Skin temperature variability is an independent predictor of survival in patients with cirrhosis

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Poincaré plot; cirrhosis; heart rate variability; survival; temperature variability; thermoregulation.