CardiovascularAutonomic Dysfunction in Cirrhotic Patients

Abstract

Background: Cirrhosis is a pathologically defined entity associated with a spectrumof characteristicmanifestations.The cardinal pathologic features reflect irreversible chronic injury of the hepatic parenchyma and include extensive fibrosis in association with the formation of regenerative nodules.Autonomic dysfunction is a frequent and important complication of cirrhosis. The risk of mortality in cirrhotic patients with autonomic dysfunction is higher than that in cirrhotic patientswithout this complication.This study aimed to determine the frequency of autonomic cardiovascular dysfunction in cirrhotic patients.

Materials andMethods:Thirty cirrhotic patientswho admitted to Shahid SadoughiHospital and thirty healthy persons (control group , matched age and sex ) inYazd from Dec 2005 to July 2006 were studied. In both group individuals with renal failure, heart failure and diabetesmellituswere excluded.Drugs that influence the autonomic nervous system were discontinued for 24 hours and then, 3standard autonomic function tests were carried out. Results fromtwo group were collected in a questionnaire and analyzed statistically.

Results: Of 30 patients, 24 (80%) were men and 6 (20%) were women. The mean age was 51.9+19.4 years and the mean duration of cirrhosis was 3.8 ± 2.7 years. Twenty-six patients (86.7%) had autonomic neuropathy. Twenty-four out of these twenty-six patients (80%) had parasympathetic dysfunction and two (6.7%) had combined sympathetic and parasympathetic neuropathy. None of themshowed sympathetic dysfunction alone. Four patients (13.3%) didn't have autonomic neuropathy.Therewas significant correlation between the frequency of autonomic neuropathy and the severity of cirrhosis (p‹0.001). Significant correlationwas seen between the frequency of autonomic dysfunction and the duration of cirrhosis (p‹0.01).Therewas no significant correlation between age, sex and the frequency of dysfunction neuropathy (p=0.118 and p=0.16, respectively).

Conclusion:To assess the correlation between the etiology of cirrhosis and the prevalence of dysfunction neuropathy, a further prospective study involving a larger number of patients is necessary. More severe and prolonged hepatic failure was associated withmore frequent autonomic neuropathy in patients with cirrhosis.