Key result
Advanced cirrhosis and higher hepatic venous pressure gradient were associated with impaired baroreceptor sensitivity and higher mortality.
Observational (n=45)
In cirrhotic patients, liver disease severity and portal hypertension are associated with impaired baroreceptor function, which in turn correlates with higher mortality.
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Impaired baroreceptor sensitivity may aid risk stratification in advanced cirrhosis; leaves open causal links and therapeutic targets.
BACKGROUND: Autonomic dysfunction has been reported as one of the complications of cirrhosis. AIMS: The aim of this study was to test autonomic dysfunction in cirrhotic patients by analysing the baroreflex sensitivity and the baroreceptor effectiveness index (BEI), in order to determine its correlation with the severity and the aetiology of liver disease. Moreover, we explored the relationship between baroreceptor function and mortality in our cohort of patients. METHODS: Clinical and laboratory evaluation, hepatic venous pressure gradient (HVPG) and haemodynamic setting and baroreceptor function were assessed in 45 cirrhotic patients (median age 55, range 38-72 years) divided in groups according to the severity of their disease (26 patients Child A, 13 patients Child B and six patients Child C). RESULTS: Baroreceptor sensitivity and BEI were impaired in more advanced cirrhotic patients compared with subjects with milder disease (P<0.001). HVPG was significantly, independently and inversely correlated with baroreceptor sensitivity (P=0.003). More severe impairment of baroreceptor function was associated with a higher mortality (P=0.04) and subjects with alcohol-related cirrhosis presented worse baroreceptor function (P=0.032) and poorer survival (P=0.003) compared with subjects with post-viral liver disease. CONCLUSIONS: These data support the hypothesis that liver disease severity and particularly portal hypertension have an important role in the derangement of baroreceptor function. The aetiology of cirrhosis seems to be related to baroreceptor impairment as well. Mortality rate is higher in subjects with a more damaged autonomic system, strengthening the idea of a worse prognosis in cirrhotic patients with autonomic neuropathy.
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Genovesi et al. (2009) conducted an observational in Cirrhosis (n=45). Advanced cirrhosis and portal hypertension vs. Milder liver disease was evaluated on Baroreceptor sensitivity and baroreceptor effectiveness index (BEI) (p=<0.001). Advanced cirrhosis and higher hepatic venous pressure gradient were associated with impaired baroreceptor sensitivity and higher mortality.
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