Clinical Significance of Autonomic Neuropathy in Liver Cirrhosis

Korean J Hepatol > Volume 7(2); 2001 > Article

The Korean Journal of Hepatology 2001;7(2): 153-161.

원저 : 간경변 환자에서 자율신경병증의 임상적 의의 ( Clinical Significance of Autonomic Neuropathy in Liver Cirrhosis )

Clinical Significance of Autonomic Neuropathy in Liver Cirrhosis

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

Department of Internal Medicine, Liver Research Institute Kyungpook National University College of Medicine, Taegu medical center*, Taegu, Korea

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.(Korean J Hepatol 2001;7:153-161)

KeyWords: Autonomic neuropathy, Chronic liver disease, E/I index, Valsalva index, Posture index, Cirrhosis