Cirrhosis was diagnosed by clinical, analytical, and ultrasonographic findings or by liver biopsy. Exclusion criteria were as follows: any hospitalization in the previous month resulting from decompensation of cirrhosis, hepatocellular

carcinoma, active alcohol intake (in the previous 3 months), current overt acute or chronic HE, cognitive impairment (mini-mental Lobo test <24), neurological disease, inability to perform psychometric tests, marked symptomatic comorbidities (e.g., cardiac, pulmonary, renal, or untreated active depression), or life expectancy less than 6 months. Patients with a follow-up of less than 1 month were excluded from the analysis of Selleckchem MI-503 the results. We recorded demographic parameters and clinical and analytical data, such as etiology of cirrhosis, previous decompensations, previous transjugular intrahepatic portosystemic shunt (TIPS), Child-Pugh score, and model for end-stage liver disease (MELD) score. We also recorded parameters that influence the predisposition to fall in populations other than patients with cirrhosis. These parameters included serum

sodium,17 mean arterial pressure (MAP),17, 18 pharmacologic treatment,17-19 body mass index (BMI),18, 19 previous falls,18, 19 degree of comorbidity17-19 determined by the modified BIBW2992 solubility dmso Charlson scale,20 visual acuity assessed by Snellen’s test,21 and walking problems.17 The PHES includes a neuropsychological battery composed of five different paper-pencil tests: Number Connection

Test A and B; Line Tracing Test; Serial Dotting Test; and Digit Symbol Test.4 This battery detects changes in attention and psychomotor speed, which are the areas most affected by HE. We used the computer program of the Red Española de Encefalopatía Hepática (available at: www.redeh.org). The PHES has been validated for the Spanish population, and results were adjusted for age and educational level.22 Patients were considered to have CD when the PHES score Niclosamide was <−4 points.2, 4, 22 Critical flicker frequency (CFF) is a computerized test to detect MHE in patients with cirrhosis. In our study, CFF was performed as a complementary test. A portable, battery-powered analyzer (Hepatonorm Analyzer; R&R Medi-Business Freiburg GmbH, Freiburg, Germany) was used. In this method, an intermittent red light gradually decreases the initially high-frequency pulse (60 Hz), and when the patient perceives that the light turns from steady to flickering, the frequency at which the patient perceives this change is recorded as the CFF value.2 The procedure was repeated five times to ensure patient understanding. The test was then repeated 10 times, and mean ± SD values were calculated for each patient. CFF was measured in a quiet, semidarkened room to avoid interferences. CFF was not performed in patients with visual defects that precluded accurate performance of the procedure.