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Open Access Highly Accessed Research article

Physiologic and laboratory correlates of depression, anxiety, and poor sleep in liver cirrhosis

Fang-Yuan Ko1, Albert C Yang234, Shih-Jen Tsai23, Yang Zhou1 and Lie-Ming Xu1*

Author affiliations

1 Section of Liver Cirrhosis, Shuguang Hospital and Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai, 201203, China

2 Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan

3 Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan

4 Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan

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Citation and License

BMC Gastroenterology 2013, 13:18  doi:10.1186/1471-230X-13-18

Published: 22 January 2013

Abstract

Background

Studies have shown psychological distress in patients with cirrhosis, yet no studies have evaluated the laboratory and physiologic correlates of psychological symptoms in cirrhosis. This study therefore measured both biochemistry data and heart rate variability (HRV) analyses, and aimed to identify the physiologic correlates of depression, anxiety, and poor sleep in cirrhosis.

Methods

A total of 125 patients with cirrhosis and 55 healthy subjects were recruited. Each subject was assessed through routine biochemistry, 5-minutes ECG monitoring, and psychological ratings of depression, anxiety, and sleep. HRV analysis were used to evaluate autonomic functions. The relationship between depression, sleep, and physiologic correlates was assessed using a multiple regression analysis and stepwise method, controlling for age, duration of illness, and severity of cirrhosis.

Results

Reduced vagal-related HRV was found in patients with severe liver cirrhosis. Severity of cirrhosis measured by the Child-Pugh score was not correlated with depression or anxiety, and only had a weak correlation with poor sleep. The psychological distress in cirrhosis such as depression, anxiety, and insomnia were correlated specifically to increased levels of aspartate aminotransferase (AST), increased ratios of low frequency to high frequency power, or reduced nonlinear properties of HRV (α1 exponent of detrended fluctuation analysis).

Conclusions

Increased serum AST and abnormal autonomic nervous activities by HRV analysis were associated with psychological distress in cirrhosis. Because AST is an important mediator of inflammatory process, further research is needed to delineate the role of inflammation in the cirrhosis comorbid with depression.

Keywords:
Liver cirrhosis; Psychological distress; Heart rate variability