The rate of and risk factors for falls among patients with cirrhosis: A multicenter study

BACKGROUND: Falls are associated with frailty and are a significant cause of morbidity among the elderly. Due to accelerated physiologic aging, frailty is common among patients with cirrhosis. We sought to identify the patients with cirrhosis at highest risk of falling and to explore the relationship between falls and frailty in this population. METHODS: We conducted a longitudinal, retrospective analysis of adults (above 18 y old) with cirrhosis from 2011 to 2021 in the multi-institutional CAPriCORN database. Falls were defined by validated International Classification of Diseases 9th and 10th edition codes. Frailty was defined using the Hospital Risk Frailty Score (mild <5, intermediate 5-15, severe >5). Multivariable Cox models identified risk factors for experiencing a first and second fall (HR: 95% CI). RESULTS: In total, 42,046 patients with cirrhosis were included with a median (IQR) age of 59.3 years (51.4-66.9) and mean (IQR) follow-up of 3.4 years (0.6-5.7). In total, 58.0% were male (n=24,390) and 59.5% had baseline compensated cirrhosis (n=25,021). Overall, 7.1% (n=2997) experienced a fall within the study period, 2.6% within 1 year of cirrhosis diagnosis. Prior fall history (HR: 5.69, 4.93-6.58), severe frailty (HR: 2.37, 2.02-2.80), and intermediate frailty (HR: 1.71, 1.49-1.96) were the strongest fall risk factors. In total, 38.4% of patients who fell experienced an additional fall during follow-up, 35% of which occurred within 1 year. Fall history (HR: 1.50, 1.18-1.90) and severe frailty (HR: 1.51, 1.16-1.96) were the strongest risk factors for a second fall. Patients with severe frailty had a 10-year cumulative fall incidence of 19.6%. CONCLUSIONS: Though 7% of patients experienced a fall, patients with a fall history or frailty were at significantly increased risk. These findings may help target patients with the highest fall risk and design fall-prevention interventions for this uniquely vulnerable population.