title: Physiologic and laboratory correlates of depression, anxiety, and poor sleep in liver cirrhosis.
abstract: BACKGROUND
  Studies have shown psychological distress in patients with cirrhosis, yet no studies have evaluated the laboratory and physiologic correlates of psychological symptoms in cirrhosis. This study therefore measured both biochemistry data and heart rate variability (HRV) analyses, and aimed to identify the physiologic correlates of depression, anxiety, and poor sleep in cirrhosis.
  
  
  METHODS
  A total of 125 patients with cirrhosis and 55 healthy subjects were recruited. Each subject was assessed through routine biochemistry, 5-minutes ECG monitoring, and psychological ratings of depression, anxiety, and sleep. HRV analysis were used to evaluate autonomic functions. The relationship between depression, sleep, and physiologic correlates was assessed using a multiple regression analysis and stepwise method, controlling for age, duration of illness, and severity of cirrhosis.
  
  
  RESULTS
  Reduced vagal-related HRV was found in patients with severe liver cirrhosis. Severity of cirrhosis measured by the Child-Pugh score was not correlated with depression or anxiety, and only had a weak correlation with poor sleep. The psychological distress in cirrhosis such as depression, anxiety, and insomnia were correlated specifically to increased levels of aspartate aminotransferase (AST), increased ratios of low frequency to high frequency power, or reduced nonlinear properties of HRV (α1 exponent of detrended fluctuation analysis).
  
  
  CONCLUSIONS
  Increased serum AST and abnormal autonomic nervous activities by HRV analysis were associated with psychological distress in cirrhosis. Because AST is an important mediator of inflammatory process, further research is needed to delineate the role of inflammation in the cirrhosis comorbid with depression.
authors: Section of Liver Cirrhosis, Shuguang Hospital and Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, 201203, China.
authors: Fang-Yuan
authors: FY
authors: Ko
authors: Albert C
authors: AC
authors: Yang
authors: Shih-Jen
authors: SJ
authors: Tsai
authors: Yang
authors: Y
authors: Zhou
authors: Lie-Ming
authors: LM
authors: Xu
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D001219:Aspartate Aminotransferases / Q000097:blood; D001341:Autonomic Nervous System / Q000503:physiopathology; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*
chemical_list: D001219:Aspartate Aminotransferases