Gait disorders and muscle changes in patients with liver cirrhosis: analysis of electroneurographic data of a subgroup of patients with and without cognitive impairment

Hepatic encephalopathy (HE) is a common complication of liver cirrhosis and minimal HE (MHE) increases the risk of falls. Gait alterations in cirrhotic patients are poorly understood, so the aims of this study is to describe the correlation between clinical parameters, such as HE, muscle changes, falls and gait disturbances, and electroneurographic changes.

Twenty-six patients underwent clinical and medical history evaluation to assess the presence of MHE and falls in the past year, and biochemical and instrumental evaluation to determine the presence of gait disturbances or sarcopenia by computed tomography (CT). Gait was assessed with the six-minute walk test (6MWT), the G-Walk device and G-STUDIO software. Ten patients underwent electroneurographic examination (ENG). Data obtained from gait analysis were compared with healthy subjects of the same age and sex.

In the gait analysis, the harmonic ratio (HR) and the recurrence quantification analysis (RQA) were considered. HR provides information on movement fluidity, balance and body coordination during movement, while RQA is based on the identification of parameters that quantify the regularity of time series.

In the subgroup of patients undergoing ENG analysis, lower values of HR in the antero-posterior and vertical directions correlated with the presence of sensory (τbAP= -0.629, p=0.039; τbV= -0.707, p=0.020) and motor (τbAP= -0.707, p=0.020; τbV= -0.629, p=0.039) neuropathy. The highest worsening of RQA index after 6MWT in vertical direction correlated with the presence of motor neuropathy (τbDET= 0.550, p=0.035). The number of falls correlated with sensory and motor electroneurographic parameters, while MELD score was inversely correlated with sensory and motor conduction velocity (ρ=-0.590, p= 0.047; ρ=-0.896, p= 0.003) and directly correlated with motor latency (ρ= 0.783, p= 0.013). Psychometric hepatic encephalopathy score (PHES) values were inversely correlated with distal motor latency signals (ρ=0.854, p= 0.003), while skeletal muscle index (SMI) values were found to be inversely correlated with proximal motor latency (ρ=0.802, p= 0.005).

Gait alterations are common in patients with cirrhosis, especially those with cognitive impairment, and correlate with severity of disease and risk of falls, identifying patients at risk of injuries and hospitalizations.