Presence of autonomie neuropathy is a poor prognostic indicator in patients with advanced liver disease

Jaquelyn F. Fleckenstein, Steven M. Frank, Paul J. Thuluvath

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Autonomic neuropathy (AN) is seen in both alcoholinduced and non-alcohol-induced liver disease, and when present is an independent predictor of mortality. We postulated that patients who were awaiting liver transplantation are likely to have a high prevalence of autonomic neuropathy with an associated increase in mortality. To test our hypothesis, we evaluated the presence of autonomic neuropathy using a battery of tests in 33 patients awaiting liver transplantation and prospectively followed them to determine their prognosis. Twenty-two of 33 (67%) patients with liver disease had evidence of autonomic neuropathy; of these, 12 (36%) had evidence of definite and 10 (31%) had early autonomic neuropathy. The prevalence of AN was similar in alcohol-induced and non-alcohol-induced liver disease. Using Child-Pugh classification, 14.3% Child A, 31.3% Child B, and 60% Child C had definite autonomie neuropathy. Six patients died during a median observation period of 10 months, and all had AN. Kaplan-Meier survival analysis showed a significantly higher mortality (P = .05) in patients with AN. On the basis of this observation, we suggest that consideration should be given for early liver transplantation in patients with advanced liver disease and autonomic neuropathy.

Original languageEnglish (US)
Pages (from-to)471-475
Number of pages5
Issue number3
StatePublished - 1996

ASJC Scopus subject areas

  • Hepatology


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