroy R. Thacker, James B. Wade, Jasmohan S. Bajaj, Velimir A. Luketic, Hannah Lee, Douglas M. Heuman, Chathur Acharya, Puneet Puri, Arun J. Sanyal, Andrew Fagan, Scott Matherly, Mohammad S. Siddiqui, Michael Fuchs, R. Todd Stravitz, Richard K. Sterling, HoChong Gilles |
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| Rok vydání: | 2020 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty Cirrhosis Physiology Tandem gait Neurological examination Article Quality of life Risk Factors Internal medicine medicine Humans Cognitive Dysfunction Prospective Studies Gait Hepatic encephalopathy medicine.diagnostic_test business.industry Gastroenterology Clinical course Middle Aged Hepatology medicine.disease Liver Transplantation Treatment Outcome Quality of Life Etiology Accidental Falls Female Gait Analysis business |
| Zdroj: | Dig Dis Sci |
| ISSN: | 1573-2568 0163-2116 |
| DOI: | 10.1007/s10620-020-06261-y |
| Popis: | BACKGROUND: Cirrhosis is associated with poor health related quality of life (HRQOL), cognitive dysfunction (CD) and lack of coordination leading to falls. Tandem gait (TG;heel-toe) can be used to assess coordination. The impact and relationship between CD, TG and falls pre/post liver transplant (LT) is unclear. We aimed to determine the impact of LT on CD, abnormal TG and HRQOL in cirrhosis. METHODS: We analyzed patients who underwent complete neurological examination, cognitive testing by psychometric hepatic encephalopathy score (PHES), and HRQOL assessment using sickness impact profile (SIP). All patients were followed for 1 post-LT visit at 6- or 12-months post-LT for clinical course and falls. Change in CD, TD and falls pre/post-LT were compared. RESULTS: Off 131 recruited, 61 patients completed all visits. Majority were men (84%), with HCV etiology (34%). Pre-LT: Abnormal TG trended towards increased falls (OR 3.3,P=0.08). Forty nine % had abnormal TG, 61% had CD, 32.7% had CD + abnormal TG, 62% had prior OHE & 14.7% had falls. Abnormal and normal TG patients had similar ages, BMI, sex, education level & MELD scores. Abnormal TG group had higher prior overt HE (P=0.03) and worse physical SIP score (P=0.008). Post-LT: There was sustained improvement in CD, HRQOL, falls and TG post-LT more at 12 than 6 months in all patients. Patients who had abnormal TG pre-LT, continued to have a worse PHES (P=0.0064) and physical SIP score (P=0.008) compared to normal pre-LT TG patients. CONCLUSION: After LT there is a sustained improvement in coordination measured via tandem gait, accompanied by a lower rate of falls. |
| Databáze: | OpenAIRE |
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