76 (P < 0.001). Figure 3 shows that the 1-year probability of falling was higher in patients with CD (52.3%) than in patients without (6.5%) (P < 0.001). In the subgroup of patients that completed the TUG, the test took longer to complete in patients with falls (n = 11) than in patients without falls (n = 20) (15.6 ± 4.4 versus 12.3 ± 2.6 seconds; P = 0.03). Orthostatic hypotension was present in 0 of 11 patients who fell and in 3 of 20 (15%) who did not fall (P = 0.53). Figure 4 shows the total number of patients and the number of patients who fell for each PHES

value. Falls began to occur especially at −5 points, but the Acalabrutinib incidence did not increase in parallel with worsening of the PHES score. Moreover, considering patients with CD (i.e., PHES <−4), there was no correlation

between PHES score and the number of falls (r = −0.08; P = 0.60), and PHES score was similar in patients who fell (n = 17) and in those who did not fall (n = 25) (−7.1 ± 2.0 versus −7.0 ± 1.7; P = 0.76). This is the first prospective study showing that CD defined by an impaired PHES is a predictive factor of falls in outpatients with cirrhosis. Patients with CD had an incidence of falls of 40.4%, in contrast with patients without CD who had an incidence of 6.2%. Moreover, the probability of CD patients falling was 52.3% at 1-year follow-up. These data confirm our previous retrospective study, in which patients with cirrhosis and PHES <−4 reported a higher incidence of falls during the previous year than patients with PHES > or equal MG-132 cell line to −4 and controls.12 In agreement with previous data, in the present study, one third of patients had CD,1-3 and this condition was associated with factors such as age,31 the degree of liver insufficiency,32 previous episodes of overt HE,32, 33 TIPS,34 hyponatremia,35 or CFF results.2 In populations other than patients with cirrhosis, mainly in elderly people and patients with neurological diseases, predisposition to falling has been related to a wide range of factors, including

age, gender, previous falls, hyponatremia, hypotension, pharmacological treatment, degree of comorbidity, impairment in visual acuity, walking problems, or BMI.17-19, 21 We assessed most of these factors Adenosine triphosphate in the present study, and comparing patients who fell to patients who did not, we found statistical differences only in gender, antidepressant treatment, and CD assessed by the PHES. However, the multivariate analysis identified CD as the only independent predictive factor of falls. Interestingly, the higher incidence of falls in patients with PHES <−4 was also evident when we analyzed only patients below 65 years old, patients without psychoactive treatment, and patients without previous overt encephalopathy. These data strongly support the association of CD with falls in patients with cirrhosis.