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Relationship between Circadian System Status, Child-Pugh Score, and Clinical Outcome in Cirrhotic Patients on Waiting
Laura Martínez-Alarcón1,2, Antonio Martínez-Nicolás2,3,4,5, Marta Jover-Aguilar2
1Departamento de Producción Animal, Hospital Clínico Universitario Virgen de la Arrixaca (UDICA), 30120 Murcia, Spain.
Insights
Circadian rhythms like activity and temperature are linked to liver cirrhosis severity. Monitoring these rhythms can improve patient care and survival for those awaiting liver transplants.
Area of Science:
- Chronobiology
- Hepatology
- Transplantation Medicine
Background:
- Liver cirrhosis patients awaiting transplantation are prioritized using scales like the Child-Pugh score.
- Current assessments do not evaluate circadian rhythms, such as motor activity and distal temperature.
Purpose of the Study:
- To investigate the relationship between circadian system function and the Child-Pugh scale in liver transplant candidates.
- To assess if circadian rhythm parameters correlate with liver disease severity.
Main Methods:
- 63 patients awaiting liver transplantation underwent a week of monitoring for distal temperature, motor activity, and light exposure using a wrist device (Kronowise 6.0).
- Circadian parameters including amplitude, regularity, and fragmentation were analyzed.
Main Results:
- Worsening circadian rhythm parameters (motor activity, distal temperature, light exposure) were closely associated with increased liver disease severity (Child-Pugh score).
- Deterioration in rhythmic parameters and liver disease correlated with reduced red blood cell count, hemoglobin, and hematocrit.
Conclusions:
- Ambulatory monitoring of circadian rhythms can supplement the Child-Pugh score in assessing liver transplant candidates.
- These findings suggest potential for personalized nutrition, exercise, and sleep guidelines to enhance survival and quality of life.
Abstract:
Background/Objectives: Many patients suffering from liver cirrhosis are eventually added to waiting lists for liver transplantation whose priority is established based on scales such as the Child-Pugh score. However, two marker rhythms of the circadian system, motor activity and distal temperature, are not evaluated. Methods: To determine the relationship between the functional status of the circadian system and the Child-Pugh scale in patients awaiting liver transplantation, distal temperature, motor activity, and light exposure rhythms were monitored for a full week using a wrist device (Kronowise 6.0) in 63 patients (17 women, 46 men) aged between 20 and 76 years. Results: Circadian parameters (amplitude, regularity, and fragmentation) of motor activity rhythms, distal temperature, and light exposure worsen in close association with liver disease severity as assessed by using the Child-Pugh score. Likewise, the worsening of rhythmic parameters and liver disease is associated with a deterioration in the markers of the red series: count, hemoglobin, and hematocrit. Conclusions: These results indicate the utility of ambulatory monitoring of marker rhythms to complement the clinical information provided by the Child-Pugh scale and to help establish nutrition, physical exercise, and sleep guidelines that promote better survival and quality of life in these patients.
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