Bottaro Matteo, Abid Noor-Ul-Hoda, El-Azizi Ilias, Hallett Joseph, Koranteng Anita, Formentin Chiara, Montagnese Sara, Mani Ali R
Department of Medicine, University of Padova, Padova, Italy.
Network Physiology Lab, Division of Medicine, UCL, London, UK.
Physiol Rep. 2020 Jun;8(12):e14452. doi: 10.14814/phy2.14452.
Cirrhosis is a disease with multisystem involvement. It has been documented that patients with cirrhosis exhibit abnormal patterns of fluctuation in their body temperature. However, the clinical significance of this phenomenon is not well understood. The aim of this study was to determine if temperature variability analysis can predict survival in patients with cirrhosis.
Thirty eight inpatients with cirrhosis were enrolled in the study. Wireless temperature sensors were used to record patients' proximal skin temperature for 24 hr. The pattern of proximal temperature fluctuation was assessed using the extended Poincaré plot to measure short-term and long-term proximal temperature variability (PTV). Patients were followed up for 12 months, and information was collected on the occurrence of death/liver transplantation.
During the follow-up period, 15 patients (39%) died or underwent transplantation for hepatic decompensation. Basal proximal skin temperature absolute values were comparable in survivors and nonsurvivors. However, nonsurvivors showed a significant reduction in both short-term and long-term HRV indices. Cox regression analysis showed that both short-term and long-term PTV indices could predict survival in these patients. However, only measures of short-term PTV were shown to be independent of the severity of hepatic failure in predicting survival. Finally, the prognostic value of short-term PTV was also independent of heart rate variability, that is, a measure of autonomic dysfunction.
Changes in the pattern of patients' temperature fluctuations, rather than their absolute values, hold key prognostic information, suggesting that impaired thermoregulation may play an important role in the pathophysiology of cirrhosis.
肝硬化是一种累及多系统的疾病。已有文献记载，肝硬化患者体温呈现异常波动模式。然而，这一现象的临床意义尚未得到充分理解。本研究的目的是确定体温变异性分析是否能够预测肝硬化患者的生存率。
38例肝硬化住院患者纳入本研究。使用无线温度传感器记录患者近端皮肤温度24小时。使用扩展庞加莱图评估近端温度波动模式，以测量短期和长期近端温度变异性（PTV）。对患者进行12个月的随访，并收集有关死亡/肝移植发生情况的信息。
在随访期间，15例患者（39%）因肝失代偿死亡或接受移植。幸存者和非幸存者的基础近端皮肤温度绝对值相当。然而，非幸存者的短期和长期心率变异性指数均显著降低。Cox回归分析表明，短期和长期PTV指数均可预测这些患者的生存率。然而，在预测生存率方面，仅短期PTV测量值显示与肝衰竭严重程度无关。最后，短期PTV的预后价值也独立于心率变异性，即自主神经功能障碍的一种测量指标。
患者体温波动模式的变化而非其绝对值，包含关键的预后信息，提示体温调节受损可能在肝硬化的病理生理学中起重要作用。
