Baroreceptor sensitivity and baroreceptor effectiveness index in cirrhosis: the relevance of hepatic venous pressure gradient.
BACKGROUND
Autonomic dysfunction has been reported as one of the complications of cirrhosis.


OBJECTIVE
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.
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy. simonetta.genovesi@unimib.it
Simonetta
S
Genovesi
Daniela M
DM
Prata Pizzala
Massimo
M
Pozzi
Laura
L
Ratti
Maria
M
Milanese
Antonio
A
Vincenti
Andrea
A
Stella
Giuseppe
G
Mancia
D000328:Adult; D000368:Aged; D017704:Baroreflex / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006503:Hepatic Veins / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011311:Pressoreceptors / Q000473:pathology / Q000503:physiopathology*; D012720:Severity of Illness Index