title: Decreased heart rate variability in patients with cirrhosis relates to the presence and degree of hepatic encephalopathy.
abstract: Heart rate variability (HRV) is reduced in several clinical settings associated with either systemic inflammation or neuropsychiatric impairment. The possibility that the changes in HRV observed in patients with neuropsychiatric impairment might relate to the overproduction of inflammatory cytokines does not seem to have been considered in the studies undertaken to date. HRV is decreased in patients with liver cirrhosis but its relationship to the impairment of neuropsychiatric performance, commonly observed in these patients, is unknown. The aim of this study was to investigate the relationship between HRV, hepatic encephalopathy, and production of inflammatory cytokines in patients with cirrhosis. Eighty patients with cirrhosis [53 men, 27 women; mean (+/-1SD) age 54 +/- 10 yr], classified as neuropsychiatrically unimpaired or as having minimal or overt hepatic encephalopathy, and 11 healthy subjects were studied. HRV was assessed by applying Poincaré plot analysis to the R-R interval series on a 5-min ECG. Inflammatory cytokines (TNF-alpha, IL-6, IL-10, and IL-12) were measured in a subgroup of patients. Long-term R-R variability was significantly decreased in the patients with cirrhosis, in parallel with the degree of neuropsychiatric impairment (P < 0.01) and independently of the degree of hepatic dysfunction (P = 0.011). The relative risk of death increased by 7.7% for every 1-ms drop in this variable. Plasma levels of IL-6 significantly correlated with indexes of both HRV and neuropsychiatric performance. The changes observed in HRV and in neuropsychiatric status in patients with cirrhosis are significantly correlated, most likely reflecting a common pathogenic mechanism mediated by inflammatory cytokines.
authors.affiliation: Centre for Hepatology, Royal Free Campus, University College London Medical School, London, UK.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Mani
authors.forename: Sara
authors.initials: S
authors.lastname: Montagnese
authors.forename: Clive D
authors.initials: CD
authors.lastname: Jackson
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Jenkins
authors.forename: Ian M
authors.initials: IM
authors.lastname: Head
authors.forename: Robert C
authors.initials: RC
authors.lastname: Stephens
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Moore
authors.forename: Marsha Y
authors.initials: MY
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000276:immunology / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D016753:Interleukin-10 / Q000097:blood; D018664:Interleukin-12 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood*; D008103:Liver Cirrhosis / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D016207:Cytokines; C508609:IL10 protein, human; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D018664:Interleukin-12