Comparing Frequency of Cardiovascular Autonomic Neuropathy in Diabetic Cirrhotic with Non Diabetic Cirrhotic Patients

Abstract

Cardiac autonomic neuropathy is most common secondary complication of diabetes mellitusis frequently undiagnosed and neglected complication even though it is an independent predictor of mortality and morbidity. This phenomenon can be further exacerbated with co-morbidities like cirrhosis. High prevalence of diabetes as well as cirrhosis has been reported in Pakistan. However, proper knowledge and information regarding incidence of diabetesin cirrhosis induced cardiovascular autonomic neuropathy in is lacking.So, its early detection and timely management is needed to prevent cirrhotic and diabetic cardiomyopathy. Our objective is to determine and compare the frequency of cardiovascular autonomic neuropathy in diabetic cirrhotic and non-diabetic cirrhotic patients. Methods:Cross sectional study was done on120 patients enrolled in Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan. Two groups, diabetic cirrhotic and nondiabetic cirrhotic patients were taken.Those diabetic cirrhotic patients were selected, who had controlled glycemic levels due to proper medication, and patients of both groups had a definite diagnosis of cirrhosis liver. Cardiac autonomic neuropathy was determined in each patient using five standard tests. There after Bellavere,s scoring system was applied to assess  the extent of cardiac autonomic dysfunction in each subject. Results: There were 33 males and 27 females in diabetic cirrhotic group and 31 males and 29 females in non-diabetic cirrhotic group. The mean age was 57.48 ± 10.80 years in diabetic cirrhotic patients whereas in the non-diabetic cirrhotic patients, mean age was 51.92 ± 14.21 years. In the diabetic cirrhotic group, 52 patients had parasympathetic tests derangement and 50 patients had sympathetic tests derangement. In non-diabetic cirrhotic 48 patients had parasympathetic tests derangement and 47 patients had sympathetic test derangement. After analysing the results of frequency of cardiovascular autonomic neuropathy, the comparison between the two groups reveal that there is no significant difference between the two groups. Conclusions:This study shows that cardiovascular autonomic neuropathy develops frequently in cirrhotic subjects, that it is found with comparable frequency in diabetics and non-diabetics, and that it increases in severity with increase in severity of liver damage, suggesting that liver damage contributes to the neurological deficit.