Incidence of Autonomic Neuropathy in Patients with Chronic Liver Disease Due to Chronic Viral Hepatitis

Abstract

Objective: To assess the incidence of Cardiac Autonomic Neuropathy in patients with cirrhosis
and its relation with the severity of liver disease.
Methods: Twenty five patients with cirrhosis of liver due to chronic active hepatitis C in various
stages and severity of disease were assessed for the presence of cardiac autonomic neuropathy
by standard bedside tests of autonomic dysfunction as described by Ewing (Ewing's battery).
Results: Of the patients with class A cirrhosis only one (25%) had early parasympathetic
dysfunction. Those belonging to class B cirrhosis, 1 (8%) had early parasympathetic dysfunction,
4 (33%) had definite parasympathetic dysfunction and 2 (17%) had combined sympathetic and
parasympathetic dysfunction. Patients with class C cirrhosis 1 (11%) had early parasympathetic
dysfunction, 3 (34%) had definite parasympathetic dysfunction and two (22%) had combined
parasympathetic and sympathetic dysfunction. None of the patients had isolated sympathetic
dysfunction and all with sympathetic dysfunction also had parasympathetic dysfunction. One
patient with class B cirrhosis and two with class C cirrhosis had evidence of peripheral neuropathy
which was asymptomatic while only three patients with advanced (class C) cirrhosis had
symptoms suggestive of autonomic dysfunction like postural dizziness.
Conclusions: Cirrhosis of liver is associated with cardiac autonomic neuropathy which is
directly related with severity of illness.