Autonomic function tests and clinical significance of dysautonomia in chronic liver disease

Autonomic function in 20 patients with chronic liver diseases was assessed clinically and by various tests like Valsalva ratio, expiratory-inspiratory ratio, postural tachycardia index, atropine ratio, blood pressure response to assumption of erect posture, hand immersion in cold water, and finger wrinkling response to hand immersion in warm water. Eighty per cent of the patients showed some clinical evidence of dysautonomia. While a good correlation between various clinical complaints of dysautonomia and the extent of parasympathetic dysfunction was observed in the individual patient, a significantly greater impairment of sympathetic function tests was observed in oliguric cirrhotics as compared to their non-oliguric counterparts.