[Evaluation of cardiovascular autonomic nervous system in ethanol withdrawal]

The aim of the study was to assess the risk factors and state of cardiovascular autonomic nervous system injury in ethanol dependent patients. The group examined consisted of 85 alcoholics (17 females and 68 males) aged from 27 to 68 y (45.7 +/- 8.82) hospitalized at the Ward of Toxicology and Environmental Diseases because of alcohol withdrawal. Ethanol dependence was diagnosed according to ICD -10 criteria, withdrawal syndrome was scored according to CIWA - A scale. A blood ethanol concentration, creatinine, urine, coagulation parameters and liver enzymes activity were measured on admission. Cardiovascular autonomic nervous system was evaluated by standard Ewing battery tests using VariaCardio TF5 system. The parasympathetic system was assessed by the heart rate response to forced breathing, the heart rate response to standing up, and to heart response to the Valsalva maneuver. The sympathetic system was evaluated by the blood pressure response to standing up. The original Ewing normal values were used.

The mean duration of ethanol dependence was 13.7 +/- 8.2 y. In 92% of examined patients heavy and in 8% moderate ethanol withdrawal syndrome was diagnosed. The mean blood ethanol concentration was 1.07 +/- 1.21g/l. Liver injury was diagnosed in 43.5% of the examined group. No changes in autonomic battery tests were found only in 28.2% of the examined subjects. Early parasympathetic damage was stated in 23.5%, definite parasympa-thetic damage in 44.7%, combined para-sympathetic and sympathetic damage was diagnosed in 3.5% of patients examined. The relative risk for parasympathetic and sympathetic system injury rose together with CIWA - scoring, blood ethanol concentration on admission (OR = 1,4 95% CI: 0,81 +/- 2,4), and when GTP activity was three times greater than normal (OR = 1.2 95% CI: 0.92 +/- 1.7).