Magnitude and pattern of autonomic neuropathy in cirrhosis of liver: A cross-sectional study from central rural India

Background: Cirrhosis of liver is an important cause of morbidity and mortality. Autonomic neuropathy need to be focused as it is independent predictor of mortality with 5-fold increased risk in patients with chronic liver disease (CLD). The aim of the present study was to study the magnitude and pattern of autonomic neuropathy (AN) among subjects with cirrhosis of liver presenting to teaching hospital in central rural India. Methodology: A cross-sectional study was performed in a tertiary care teaching hospital. In all patients of cirrhosis of liver irrespective of etiology, aged 15 and above, underwent clinical assessment and cardiovascular autonomic function tests to confirm autonomic nervous systems damage. We used chi square test to study associations. P value ≤0.05 was considered as significant. Crude odds ratios were computed to assess the strength of association between independent variables and dependent variables along with their 95% confidence intervals. Results: We included 199 cirrhosis of liver patients admitted in medicine department from November 2010 through November 2013. Nearly 83% patients were male and 63.3% patients were under the age of 45 years. Common features present in these patients were ascites (67.8%), splenomegaly (63.5%), pedal edema (60.3%), icterus (45.2%) and gastrointestinal bleeding (39.7%). Among the manifestation of autonomic nerves involvement dizziness on standing was the most common feature in 47.2%, followed by gustatory sweating in 21.6%, and nocturnal diarrhoea in 21.1%. Autonomic neuropathy was found in 70.9% [95% CI: 64.02-77.17] of study subjects on cardiovascular autonomic function tests. Conclusions: Analysis of cardiovascular autonomic function tests shows that the AN is very common in subjects with cirrhosis of liver.