Clinical Significance of Autonomic Neuropathy in Liver Cirrhosis

Park, Jae Hong; Jeon, Sung Woo; Jung, Min Kyu; Lee, Jong Hyub; Cho, Chang Min; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo; Park, Ki Soo

Abstract

BACKGROUND/AIMS: Autonomic neuropathy is not rare in patients with liver cirrhosis but little is known about the mechanisms and clinical characteristics of it. We evaluated the relationship between the severity of liver disease and that of autonomic neuropathy.
METHODS
Sixty patients with liver cirrhosis (age 53+/-8.4, mean+/-SD) were studied. Liver function and prothrombin time were tested and an ultrasonography or CT scan was performed. Liver function reservoir was classified according to Child-Pugh score for all patients. Heart rate variations in response to deep breathing, to Valsalva maneuver, and to orthostatism were also measured and were expressed by E/I index, Valsalva index, and Posture index, respectively. The prevalence was estimated and divided into early involvement and definite involvement using each index. The correlation between the severity of the liver disease and that of autonomic neuropathy was also studied.
RESULTS
Evidence of autonomic neuropathy was found in 68.3% (41); early involvement 46.7% (28), and definite involvement 21.7% (13), respectively. The prevalence of autonomic neuropathy was similar in alcohol induced, and virus induced, liver disease (84.6% vs 63.8%). Child-Pugh score showed inverse correlation with E/I index (r=-0.38, p<0.01) and Valsalva index (r=-0.34, p<0.05). On multiple logistic regression analysis, cardiovascular autonomic neuropathy was related to the serum albumin level (odds ratio 0.063, 95% CI).
CONCLUSION
In liver cirrhosis the prevalence and the severity of cardiovascular autonomic dysfunction are related to the severity of hepatic dysfunction (Child-Pugh score). It is possible that this complication may be of prognostic significance in patients with liver cirrhosis.